Liệu pháp giải quyết vấn đề nhóm cho trầm cảm trong giai đoạn perinatal ở các cơ sở chăm sóc sức khỏe ban đầu tại Uganda nông thôn: một nghiên cứu can thiệp theo nhóm

Springer Science and Business Media LLC - Tập 21 - Trang 1-12 - 2021
Juliet E. M. Nakku1, Oliva Nalwadda1, Emily Garman2, Simone Honikman3, Charlotte Hanlon4,5, Fred Kigozi1, Crick Lund3,4
1Butabika National Referral Mental Hospital, Kampala, Uganda
2Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
3Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
4Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
5Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

Tóm tắt

Trầm cảm trong giai đoạn perinatal là một vấn đề sức khỏe công cộng quan trọng ở các quốc gia có thu nhập thấp và trung bình. Nghiên cứu nhằm đánh giá tác động của can thiệp sức khỏe tâm thần do nhân viên y tế không chuyên thực hiện lên mức độ triệu chứng và khuyết tật ở phụ nữ mắc trầm cảm trong giai đoạn perinatal tại Uganda. Các bà bầu ở tam cá nguyệt thứ hai và thứ ba được sàng lọc liên tiếp bằng phiên bản tiếng Luganda của Câu hỏi sức khỏe bệnh nhân 9 mục (PHQ-9). Những phụ nữ có điểm số ≥5 trên PHQ-9 và được xác nhận mắc trầm cảm bởi một nữ hộ sinh đã được tuyển vào nhóm điều trị và được cung cấp can thiệp tâm lý theo hình thức chăm sóc tuần tự. Phụ nữ được đánh giá bằng PHQ-9 và WHODAS-2.0 ở thời điểm xuất phát và lại vào 3 và 6 tháng sau can thiệp. Phân tích hồi quy tiêu cực được thực hiện để kiểm tra sự thay đổi trong điểm số PHQ-9 và WHODAS-2.0 từ điểm xuất phát đến điểm kết thúc. Dữ liệu được phân tích bằng phần mềm STATA phiên bản 14. Tổng cộng có 2652 phụ nữ mang thai (98,3%) đồng ý tham gia nghiên cứu và 153 (5,8%) được chẩn đoán là mắc trầm cảm. Hơn một phần tư (28,8%) báo cáo đã trải qua bạo lực thể chất giữa cá nhân (IPV) trong năm qua, trong khi (25,5%) báo cáo bạo lực tình dục IPV. Một phần ba (34,7%) phụ nữ được chẩn đoán mắc trầm cảm nhận được 4 hoặc nhiều phiên nhóm PST. Có sự giảm trung bình điểm PHQ-9 là 5,13 (95%CI -6,79 đến -3,47, p < 0,001) và 7,13 (95%CI -8,68 đến -5,59, p < 0,001) ở giữa và cuối nghiên cứu, tương ứng. Điểm WHODAS giảm đáng kể với −11,78 điểm (CI 17,64 đến −5,92, p < 0,001) ở giữa và −22,92 điểm (CI 17,64 đến −5,92, p < 0,001) ở cuối nghiên cứu. Phản ứng lâm sàng được ghi nhận ở 69,1% (95%CI 60,4–76,6%) và 93,7% (95%CI 87,8–96,8%) của những người tham gia ở giữa và cuối nghiên cứu, tương ứng. Một can thiệp tâm lý dựa trên bằng chứng được thực hiện trong chăm sóc antenatal ban đầu bởi các nữ hộ sinh được đào tạo và giám sát trong môi trường thực tế có thể dẫn đến cải thiện kết quả cho phụ nữ bị trầm cảm trong giai đoạn perinatal. Cần có các nghiên cứu ngẫu nhiên trong tương lai để xác nhận hiệu quả của can thiệp này và khả năng mở rộng.

Từ khóa

#trầm cảm #giai đoạn perinatal #can thiệp tâm lý #Uganda #sức khỏe tâm thần

Tài liệu tham khảo

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