精神医学63巻4号

2021年04月発行

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特集 精神医療に関する疫学のトピック—記述疫学，リスク研究からコホート研究まで

周産期うつ病の疫学

著者： 西大輔¹

所属機関： ¹東京大学大学院医学系研究科精神保健学分野

ページ範囲：P.489 - P.494

抄録　周産期はホルモンが大きく変動し，生活上の変化も大きいため，うつ病などの精神疾患を発症する妊産婦は少なくない。特にうつ病に関しては頻度が高く，本人の精神的苦痛や生活の支障だけでなく子どもへの悪影響の可能性もあることから，対策の必要性が非常に高い。近年では「妊娠期からの切れ目ない対策」の重要性が謳われ，産後だけでなく妊娠期における対策の重要性も広く共有されるようになってきている。
　本稿では，妊娠期および産後のうつ病の有病率，関連因子，影響，わが国で実施されている大規模調査，そして治療・予防に向けた課題について概観した。有病率の高さ，関連因子を抱えている妊産婦の数もかなり多いこと，悪影響の大きさなどを考えれば，医療機関における治療だけでなく，すべての妊産婦を対象とした対策や予防を視野にいれた介入法の開発が今後望まれると考えられた。

参考文献

1)Marcé LV：Treatise on madness in pregnant women, in women who have recently given birth, and in wet nurses, and medical/legal considerations on this subject(Traité de la folie des femmes enceintes des nouvelles accouchées et des nourrices et considérations médico-légales qui se rattachent à ce sujet). JB Baillière et Fils, Paris, 1858

2)Paffenbarger RS Jr, McCabe LJ Jr：The effect of obstetric and perinatal events on risk of mental illness in women of childbearing age. Am J Public Health Nations Health 56：400-407, 1966

3)Beck CT：A meta-analysis of predictors of postpartum depression. Nurs Res 45：297-303, 1996

4)Bennett HA, Einarson A, Taddio A, et al：Prevalence of depression during pregnancy：systematic review. Obstet Gynecol 103：698-709, 2004

5)Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I：Economic and health predictors of national postpartum depression prevalence：a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front Psychiatry 8：248, 2017

6)Tokumitsu K, Sugawara N, Maruo K, et al：Prevalence of perinatal depression among Japanese women：a meta-analysis. Ann Gen Psychiatry 19：41, 2020

7)Kitamura T, Yoshida K, Okano T, et al：Multicentre prospective study of perinatal depression in Japan：incidence and correlates of antenatal and postnatal depression. Archi Women's Ment Health 9：121-130, 2006

8)Usuda K, Nishi D, Makino M, et al：Prevalence and related factors of common mental disorders during pregnancy in Japan：a cross-sectional study. Biopsychosoc Med 10：17, 2016

9)Buttner MM, O'Hara MW, Watson D：The structure of women's mood in the early postpartum. Assessment 19：247-256, 2012

10)Hannah P, Adams D, Lee A,：Links between early post-partum mood and post-natal depression. Br J Psychiatry 160：777-780, 1992

11)Lancaster CA, Gold KJ, Flynn HA, et al：Risk factors for depressive symptoms during pregnancy：a systematic review. Am J Obstet Gynecol 202：5-14, 2010

12)Wilson LM, Reid AJ, Midmer DK, et al：Antenatal psychosocial risk factors associated with adverse postpartum family outcomes. CMAJ 154：785-799, 1996

13)Stewart DE：Clinical practice. Depression during pregnancy. N Engl J Med 365：1605-1611, 2011

14)Grigoriadis S, VonderPorten EH, Mamisashvili L, et al：The impact of maternal depression during pregnancy on perinatal outcomes：a systematic review and meta-analysis. J Clin Psychiatry 74：e321-341, 2013

15)El Marroun H, Jaddoe VW, Hudziak JJ, et al：Maternal use of selective serotonin reuptake inhibitors, fetal growth, and risk of adverse birth outcomes. Arch General Psychiatry 69：706-714, 2012

16)Ciesielski TH, Marsit CJ, Williams SM：Maternal psychiatric disease and epigenetic evidence suggest a common biology for poor fetal growth. BMC Pregnancy Childbirth 15：192, 2015

17)Takehara K, Suto M, Kakee N, et al：Prenatal and early postnatal depression and child maltreatment among Japanese fathers. Child Abuse Negl 70：231-239, 2017

18)Pereira PK, Lima LA, Legay LF, et al：Maternal mental disorders in pregnancy and the puerperium and risks to infant health. World J Clin Pediatr 1：20-23, 2012

19)Brennan PA, Hammen C, Andersen MJ, et al：Chronicity, severity, and timing of maternal depressive symptoms：relationships with child outcomes at age 5. Dev Psychol 36：759-766, 2000

20)Kim-Cohen J, Moffitt TE, Taylor A, et al：Maternal depression and children's antisocial behavior：nature and nurture effects. Arch Gen Psychiatry 62：173-181, 2005

21)Barker ED, Jaffee SR, Uher R, et al：The contribution of prenatal and postnatal maternal anxiety and depression to child maladjustment. Depress Anxiety 28：696-702, 2011

22)竹田省：妊産婦死亡”ゼロ”への挑戦．日本産科婦人科学会雑誌 68：345-346, 2016

23)Hamazaki K, Takamori A, Tsuchida A, et al：Dietary intake of fish and n-3 polyunsaturated fatty acids and risks of perinatal depression：the Japan Environment and Children's Study(JECS). J Psychiatric Res 98：9-16, 2018

24)Hamazaki K, Matsumura K, Tsuchida A, et al：Dietary intake of fish and n-3 polyunsaturated fatty acids and risk of postpartum depression：a nationwide longitudinal study-the Japan Environment and Children's Study(JECS). Psychol Med 50：2416-2424, 2020

25)Susukida R, Usuda K, Hamazaki K, et al：Association of prenatal psychological distress and postpartum depression with varying physical activity intensity：Japan Environment and Children's Study(JECS). Sci Rep 10：6390, 2020

26)National Institute for Health and Clinical Excellence. Antenatal and potnatal mental health：the NICE guideline on clinical management and service guidance London2018　https://www.nice.org.uk/guidance/cg192. (2021年2月10日閲覧)

27)Tachibana Y, Koizumi N, Mikami M, et al：An integrated community mental healthcare program to reduce suicidal ideation and improve maternal mental health during the postnatal period：the findings from the Nagano trial. BMC Psychiatry 20：389, 2020

28)Nishi D, Imamura K, Watanabe K, et al：Internet-based cognitive-behavioural therapy for prevention of depression during pregnancy and in the post partum(iPDP)：a protocol for a large-scale randomised controlled trial. BMJ Open 10：e036482, 2020