Mariana Bonati de Matos

The impact of maternal post-partum depression on the language development of children at 12 months

BACKGROUND Language is one of the most important acquisitions made during childhood. Before verbal language, a child develops a range of skills and behaviours that allow the child to acquire all communication skills. Factors such as environmental factors, socio-economic status and interaction with parents can affect the acquisition of vocabulary in children. Post-partum depression can negatively affect the first interactions with the child and, consequently, the emotional, social and cognitive development of the child. OBJECTIVE To analyse the effect of the duration of the mothers depression on the language development of children at 12 months old. METHODS This was a longitudinal study. The participants of this study were mothers who had received prenatal care from the Brazilian National System of Public Health in Pelotas city, State of Rio Grande do Sul, Brazil. The mothers were interviewed at two different time points: from 30 to 90 days after delivery and at 12 months after delivery; the children were also evaluated at this later time point. To diagnose maternal depression, we used the Mini International Neuropsychiatric Interview, and to assess child development, we used the language scale of the Bayley Scales of Infant Development III. RESULTS We followed 296 dyads. Maternal depression at both time points (post partum and at 12 months) was significantly associated with the language development of infants at 12 months of age. This impact was accentuated when related to the duration of the disorder. Older women and women with more than two children were more likely to have children with poorer language development, while women who were the primary caregiver had children with higher scores on the language test. CONCLUSION The findings indicate that maternal age, parity, primary caregiver status and duration of post-partum depression are associated with the language development of the child.

Suicidal behavior in pregnant teenagers in southern Brazil: Social, obstetric and psychiatric correlates

BACKGROUND Suicidal behavior and its correlates remain relatively understudied in pregnant teenagers. METHODS A cross-sectional study with a consecutive sample of pregnant teenagers recipient of prenatal medical assistance by the national public health system in the urban area of Pelotas, southern Brazil. Sample size was estimated in 871 participants. Suicidal behavior and psychiatric disorders were assessed with the Mini International Neuropsychiatric Interview; the Abuse Assessment Screen was used to identify physical or sexual abuse; social support was assessed with the Medical Outcomes Survey Social Support Scale; a self-report questionnaire was used to collect socio-demographic, obstetric and other psychosocial data. RESULTS Forty three (4.94%) teenagers refused to participate, resulting in 828 participants. Prevalence of suicidal behavior was 13.3%; lifetime suicide attempts were referred by 7.4%, with 1.3% reporting attempting suicide within the last month. After adjustment, we found significant associations of suicidal behavior with the 18-19 years old subgroup, low education, prior abortion, previous major depression, and physical abuse within the last 12 months. Pregnant teenagers with high social support showed prevalence ratios (PR) 67% lower (PR: 0.33; 95%CI: 0.19-0.56) than those with low social support. Furthermore, a wide range of psychiatric disorders, most notably major depressive disorder (PR: 2.75; 95%CI: 1.34-5.63) and panic disorder (PR: 6.36; 95%CI: 1.61-25.10), remained associated with suicidal behavior after adjustment. LIMITATIONS The cross-sectional design precludes causal inferences. CONCLUSIONS We found that suicidal behavior is a relatively common feature in pregnant teenagers, frequently associated with psychiatric disorders.

Comparison of two instruments to track depression symptoms during pregnancy in a sample of pregnant teenagers in Southern Brazil.

INTRODUCTION Depression during pregnancy in adolescents is increasing significantly. However, instruments for early depression screening during prenatal care are scarce. Faced this fact, the objective of this research is to identify the best cutoff points for the Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) in a sample of pregnant adolescents. METHOD 807 pregnant adolescents, with a mean age of 17 years, met in public antenatal services were evaluated. Two screening scales for depression were analyzed, EPDS and the BDI. These scales had their accuracy measured by AUC of their ROC curve, as well as their respective sensitivity and specificity. RESULTS In the analysis, the best cutoff for the EPDS was≥10, in which the sensitivity was 81.1% and specificity 82.7%. For the BDI, it was with recognized the cutoff ≥11, sensitivity 86.7% and specificity 73.8%. In the analysis of the ROC AUC, values of 0.89 (CI 0.87-0.92) for the EPDS and BDI for 0.87 (CI 0.84-0.89) were identified compared to the MINI. LIMITATIONS The sample was composed majority by middle and low income adolescent and the study was performed only with pregnant women in the second trimester. CONCLUSIONS The results indicate that both scales have good accuracy in screening of depression in adolescent mothers. However, the EPDS scale shows higher AUC ROC and also better sensitivity and specificity values, the latter being more precise and effective for screening for depression in this population.

Association between perceived social support and anxiety in pregnant adolescents

Objective: To evaluate the association between perceived social support and anxiety disorders in pregnant adolescents. Methods: We conducted a cross-sectional study with a sample of 871 pregnant women aged 10 to 19 years who received prenatal care in the national public health care system in the urban area of Pelotas, state of Rio Grande do Sul, southern Brazil. We assessed perceived social support and anxiety disorders using the Medical Outcomes Study Social Support Survey and the Mini International Neuropsychiatric Interview. A self-report questionnaire was used to obtain sociodemographic information. Results: The prevalence of any anxiety disorder was 13.6%. Pregnant adolescents with an anxiety disorder reported less perceived social support in all domains (affectionate, emotional, tangible, informational, and positive social interaction). Older teenagers reported lower perceived support in the emotional, informational, and positive social interaction domains, whereas those with low socioeconomic status reported lower perceived social support in the material domain. Women who did not live with a partner had less perceived social support in the affectionate and positive social interaction domains. Conclusion: Perceived social support seems to be a protective factor against anxiety disorders in pregnant adolescents, with a positive effect on mental health.

Eventos estressores na família e indicativos de problemas de saúde mental em crianças com idade escolar

The scope of this article is to evaluate the relationship between stressor events that occurred last year in the family of children and adolescents that are indicative of mental health problems in a sample of students from two schools in a city in southern Brazil. It involved a cross-sectional study with 1,075 students enrolled in two public elementary schools. The Strengths and Difficulties Questionnaire was used to assess emotional and behavioral factors of the child and the Social Readjustment Rating Scale (SRRS) of Holmes and Rahe (1967) to assess stressor events. The chi-square and Poisson regression test with robust variance adjustment for expressing the results in the prevalence ratio (PR) and confidence intervals of 95% were used. The chances of presenting problems of hyperactivity were 1.42 (95% CI 1.10 to 1.83) times higher in the intermediate tercile and 1.37 (95% CI 1.06-1.78) in the higher tercile compared with the lower tercile. With respect to relationship problems the chances were of 1.49 (95% CI 1.15 to 1.93) times higher in the higher tercile when compared with the lower tercile. The results suggest that environmental factors may be strongly related to the etiology of mental disorders in childhood and adolescence.The scope of this article is to evaluate the relationship between stressor events that occurred last year in the family of children and adolescents that are indicative of mental health problems in a sample of students from two schools in a city in southern Brazil. It involved a cross-sectional study with 1,075 students enrolled in two public elementary schools. The Strengths and Difficulties Questionnaire was used to assess emotional and behavioral factors of the child and the Social Readjustment Rating Scale (SRRS) of Holmes and Rahe (1967) to assess stressor events. The chi-square and Poisson regression test with robust variance adjustment for expressing the results in the prevalence ratio (PR) and confidence intervals of 95% were used. The chances of presenting problems of hyperactivity were 1.42 (95% CI 1.10 to 1.83) times higher in the intermediate tercile and 1.37 (95% CI 1.06-1.78) in the higher tercile compared with the lower tercile. With respect to relationship problems the chances were of 1.49 (95% CI 1.15 to 1.93) times higher in the higher tercile when compared with the lower tercile. The results suggest that environmental factors may be strongly related to the etiology of mental disorders in childhood and adolescence.

Eventos de vida estressores e episódios de humor: uma amostra comunitária

Mood disorders are a consequence of the interaction between environmental and biological factors. The objective of this study was to identify associations between stressful life events (LEs) and mood disorders in a community sample of young people in southern Brazil. It is a cross-sectional population-based study on young people between 18 and 24 years of age. The selection of the sample was conducted via conglomerates. Mini International Neuropsychiatric Interviews were used to evaluate mood disorders, and the Social Readjustment Rating Scale to assess stressful life events. The sample included 1172 young people. Of the total sample, the proportion of stressful life events in the last year in each category was: 53.8% work, 42.4% loss of social support, 63.8% family, 50.9% environmental changes, 61.1% personal difficulties, and 38.7% finances. A significant relationship was found between categories of stressful life events and mood disorder episodes. A higher incidence of stressful life events was found among young people in a mixed episode compared to young people in a depressive, (hypo)maniac episode with controls. This finding suggests a psychosocial interaction between stressful life events and the occurrence of mood disorders.

Cognitive and language performance in children is associated with maternal social anxiety disorder: A study of young mothers in southern Brazil

BACKGROUND It has been shown that maternal mental health is associated with poorer skills development in the offspring. However, the evidence evaluating the association between social anxiety disorder (SAD) and cognitive or language development, is scarce. AIM To evaluate the association between maternal SAD and performance in cognitive and language tests in 30-month old children. STUDY DESIGN This was a cohort study involving young women evaluated since pregnancy. SUBJECTS We evaluated 520 mother-child dyads who received prenatal medical assistance through the National Public Health System in a southern Brazilian city, from October 2009 to March 2011. OUTCOME MEASURES We used the Mini Neuropsychiatric Interview Plus (MINI Plus) to assess SAD among young mothers. Cognitive and language performance in their offspring was analyzed using the Bayley Scales of Infant and Toddler Development - 3rd Edition. RESULTS We found an association between maternal SAD and performance in cognitive and language tests. Children of mothers with SAD had in average 4.5 less points in the Bayley scale, when compared to those with mothers without SAD: in the cognitive (β=-4.53 [95% CI -7.8; -1.1] p=0.008) and language subscales (β=-4.54 [95% CI -9.0; -0.5] p=0.047). CONCLUSIONS Our findings suggest that children with mothers suffering from SAD have poorer cognitive abilities and language skills.

Psychoactive substance abuse and dependence and its association with anxiety disorders: a population-based study of young adults in Brazil

Objective: To evaluate the association between abuse of and dependence on different psychoactive substances and the presence of anxiety disorders in a sample of young adults from a city in southern Brazil. Methods: Between 2007 and 2009, we carried out a cross-sectional, population-based study of individuals aged 18-24 years who lived in Pelotas, a city in southern Brazil. We evaluated anxiety disorders using the Mini International Neuropsychiatric Interview 5.0 (MINI), and use of psychoactive substances with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST 2.0/0MS). We used Fisher’s exact test for univariate analysis, and Poisson regression models with robust variance for multivariable analysis. Results: The sample consisted of 1,560 young adults. The overall prevalence of abuse/dependence was 26.9% for alcohol, 24.9% for tobacco, and 7.3% for illicit substances. Individuals with agoraphobia had a 32% higher prevalence of tobacco abuse/dependence (prevalence ratio [PR] = 1.32 [95%CI 1.01-1.74]). Individuals with posttraumatic stress disorder (PTSD) or generalized anxiety disorder (GAD) had a 2.41-fold (95%CI 1.22-4.77) and 1.76-fold (95%CI 1.00-3.11) higher prevalence of illicit substance abuse/dependence, respectively. Conclusion: In this population-based sample, we found associations between GAD, PTSD, and increased prevalence of illicit substance abuse/dependence. In addition, individuals with agoraphobia seem to have increased tobacco abuse/dependence.

The perception of parental bonding in pregnant adolescents and its association with generalized anxiety disorder

BACKGROUND The parental bonding is influenced by two dimensions: care and control or protection over the child of both parents. The lack of care during childhood may make the individual more susceptible to the onset of psychiatric disorders when adult. These psychiatric disorders when present during pregnancy may have a negative impact on the health of pregnant women and children. The aim of this study was to assess the association between generalized anxiety disorder (GAD) in pregnant adolescents and the perception of parental bonding. METHODS This is a cross-sectional study with 871 pregnant women under the age of 19, receiving prenatal care in 47 Basic Health Units in the one city, Brazil. The generalized anxiety disorder was measured using the Mini International Neuropsychiatric Interview (MINI) and the perception of parental bonding in childhood using the Parental Bonding Instrument (PBI). RESULTS The prevalence of GAD was 8.5%. Among all the parental bonding dimensions, only a perceived lack of maternal care under 16 years was associated with GAD. CONCLUSIONS The results showed that only the perception of maternal bonding was associated with later GAD. It suggests that an adequate maternal bond is an essential component of psychological health.

Association between perception of maternal bonding styles and social anxiety disorder among young women

OBJECTIVE To evaluate the association between social anxiety disorder (SAD) and perceived maternal bonding styles among young women during pregnancy and 30 months after childbirth. METHODS A cohort of young women from the city of Pelotas, Brazil was followed up from pregnancy to 30 months postpartum. The Mini Neuropsychiatric Interview Plus was used to assess SAD and the Parental Bonding Instrument was administered to measure maternal bonding styles. Poisson regression with robust variance was used for multivariable analysis. RESULTS After adjusting for potential confounding factors, SAD prevalence was 6.39 times higher among young women who perceived their mothers as neglectful (prevalence ratio [PR] 6.39; 95% confidence interval [95%CI] 1.2-32.0), and 5.57 times higher in women who perceived their mothers as affectionless controlling (PR = 5.57; 95%CI 1.5-19.7) when compared with those who received optimal care. CONCLUSION Maternal bonding style may have an influence on the development of SAD. Therefore, support and early prevention strategies should be offered to the family.