基于移动平台的妇幼保健机构产后抑郁阶梯式干预方案构建研究
Development of a Mobile Platform-based Stepped-Care Intervention Program for Postpartum Depression in Maternal and Child Health Institutions
吴大东 1宋臻 2张嘉怡 3刘慧敏 3魏颖3
作者信息
- 1. 518028 广东省深圳市，南方医科大学妇女儿童医学中心 深圳市妇幼保健院;518028 广东省深圳市，深圳市孕产疾病与母婴健康重点实验室
- 2. 510632 广东省广州市，暨南大学护理学院
- 3. 518028 广东省深圳市，南方医科大学妇女儿童医学中心 深圳市妇幼保健院
- 折叠
摘要
背景 产后抑郁症防治是重要公共卫生议题，但我国抑郁筛查阳性产妇的心理干预率普遍偏低，已成为防治工作的关键瓶颈。WHO于2022年指出，阶梯式医疗模型为孕产期心理健康服务融入妇幼保健服务体系提供了理论框架，然而其在我国的实证研究仍较有限，适用性和有效性尚待进一步验证。目的 基于深圳市产后抑郁筛查与干预项目平台，构建适用于我国妇幼保健机构并充分利用移动平台的产后抑郁阶梯式干预方案。方法 采用社区参与式研究方法，于2024年2—10月开展多利益相关方定性访谈、焦点小组讨论及补充性文献回顾，综合分析多来源定性证据，初步拟定干预方案内容。于2024年10月—2025年1月，采用德尔菲法对15名专家进行两轮函询，评估专家积极程度（以问卷回收率和提出具体意见的专家比例表示），计算专家权威系数（Cr）及各级条目的科学性和可行性变异系数（CV），依据条目筛选标准及专家意见调整、优化干预方案。结果 纳入综合分析的定性资料包括25份多利益相关方访谈资料、1份焦点小组讨论记录、5份政策文件、5份临床指南、3项系统综述、5项随机对照试验1项混合方法研究。初步方案包括4个干预阶段（一级条目）、10项干预内容（二级条目）和12个干预措施（三级条目）。两轮专家函询问卷有效回收率均为100.0%，分别有14名（93.3%）和11名（73.3%）专家提出具体建议，Cr分别为0.86和0.87。第一轮函询条目的重要性CV范围为0~0.16，可行性CV为0.05~0.27；第二轮函询条目的重要性CV为0~0.13，可行性CV为0~0.21。最终确定干预方案包括4个干预阶段、14项干预内容和35个具体干预措施。结论 本研究构建了一套依托移动平台的产后抑郁阶梯式干预方案，具有科学性和可行性，可为妇幼保健机构优化产后抑郁症防治工作提供理论依据和方法指导。
Abstract
Background Postpartum depression prevention and treatment is an important public health issue. Howeverin Chinathe psychological intervention rate among women with positive depression screening results remains lowposing a key bottleneck for prevention efforts. In 2022the World Health Organization proposed the Stepped Care Model as a theoretical framework for integrating perinatal mental health services into maternal and child health care systems. Howeverempirical research on its applicability and effectiveness in China remains limited and requires further validation. Objective To develop a stepped-care intervention program for postpartum depression that is applicable to maternal and child health institutions in China and fully leverages a mobile health platformbased on the Shenzhen Postpartum Depression Screening and Intervention Program. Methods Using a community-based participatory research approachthis study conducted multi-stakeholder qualitative interviewsone focus group discussionand a supplementary literature review from February to October 2024. Multiple sources of qualitative evidence were synthesized to draft a preliminary intervention framework. From October 2024 to January 2025a two-round Delphi consultation was conducted with 15 experts. Indicators of expert engagementresponse rate and proportion providing specific suggestionsauthority coefficientCrand coefficients of variationCV for the scientific soundness and feasibility of each item were calculated. The intervention program was iteratively refined based on item screening criteria and expert feedback. Results The synthesized evidence included 25 stakeholder interviewsone focus group discussionfive policy documentsfive clinical guidelinesthree systematic reviewsfive randomized controlled trialsand one mixed-methods study. The initial program comprised four intervention stagesfirst-level itemsten intervention contents second-level itemsand twelve specific measuresthird-level items. Both Delphi rounds achieved a 100.0% response rate93.3% and 73.3% of experts provided specific suggestions in the first and second roundsrespectively. The Cr values were 0.86 and 0.87. In the first roundCVs for importance ranged from 0 to 0.16 and for feasibility from 0.05 to 0.27in the second roundCVs for importance ranged from 0 to 0.13 and for feasibility from 0 to 0.21. The final intervention program consisted of four intervention stages14 intervention contentsand 35 specific measures. Conclusion This study developed a scientifically robust and feasible stepped-care intervention program for postpartum depressionsupported by a mobile health platform. The program offers theoretical and methodological guidance for maternal and child health institutions in optimizing postpartum depression prevention and intervention efforts.关键词
抑郁症，产后/阶梯式医疗模型/心理干预/妇幼保健服务/移动健康/德尔菲法引用本文复制引用
吴大东,宋臻,张嘉怡,刘慧敏,魏颖.基于移动平台的妇幼保健机构产后抑郁阶梯式干预方案构建研究[EB/OL].(2026-02-25)[2026-03-01].https://chinaxiv.org/abs/202602.00225.学科分类
医学研究方法/预防医学/妇产科学
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