| Summary: | 碩士 === 國立臺北護理健康大學 === 助產及婦女健康照護系護理助產研究所 === 106 === Objectives: This nationwide population–based study aimed to investigate the prevalence of postpartum depression, the prevalence of depression in women of the same age, the predict factors of postpartum depression, the number of outpatients and inpatient visits, and the cost of medical expenses and other related factors.
Methods: The National Health Insurance Research Database (NHIRD) of Taiwan from January 1999 to December 2008 was used for this population-based study. The diagnosis of major depressive disorder was made according to the International Classification of Disease, 9th revision, Clinical Modification (ICD-9-CM), which included major depressive disorder, single episode (ICD-9-CM: 296.2), Dysthymic disorder (ICD-9-CM: 296.9), neurological depression (ICD-9-CM: 300.4), adjustment disorder with depressive mood (ICD-9-CM: 309), depressive disorder not otherwise specified (ICD-9-CM: 311), Mental disorders, conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not appl (ICD-9-CM: 648.40), mental disorders condition in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication (ICD-9-CM: 648.42) and mental disorders conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication (ICD-9-CM: 642.44).The postpartum depression patients were selected by the diagnosis of major depressive disorder within six months after childbirth with more than two outpatient clinic visits or more than one hospitalization. The background data of these patients were collected: including age, modes of delivery (emergency caesarean section, selective caesarean section, vaginal delivery), parity (first child, second child, third child or more), level of hospital (medical center, regional hospital, district Hospital, clinic or midwifery), history of chronic disease (hypertension, diabetes, hyperlipidemia), postpartum comorbidities (postpartum hemorrhage, endometritis, uterine related diseases, breast related problems). The control group was randomized selected from the giving birth women without postpartum depression according to the background data and birth parity and each one was selected only once. The number of case group was 241, while the number of control group was 76,406, and the total number was 76,647. The prevalence of postpartum depression women within six months after birth, the prevalence of depression in women of the same age, the predict factors of postpartum depression, the cost of one-year postpartum visits and hospitalization, and the number of visits were analyzed.
Results:(1)There was no significant statistic difference in the demographic characteristics between the postpartum depression group and the control group except age and modes of delivery by using the Chi-square test. (2)The prevalence of women with postpartum depression has continued to rise; the prevalence rate was 19.912 per 10,000 in 1999 and 40.339 per 10,000 in 2008, which was 2.02 times more. (3)The prevalence of depression in women of the same age group has continued to rise; the prevalence rate was 39.825 per 10,000 in 1999 and 98.414 per 10,000 in 2008, which was 2.47 times more. (4)Using regression analysis to predict the predictive power of predictive variables on postpartum depression, if is found that age, selective caesarean section can positively predict postpartum depression, but parity, level of hospital, history of chronic disease, and postpartum comorbidities can not predict postpartum depression disease. (5)The cost and numbers of clinic visits between the postpartum depression group and the control group is significantly different. The average medical expenditure for one year after childbirth is 38,298 yuan in postpartum depression group, while that of the control group is 11,474 yuan. It was 26,824 yuan more and about 3.34 times of the expenditure. In addition, the average number of clinical visits of women with postpartum depression was 33 in one year after birth, while the average number was 15 in the control group. It was 18 visits more and about 2.2 times of the visit.(6)Analysis of the factors related to the cost of hospitalization and clinical visits in postpartum depression patients within one year after childbirth, including emergency laparotomy, parity (third delivery), level of hospital (medical center, regional hospital), chronic disease history (hypertension), Complications (postpartum hemorrhage, uterine-related diseases, breast-related problems) were significantly associated; but age, selective caesarean section, parity (second delivery), production hospital (regional hospital), chronic disease history (diabetes), comorbidities ( Endometritis) were not significantly associated. (7)Analysis of the factors related to the number of hospitalization and clinical visits in postpartum depression patients within one year after childbirth, including age, emergency laparotomy, parity (second delivery), production hospital (medical center, regional hospital), comorbidities (postpartum Hemorrhage, endometritis, uterine-related diseases, breast-related problems) were significantly associated; but selective caesarean section, parity (third child), production hospital (regional hospital), disease history (hypertension, diabetes, dyslipidemia) were not significant correlated.
Conclusions: Postpartum depression does cause a certain degree of medical resource consumption to the country. According to statistics, the prevalence of postpartum depression and depression increased by 2.02 times and 2.47 times in ten years. It may bring more social problems to the country according to the annual upward trend. Prevention is better than treatment. The results of this study showed that age and selective caesarean section were a predict factor of postpartum depression; emergency laparotomy, parity (third delivery), production hospital (medical center, regional hospital), chronic disease history (hypertension), comorbidities (postpartum hemorrhage, uterine related diseases, breast related problems) were factors that related to the cost of hospitalization and clinical visits in postpartum depression patients within one year after childbirth; and age, emergency laparotomy, parity (second delivery), level of hospital (medical center, regional hospital), comorbidities (postpartum hemorrhage, endometritis, uterine-related diseases, breast-related problems) were related to the number of hospitalization and clinical visits in postpartum depression patients within one year after childbirth. This study may provide useful information to the health care workers and national policy implementers to improve the care of women and families, and to reduce economic problems in the society and the country.
Key words: postpartum depression, prevalence, postpartum comorbidities, National health insurance research database (NHIRD), outpatients utilization, inpatient utilization
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