Lúcia Abelha Lima

Depression during pregnancy: prevalence and risk factors among women attending a public health clinic in Rio de Janeiro, Brazil

Depression is the most prevalent psychiatric disorder during pregnancy and is associated with psychosocial and clinical obstetric factors. Despite being an important public health issue, there are few studies about this issue in Brazil. A cross-sectional study was carried out, involving 331 pregnant women attending a public primary health service over a one-year period in Rio de Janeiro city, Brazil. Participants were interviewed about their socio-demographic status, obstetric/medical conditions, life events and violence during pregnancy. Depression was assessed using the Composite International Development Interview. The prevalence of depression during pregnancy was 14.2% (95%CI: 10.7-18.5) and associated factors included: previous history of depression and any psychiatric treatment, unplanned pregnancy, serious physical illness and casual jobs. These data emphasize the need for screening for depression and its risk factors during pregnancy in settings where care is available. Psychosocial interventions and social policies need to be devised for this population.

Tentativas de suicídio: fatores prognósticos e estimativa do excesso de mortalidade

No mundo, ainda sao relativamente poucos os estudos sobre a incidencia e mortalidade por câncer em adultos jovens. O objetivo foi explorar a distribuicao de câncer em adultos jovens no Brasil. Foi realizado um estudo descritivo da incidencia (capitais selecionadas), da morbidade hospitalar e da mortalidade (Brasil e capitais selecionadas) por câncer aos 20-24 anos, no periodo de 2000-2002, e da evolucao das taxas de mortalidade por câncer no Brasil no periodo de 1980-2008, na mesma populacao. O câncer de testiculo foi a principal localizacao anatomica em homens; e as neoplasias da glândula tireoide, do colo de utero e a doenca de Hodgkin nas mulheres. O câncer de encefalo foi a principal causa de obito por câncer em ambos os sexos, e a tendencia temporal da mortalidade mostra um aumento da mortalidade por câncer de encefalo em homens e pela leucemia linfoide em ambos os sexos. Em conjunto, os resultados apresentados retratam um padrao epidemiologico de câncer em adultos jovens no Brasil com caracteristicas regionais de distribuicao.Coorte retrospectiva com objetivos de analisar o perfil epidemiologico dos individuos que tentaram suicidio entre 2003 e 2009 na microrregiao de Barbacena, Minas Gerais, Brasil, verificar a taxa de mortalidade por suicidio e por outras causas, e estimar o risco de morrer nestes individuos. Foram utilizados dados dos Boletins de Ocorrencia Policial e das Declaracoes de Obitos. Foi realizada analise de sobrevida e empregada regressao multipla de Cox. Entre os 807 individuos que tentaram suicidio ocorreram 52 obitos, sendo 12 por suicidio, dez por causas externas e trinta por outras causas. Noventa por cento das mortes por suicidio ocorreram no periodo de 24 meses depois da tentativa. Verificou-se significativo aumento do risco de morrer entre os homens, nas pessoas casadas e naqueles com idade maior que 60 anos. A razao de mortalidade padronizada evidenciou excesso de mortalidade por suicidio. Os resultados do estudo mostraram que a taxa de mortalidade entre pacientes que tentaram o suicidio foi superior a esperada na populacao geral, indicando a necessidade de melhorar os cuidados a saude desses individuos.

Complicações obstétricas, eventos estressantes, violência e depressão durante a gravidez em adolescentes atendidas em unidade básica de saúde

CONTEXTO: A depressao e um transtorno psiquiatrico comum entre as adolescentes gravidas e esta associada a diversos fatores de risco. OBJETIVOS: Estimar a prevalencia da depressao em adolescentes gravidas e identificar os principais fatores de risco. METODOS: Dados seccionais foram coletados de 120 gestantes adolescentes atendidas em uma unidade basica de saude do Rio de Janeiro. Os instrumentos utilizados foram o Composite International Diagnostic Interview (CIDI), para diagnosticar a depressao; a escala Stressful Life Events, para avaliar a presenca de eventos estressantes; o Abuse Assessment Screen (AAS), para o rastreamento de violencia contra a mulher durante a gestacao. RESULTADOS: A prevalencia de depressao gestacional foi de 14,2% (IC: 8,7-21,9), sendo os principais fatores associados: historia anterior de depressao, sangramento anomalo e hospitalizacao na atual gravidez, historia de acidente, incendio ou catastrofe e maus-tratos durante a vida. CONCLUSOES: Os resultados reforcam que a investigacao dos fatores de risco, o diagnostico e o tratamento da depressao devem ser parte integrante do atendimento pre-natal a adolescentes gravidas.

Suicidios e tentativas de suicidios por intoxicacao exogena no Rio de Janeiro: analise dos dados dos sistemas oficiais de informacao em saude, 2006-2008*

OBJECTIVE To describe the profile of suicide and attempts suicide by exogenous intoxication and completeness of data from the Center for Poisoning Control in Niterói City (CCIn), Information System for Notifiable Diseases (Sinan), and Mortality Information System (SIM) for Rio de Janeiro state (RJ). METHODS It was verified the frequency of suicide attempts and mortality in Rio de Janeiro state, period 2006-2008. The variables analyzed were sex, area of occurrence, circumstance, evolution, age, toxic agents and cause (ICD-10: X60-X69). The percentage of unknown information/blank was classified as excellent (≤ 10%), good (10 to 29.9%) and poor (≥ 30%). SPSS was used for statistical analysis. RESULTS Nine hundred and forty records of attempts (CCIn) and 470 (Sinan) were analysed. The female and the age group of 20-39 years predominated, as well as use of toxic agents like medicines and pesticides. About suicide, were identified 33 records (CCIn), 23 (Sinan) and 180 (SIM). In CCIn were more frequent female and age group of 15-29 years, through Sinan and SIM from 40-59 years. For both events, psychotropic drugs accounted for more than 70% of drugs. The Sinan system has shown the worst performance for toxic agents. CONCLUSIONS Despite advances in improving the quality of information generated by the systems, problems regarding the coverage and data completeness remain committing the analysis of the magnitude of injuries. The study points out to the needs of systems compatibility and the improvement of the quality of information that are generated.Objective: To describe the profile of suicide and attempts suicide by exogenous intoxication and completeness of data from the Center for Poisoning Control in Niteroi City (CCIn), Information System for Notifiable Diseases (Sinan), and Mortality Information System (SIM) for Rio de Janeiro state (RJ). Methods: It was verified the frequency of suicide attempts and mortality in Rio de Janeiro state, period 2006-2008. The variables analyzed were sex, area of occurrence, circumstance, evolution, age, toxic agents and cause (ICD-10: X60-X69). The percentage of unknown information/blank was classified as excellent (≤ 10%), good (10 to 29.9%) and poor (≥ 30%). SPSS was used for statistical analysis. Results: Nine hundred and forty records of attempts (CCIn) and 470 (Sinan) were analysed. The female and the age group of 20-39 years predominated, as well as use of toxic agents like medicines and pesticides. About suicide, were identified 33 records (CCIn), 23 (Sinan) and 180 (SIM). In CCIn were more frequent female and age group of 15-29 years, through Sinan and SIM from 40-59 years. For both events, psychotropic drugs accounted for more than 70% of drugs. The Sinan system has shown the worst performance for toxic agents. Conclusions: Despite advances in improving the quality of information generated by the systems, problems regarding the coverage and data completeness remain committing the analysis of the magnitude of injuries. The study points out to the needs of systems compatibility and the improvement of the quality of information that are generated.

Attempted suicide: prognostic factors and estimated excess mortality

This retrospective cohort study aimed to analyze the epidemiological profile of individuals that attempted suicide from 2003 to 2009 in Barbacena, Minas Gerais State, Brazil, to calculate the mortality rate from suicide and other causes, and to estimate the risk of death in these individuals. Data were collected from police reports and death certificates. Survival analysis was performed and Cox multiple regression was used. Among the 807 individuals that attempted suicide, there were 52 deaths: 12 by suicide, 10 from external causes, and 30 from other causes. Ninety percent of suicide deaths occurred within 24 months after the attempt. Risk of death was significantly greater in males, married individuals, and individuals over 60 years of age. Standardized mortality ratio showed excess mortality by suicide. The findings showed that the mortality rate among patients that had attempted suicide was higher than expected in the general population, indicating the need to improve health care for these individuals.

Maternal mental disorders in pregnancy and the puerperium and risks to infant health

Prenatal and postnatal period presents the highest prevalence of mental disorders in womens lives and depression is the most frequent one, affecting approximately one in every five mothers. The aggravating factor here is that during this period psychiatric symptoms affect not only womens health and well-being but may also interfere in the infants intra and extra-uterine development. Although the causes of the relationship between maternal mental disorders and possible risks to a childs health and development remain unknown, it is suspected that these risks may be related to the use of psychotropic drugs during pregnancy, to substance abuse and the mothers lifestyle. Moreover, after delivery, maternal mental disorders may also impair the ties of affection (bonding) with the newborn and the maternal capacity of caring in the post-partum period thus increasing the risk for infant infection and malnutrition, impaired child growth that is expressed in low weight and height for age, and even behavioral problems and vulnerability to presenting mental disorders in adulthood. Generally speaking, research on this theme can be divided into the type of mental disorder analyzed: studies that research minor mental disorders during pregnancy such as depression and anxiety find an association between these maternal disorders and obstetric complications such as prematurity and low birth weight, whereas studies that evaluate severe maternal mental disorders such as schizophrenia and bipolar disorder have found not only an association with general obstetric complications as well as with congenital malformations and perinatal mortality. Therefore, the success of infant growth care programs also depends on the mothers mental well being. Such findings have led to the need for new public policies in the field of maternal-infant care geared toward the population of mothers. However, more research is necessary so as to confirm the association between all factors with greater scientific rigor.

The measurement of social disablement and assessment of psychometric properties of the Social Behaviour Schedule (SBS-BR) in 881 Brazilian long-stay psychiatric patients.

Background: Data on the prevalence of social disablement in long-stay psychiatric patients, and the assessment of the psychometric properties of the instruments that evaluate social behaviour in this population are scarce in Brazil. Therefore, this cross-sectional study aimed to estimate the prevalence rates of social disablement in a population of long-stay psychiatric patients from the Rio de Janeiro metropolitan area, and assessed the psychometric properties of the Social Behaviour Schedule (SBS). Method: Data were collected from a population of 881 psychiatric patients housed in the Municipal Mental Health Institute using the 21-item SBS. Results: Most of the patients were women (59%), the mean age was 65.8 years (SD = 11) and the mean length of stay was 37.3 years (SD = 11.5). Of the population,-50.6% were scored as having poor self-care, 46% with little spontaneous communication, 41.1% with poor attention span, and 37.1% with underactivity. Comparing our data with international studies that used the same instrument, we found that our population was more disabled than the others, especially on the social withdrawal factor. Regarding psychometric properties, the inter-rater kappa was 0.709, the inter-informant kappa was 0.500, and the Cronbachs alpha coefficient was 0.766. The groups of patients in the six settings of the institute presented significant statistical differences in the total score (F = 11.447, p < 0.001). Conclusions: This study demonstrates the high rates of social disablement in this population. The precarious conditions of the institution where the patients have been living for decades and unmet individual care may have exacerbated their social disablement. Furthermore, the SBS-BR had satisfactory psychometric properties, particularly reliability, showing it to be an adequate instrument for measuring social disablement in Brazil.

Depression During Pregnancy: Review of Epidemiological and Clinical Aspects in Developed and Developing Countries

Contrary to general belief, gestation is not always characterized by joy and accomplishments. Many women experience sadness or anxiety in these periods of their lives. Gestation and postpartum (puerperium) are periods of woman s life which involve many physical, hormonal, psychic and social insertion changes which can have a direct effect on her mental health (Camacho et al., 2006). The changes caused by the newborn arrival are not limited to psychological and biochemical variables but also involve socioeconomic factors, especially in societies in which women are active in the labor market, contributing to the family income, and pursuing diverse professional and social interests (Maldonado, 1997). The scientific literature indicates that in the gestational-postpartum period is the phase with the highest prevalence of mental disorders of women s life, particularly in the first and third quarters of gestation and during the first 30 days of postpartum (Botega & Dias, 2006). The intensity of these mental health alterations depend and are regulated by interaction of multiple factors, including organic, family, marital, social, cultural aspects and the pregnant woman’s personality (Falcone et al., 2005). Approximately one fifth of pregnant women and women in puerperium present symptoms of depression (Limlomwongse & Liabsuetrakul, 2006). Most of these women are not diagnosed neither adequately treated (Andersson et al, 2003). Depression is the most prevalent mental disorder during pregnancy and the puerperium period (Bennett et al., 2004) and is associated with risk factors such as a psychiatric history, financial hardships, low education level, teenage pregnancy, lack of social support, stressful events and a history of domestic violence. There is evidence that pre-natal depression is not only more common, but it constitutes the main risk factor for postpartum depression. Indeed, in many cases it is the continuation of the depression that started during pregnancy (Alami et al., 2006; Andersson et al., 2006; Da Costa et al., 2000; Heron et al., 2004; Josefsson et al., 2001; Lovisi et al., 2005; Patel et al., 2003; Rich-Edwards et al., 2006; Ryan et al., 2005). Current studies suggest that gestational depression needs to be addressed in a more consistent manner. Although there is a consensus that the factors that affect the relationship

Avaliação de desfechos perinatais/infantis em partos de pacientes com transtornos mentais maiores de um hospital psiquiátrico do Rio de Janeiro, Brasil

Adverse perinatal and infant outcomes are the leading causes of infant morbidity and mortality in developing countries like Brazil. Among the risk factors are maternal mental disorders. A retrospective longitudinal study was conducted based on passive follow-up using probabilistic record linkage to estimate the prevalence of adverse perinatal and infant outcomes in children of women admitted to a public psychiatric hospital in Rio de Janeiro, Brazil, and who gave birth from 1999 to 2009. Prevalence rates were: low birth weight (27.6%), prematurity (17.4%), malformations (2.5%), stillbirths (4.8%), and neonatal deaths (3.7%). Associated factors were deficient prenatal care, schizophrenia, and low income. The results corroborate the high prevalence of adverse perinatal and infant outcomes in mothers with major mental disorders, and that screening of psychiatric symptoms and specialized care by mental health professionals are essential throughout prenatal and postpartum care.Abstract Adverse perinatal and infant outcomes are the leading causes of infant morbidity and mortal-ity in developing countries like Brazil. Among the risk factors are maternal mental disorders. A retrospective longitudinal study was conducted based on passive follow-up using probabilis-tic record linkage to estimate the prevalence of adverse perinatal and infant outcomes in chil-dren of women admitted to a public psychiatric hospital in Rio de Janeiro, Brazil, and who gave birth from 1999 to 2009. Prevalence rates were: low birth weight (27.6%), prematurity (17.4%), malformations (2.5%), stillbirths (4.8%), and neonatal deaths (3.7%). Associated factors were deficient prenatal care, schizophrenia, and low income. The results corroborate the high preva-lence of adverse perinatal and infant outcomes in mothers with major mental disorders, and that screening of psychiatric symptoms and spe-cialized care by mental health professionals are essential throughout prenatal and postpartum care.Schizophrenia; Mood Disorders; Pregnancy Complications; Health Information Systems

Depressão e apoio social em gestantes de fetos com malformações atendidas em um hospital materno-infantil público de referência no Rio de Janeiro

INTRODUCTION: The pregnancy and postnatal period are the time of major prevalence of depression in womens life. Obstetric complications, including congenital malformations are important risk factors for depression during pregnancy. Mothers of fetuses with malformations experience a severe stressful life event. This fact could be aggravated by lack of social support. OBJECTIVE: The present study aimed to estimate depression in pregnant women with fetal malformations attended at a reference hospital fetal malformations in the Rio de Janeiro. METHOD: Interviews were conducted with 86 mothers of fetuses with malformations, which were assessed sociodemographic characteristics, clinical conditions/obstetric diagnosis of depression, social support and stressful life event. The period of study was from August 2011 to July 2012. RESULTS:The prevalence of depression during pregnancy was 17.4% (95%CI 0.09-0.26) and associated factor included being unemployed. The lack of emotional and information supports showed the highest frequency (57%). CONCLUSION:Depression is common during pregnancy of women with fetal malformations and was associated with indicators of socioeconomic deprivation. Psychosocial interventions and appropriate social policies need to be implemented in this population to reduce the burden of maternal depression.Introduction: The pregnancy and postnatal period are the time of major prevalence of depression in women’s life. Obstetric complications, including congenital malformations are important risk factors for depression during pregnancy. Mothers of fetuses with malformations experience a severe stressful life event. This fact could be aggravated by lack of social support. Objective: The present study aimed to estimate depression in pregnant women with fetal malformations attended at a reference hospital fetal malformations in the Rio de Janeiro. Method: Interviews were conducted with 86 mothers of fetuses with malformations, which were assessed sociodemographic characteristics, clinical conditions/obstetric diagnosis of depression, social support and stressful life event. The period of study was from August 2011 to July 2012. Results: The prevalence of depression during pregnancy was 17.4% (95%CI 0.09–0.26) and associated factor included being unemployed. The lack of emotional and information supports showed the highest frequency (57%). Conclusion: Depression is common during pregnancy of women with fetal malformations and was associated with indicators of socioeconomic deprivation. Psychosocial interventions and appropriate social policies need to be implemented in this population to reduce the burden of maternal depression.