Claudia Navarro

Outcome results of a psycho-educational intervention in pregnancy to prevent PPD: A randomized control trial

BACKGROUND This study aims to evaluate the effectiveness of an antenatal psycho-educational intervention to prevent postpartum depression in Mexican women. METHOD Pregnant women at high risk for depression were randomized to intervention or a usual care condition. Assessments of depression (SCID, BDI-II) occurred during pregnancy, 6 weeks and 4-6 months postnatally, and subjective impact of the intervention in the postpartum. RESULTS Of the 6484 women approached, 377 were eligible and consented to randomization (250 intervention, 127 control). Sixty-eight intervention (27.2%) and 68 (53.5%) control participants completed the three assessment periods. The cumulative incidence of major depression over three time periods was significantly lower (p<0.05) in the intervention (10.7%) than the control group (25%). Repeated-measures analysis of variance showed a significant reduction of BDI-II in both groups, but no significant treatment effect. Even when controlling for initial levels of depressive and anxiety symptoms, a treatment effect on depressive symptoms could not be confirmed, although there was a trend demonstrating that intervention participants with high initial symptoms had a larger reduction of BDI-II. Most participants that completed the intervention reported that it had a medium to great influence on their well-being, depression, current problems, role as mothers and their relationship with the baby. LIMITATIONS Attrition was the most salient methodological problem in this study. CONCLUSIONS This is the first randomized control depression prevention trial in high-risk pregnant Mexican women. Available data are consistent with the possibility that the incidence of depression may have been reduced by the intervention, but differential attrition makes interpretation of the findings difficult.

Influencia de los sucesos vitales y el apoyo social en una intervención psicoeducativa para mujeres con depresión

Objective. To investigate the influence of social support and adverse life events on depression symptoms, before and after therapy (15-30 days) and during follow-up (4 months) of a psycho-educational intervention for depression. Material and Methods. The study population consisted of 254 women with depression symptoms selected among those seeking treatment for their symptoms in three community mental health centers and in one Ministry of Health center, all of them in Mexico City, between January 1998 and December 2000. The intervention has been proved effective previously in reducing depression symptoms. Symptoms were assessed using Radloff’s CES-D scale, while specifically designed scales were used for events and social support. Hierarchical regression analyses were carried out to test various models. Results. Model 1: effect of variables: life events, social support, and socio-demographic variables (age, education level, income, and work status) on CES-D pre-treatment. The model was significant (p<0.000) and the first two variables and age were included in the model. Model 2: effect of the same predictive variables on CES-D post-treatment. The model was significant (p<0.001) and included social support and life events. Model 3: effect of the same variables on CES-D during follow-up. The model was significant (p<0.000) and included life events and educational achievement. Model 4: effect of social support

Evaluation of the psychometric measures for the Postpartum Depression Screening Scale-Spanish version for Mexican women

This study assessed the reliability, validity, sensitivity, specificity, and predictive values of the Spanish Postpartum Depression Screening Scale (PDSS–Spanish Version) for Mexican women. The scale was administered at 6 weeks (T1; n = 149) and between 4 and 6 months postpartum (T2; n = 156). Women also completed the Beck Depression Inventory–Second Edition (BDI-II) and the mood module of the Standardized Clinical Interview for DSM-IV (SCID). At both time points, the internal consistency value of the PDSS-Spanish Version was α = .96. Concurrent validity was adequate, compared with the BDI-II (T1: r = .75; T2: r = .74, ps < .01) and the SCID (T1: r = .43; T2: r = .36, ps < .01). Based on receiver operator characteristic curves, cutoff scores on the PDSS-Spanish Version of 60 for depressive symptoms (BDI-II as gold standard) and 80 for major depression (SCID) showed high sensitivity (>88.9%) but low specificity (60.9% to 70.6%). More parsimonious values are obtained at a cutoff of 77 for subsyndromal depression and 95 for major depression. The choice for using different cutoff scores may depend on the purpose of using the instrument. Overall, the psychometric properties for the PDSS-Spanish Version in Mexican women are similar to the ones obtained in Hispanic women in the United States.

Evaluación de la efectividad de una intervención interactiva para el manejo del estrés en profesionales de la salud

Background. The effects of stress depend on the perception of stressors and a person’s skills for coping with stressful situations. Objective. Evaluate an interactive intervention to develop resources and skills for proper stress management among healthcare professionals. Method. This intervention was tested using a chart designed to evaluate the knowledge, skills and attitudes components of stress management, consisting of 17 statements about Knowledge, 11 about Stress management; 20 about Attitudes for reacting to stress. A total of 165 professionals and interns from related careers participated. Statistical analyses were conducted to compare the scores of the three components before and after the intervention using the Student’s t test. McNemar’s test was used to compare the results. Results. In regard to the effectiveness of the intervention, an analysis of the comparison of scores found statistically significant differences in favor of intervention in the three components: Knowledge (t=-9.77, df=164, p=.000), Skills (t=-10.19, df=164, p=.000) and Attitudes (t=-4.80, df=164, p=.000). The item analysis showed statistically significant increases in the number of correct answers after the intervention in the three components. Discussion and conclusion. The results of this interactive intervention were statistically significant in Knowledge, Skills and Attitudes for stress management. In addition to being a brief, innovative intervention, based on knowledge translation (4 weeks) and available on the Internet, the evidence of its effectiveness suggests it is a valid tool for proper stress management.