Priscila Krauss Pereira

Prevalence of gestacional depression and associated factors

Background: Depression is a common mental disorder during pregnancy and is associated with several risk factors. Studies have reported an association between gestational depression and deleterious effects to the development of the infant. Objectives: To review the prevalence and risk factors for depression during pregnancy. Methods: The keywords: “depression during pregnancy” OR “gestational depression” OR “antenatal depression” AND “prevalence” AND “risk factors” were used to search for articles published between 1997 and 2007 in the MEDLINE, LILACS and SciELO databases. Results: The prevalence of depression during pregnancy in developing countries, including Brazil, was higher than in developed countries, respectively 20% and 15%. Despite being an important public health issue, there are few studies about this subject in Brazil. The main risk factors were: previous history of depression, financial difficulties, low level of education, unemployment, poor social support, substance dependence and domestic violence. Discussion: We emphasize the importance of the screening for depression in the context of antenatal care. Obstetricians and other related health care providers must be aware of the various risks factors for depression during pregnancy. In addition, psychosocial interventions and social policies need to be implemented in this population. Pereira PK, Lovisi GM / Rev Psiq Clín. 2008;35(4):144-53 Key-words: Depression, pregnancy, prevalence, risk factors. Endereço para correspondência: Priscila Krauss Pereira. Rua Alexandre Rosa, 14 – 21930-160 – Rio de Janeiro, RJ. E-mail: priscilakrauss@ig.com.br 145 Pereira PK, Lovisi GM / Rev Psiq Clín. 2008;35(4):144-53

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.

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.

Depressão durante a gestação e os desfechos na saúde do recém-nascido: coorte de mães atendidas em unidade básica de saúde

OBJECTIVE: Describe the association between depression during pregnancy and effects on the newborn (low birth weight and prematurity). METHODS: We conducted a cohort study of 100 pregnant women enrolled between March and September 2011 in a public primary health service in Nova Iguacu. Participants were interviewed about their sociodemographic characteristics, medical/obstetric conditions, stressful life events and social support. Depression was assessed using the Composite International Diagnostic Interview (CIDI). After the post-partum mothers were interviewed about low birth weight and preterm birth. RESULTS: The prevalence of depression during pregnancy was 18% (95% CI: 12.2 to 23.8). Factors associated with neonatal outcome were gestational depression (OR: 6,60 CI: 1,51-28,91) and alcohol (OR: 8,75 CI: 1,10-69,71). CONCLUSION: The implications of this study to the practice emphasize the need for screening for depression during pregnancy.

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.

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

Adverse perinatal and infant outcomes among children born to mothers with major mental disorders in a psychiatric hospital in Rio de Janeiro, Brazil

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

Evaluación de los resultados perinatales/nacimientos infantiles en los pacientes con trastornos mentales en un hospital psiquiátrico de Río 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

P02-381 - Prevalence of depression among pregnant women seen in a public primary health service in rio de janeiro city

Background Depression is the most prevalent psychiatric disorder during pregnancy and it is associated with psychosocial and clinical obstetric factors. Despite being an important Public Health issue, there are few studies about this subject in Brazil. Aim This study aimed to estimate the prevalence and risk factors for depression during pregnancy. Method A Cross-sectional study of 331 pregnant women attending a public primary health service over a one-year period in Rio de Janeiro. Participants were interviewed about their socio-demographic status, obstetric/medical conditions, life events and violence during pregnancy. Depression was assessed through the Composite International Development Interview. Results The 12-month prevalence of depression was 14.2% (CI 95% 10.7 - 18.5) and associated factors were: previous history of depression and any psychiatric treatment, unplanned pregnancy, serious physical illness and casual jobs. Conclusion 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 implemented in this population