Objectives: Primary health workers are the first fine to identify postpartum depression, which is important for patients with this disease to get early specialist diagnosis and treatment. The smartphone-based virtual patient is economical, convenient and effective, and has been applied extensively to evaluate the competency to detect postpartum depression, but there is no relevant application in China. This study aims to use virtual patient to assess the current status on the competency of detecting postpartum depression among primary maternal and child health workers in Hunan Province, and to explore potential influencing factors.
Methods: A total of 222 primary maternal and child health workers from 3 regions with low, medium, and high economic levels in Hunan Province were enrolled, and smartphone-based virtual patients with postpartum depression were used for the assessment from May to July in 2018, and a self-designed questionnaire was used to investigate their demographic characteristics. The competency to detect postpartum depression was measured by 2 indicators: diagnostic accuracy and treatment accuracy. Descriptive statistical methods were used to describe the competency to detect postpartum depression among them and their demographic characteristics. A logistic regression analysis was used to explore the possible influencing factors for the diagnostic accuracy and treatment accuracy.
Results: The diagnostic accuracy rate was 64.0%. There was no significant difference between the demographic characteristics and diagnostic accuracy rate (P>0.05). The treatment accuracy rate was 50.9%. The workers from the middle economic level area were more likely to make the correct treatment than those from the low economic level area (OR= 3.229, 95% CI 1.478 to 7.014).Apart from postpartum depression, the 3 most frequently diagnosed items were bipolar disorder (22.1%, 49/222), secondary depression disorder (13.5%, 30/222), and neurasthenia (5.4%, 12/222). Among the correctly diagnosed health workers, the proportion for correct treatment was 29.6% (42/142), and there was no significant difference between the diagnostic accuracy and treatment accuracy (P>0.05).
Conclusions: About half of the primary maternal and child health workers in Hunan Province, China have basic competency to detect postpartum depression, but the overall results are not satisfactory. The regional economic level is correlated with the competency of detecting postpartum depression, and the competency of detecting postpartum depression is stronger in more developed areas. Moreover, for the patients who have been identified as postpartum depression, the rate of correct treatment is low, which warrants particular attention in the follow-up training.
目的: 基层医务人员是识别产后抑郁的第一道关卡，其对于产后抑郁患者及时获得早期专科诊疗具有重要意义。虚拟患者法具有经济、方便、有效的特点，已被国外应用于产后抑郁识别能力的评估，我国尚无相关应用。本研究旨在使用经开发与验证的产后抑郁虚拟患者，评估湖南省基层妇幼专干对产后抑郁的识别能力现状，并探索其可能的影响因素。方法: 于2018年5至7月抽取湖南省低、中、高3种经济水平区/县的妇幼专干共222名，使用基于智能手机的产后抑郁虚拟患者对专干进行评估，使用自编问卷调查其人口学特征。产后抑郁的识别能力包括诊断正确率与处置正确率两个结果指标。将所有专干的人口学特征作为自变量，采用logistic回归分析分别探索产后抑郁识别能力两个指标可能的影响因素。结果: 参与评估的专干诊断正确率为64.0%，不同人口学特征专干对产后抑郁的诊断正确率差异无统计学意义(P>0.05)；处置正确率为50.9%，来自中等经济水平地区的专干作出正确处置的可能性比低等经济水平地区者更高(OR=3.229，95% CI：1.478~7.014)。除产后抑郁外，专干所作最多的3个诊断条目分别为双相情感障碍(22.1%，49/222)、继发性抑郁障碍(13.5%，30/222)及神经衰弱(5.4%，12/222)。在诊断正确的专干中，处置正确的专干占比为29.6%(42/142)，诊断正确率与处置正确率之间的差异无统计学意义(P>0.05)。结论: 约半数的湖南省基层妇幼专干具备基本的产后抑郁识别能力，总体水平有待提升；地区的经济水平与专干的产后抑郁识别能力相关，经济更发达的地区专干产后抑郁识别能力更高。专干对于已识别为产后抑郁的患者，能作出将患者转诊至精神科专科这类正确处置的比率较低，在后续开展相关培训时可对此予以重点关注和考查。.
Keywords: competency; postpartum depression; recognition; virtual patient.