Estudio de casos y controles en un grupo de mujeres embarazadas con experiencias adversas en la infancia y/o adolescencia e infecciones de transmisión sexual / Case studies and controls in a group of pregnant with adverse experience in childhood and/or adolescence and sexually transmitted infections

Introduction Psychic traumas, also called adverse experiences, are events from the subject's life characterized by its intensity, the subject's inability to respond to them properly and the pathogenic lasting effects they cause in the psychic organization. The violence effects against women and girls are usually devastating for their reproductive health and other aspects of their physical and mental well-being. Besides injuries, violence causes an increase in the long-term risk of women developing other health problems. Women with a history of psychic mistreat or sexual abuse face also a bigger risk of non-expected or involuntary pregnancies, sexual transmitted infections and adverse results from pregnancy. High rates of childhood abuse were found: 42.2% had suffered physical mistreat, 21.4% had been insulted, 16.5% was victim of humiliation and 7.6% had been a victim of sexual abuse before fifteen years of age. The main aggressors were male relatives, the stepfather or the father. A study done in the United States found that women exposed to this form of violence suffered STI in adult age in a bigger proportion (10.7%) than the ones that were never exposed (5.7%). An investigation was made in the National Perinatolgy Institute called «STD/HIV-AIDS and Personality Disorders (PD) in pregnant women and their couples. Detection and prevention from high risk practices¼ with the objective -among others- to resolve the existing association between adverse experiences in childhood and the presence of sexually transmitted infections in gestation. Material and method The investigation design was of cases and controls; the characteristics of the study in relation to temporality was prospective with respect to the presence or absence of the pathogenic agent in gestation and retrospective (investigating adverse experiences in childhood), analytical referring to the analysis type and transverse with respect to the capture of the sample. The evaluation of the STIs was made through the Laboratory of the Sexually Transmitted Infections Clinic of the INPer and from the pertinent clinic exams. The diagnostic evaluation was made on the basis of the structured clinic interviews for the diagnostic psychiatric evaluation of I and II axes of DSM-IV. To investigate adverse childhood experiences, a psychodynamic interview was made and answers were transcribed then to the questionnaire made by Whitfields, Dube, Felitti and Anda, who developed the instrument Adverse Experiences in Childhood and/or Adolescence (ACE) with the aim to measure the amplitude of the exposition to emotional, physical and sexual abuse, as well as family dysfunction in these stages of life. It includes seven categories of adverse experiences, three relative to active abuse and five to passive abuse: 1. psychological abuse; 2. physical abuse; 3. sexual abuse; 4. conjugal violence against the mother; 5. living with parent or adults with alcohol problems and/or substance abusers; 6. living with parents or adults with mental disorders or suicidal; 7. living with parents that had been in jail. Results One hundred seventy-eight pregnant women were divided in two groups, the first one with 89 participants, in which a virus that caused the STI was identified, and the second group was the control group with also 89 pregnant women without STI. Significant differences were obtained in the socioeconomic level. There was also a significant association between fathers of the women with STI that had some legal problem and had being sent to jail for a period of time (RM 3.311); they also show small alcoholic problems (RM 2.073). There was a significant association with the different types of passive abuse (carelessness, negligence and indifference) physical, emotional and sexual, emphasizing that the relation between these categories and having an STI by a virus is highly significant; this is, being exposed in childhood to adverse events, more probability to get a viral STI in adulthood. The cases group accumulated three or more in bigger proportion (20.2%) than the control group (9%). The STI pregnant group presented a bigger number of traumatic events (69.9%) in comparison to the group with no STI that was 48.3%. It is appraised the bigger prevalence of mental disorders in the STI pregnant group, having a disorder increased the potential risk of infection by 2.45 times (C:I to 95% that oscillates between 1.303 and 4.61). Conclusions The STI viral group and the control group are different concerning socioeconomic level and schooling, finding in the STI group a bigger proportion of women whose monthly family income is lower, the poverty as a risk factor and/or social vulnerability for the HIV infection, the interaction between living in poverty conditions and the difficulty to access and to stay in the national educative system are closely related. In addition, this case group was integrated in a bigger proportion with pregnant who were not united in the study period. It is important to mention that half of the pregnant that formed the HIV/ AIDS group suffered the pain of seeing their couple die. From the adverse experiences in childhood and/or adolescence that could have been in the start or been a beginning factor for getting afterwards a viral STI in adulthood, the significant ones were having lived with a alcohol abuser adult, thus being victim of carelessness, negligence or indifference, same as being hit, pushed, pushed or hit so hard to leave marks, humiliations, coarses, insults, feelings of being less and victim of being touched or having a sexual experience. These traumatic events happened simultaneously, mainly in the cases group where 40 pregnant declared being exposed to two or more categories in contrast with 22 of the control group. Alcohol abuse is a generalized health problem and common in all societies; pregnant women with STI were in bigger proportion more exposed to familiar alcohol than the control group and approximately half of them were at the same time victims of some forms of abuse or violence by their fathers or stepfathers. Studies made in 21 countries show that between 7% and the 36% of the women had accepted being victims of sexual aggressions during their childhood and, according to most of these studies, the rate of abuses suffered by girls is 1.5 to 3 times bigger than men. The same report makes evident the fact that between 133 and 275 millions of children from all over the world are witnesses of domestic violence each year; this is, witness violent scenes at their home, generally through fights between their parents or between their mother and couple, which can also seriously affect their well-being, development and their social interaction in childhood and adult age. It has also been found that suffering an active abuse in childhood is a risk factor for structuring a borderline personality disorder.

Resumen Introducción Los traumas psíquicos, también denominados experiencias adversas, son acontecimientos de la vida del sujeto caracterizados por su intensidad, la incapacidad del sujeto para responder a ellos adecuadamente y los efectos patógenos duraderos que provocan en la organización psíquica. Los efectos de la violencia contra las mujeres y las niñas suelen ser devastadores para la salud reproductiva de la mujer y otros aspectos de su bienestar físico y mental. Además de causar lesiones, la violencia lleva a que aumente el riesgo a largo plazo de que las mujeres desarrollen otros problemas de salud. Las mujeres con una historia de maltrato físico o abuso sexual también enfrentan un riesgo mayor de embarazos no previstos o involuntarios, infecciones de transmisión sexual (ITS) y resultados adversos del embarazo. En el Instituto Nacional de Perinatología se realizó una investigación titulada «ETS/VIH-SIDA y trastornos de la personalidad en mujeres embarazadas y sus parejas. Detección y prevención de prácticas de alto riesgo¼ con el objetivo -entre otros- de determinar la asociación existente entre experiencias adversas en la infancia y la presencia de infecciones de transmisión sexual en la gestación. Material y método El diseño de la investigación fue de casos y controles; el estudio fue prospectivo respecto de la presencia o ausencia del agente patógeno en la gestación y retrospectivo (indagación de experiencias adversas en la infancia). La evaluación de las ITS se efectuó por medio del laboratorio; la evaluación diagnóstica se efectuó con base en las Entrevistas Clínicas Estructuradas para la evaluación diagnóstica psiquiátrica de los Ejes I y II del DSM-IV. Se aplicó el instrumento Experiencias Adversas en la Infancia y/o Adolescencia (ACE, por sus siglas en inglés), con el fin de medir la amplitud de la exposición al abuso emocional, físico y sexual, así como la disfunción familiar en estas etapas de la vida. El instrumento comprende siete categorías: 1. abuso psicológico; 2. abuso físico; 3. abuso sexual; 4. violencia conyugal contra la madre; 5. vivir con padres o adultos con problemas de alcoholismo y/o que eran abusadores de sustancias; 6. vivir con padres o adultos con trastornos mentales o suicidas; 7. vivir con padres que fueron encarcelados. Resultado Se estudiaron dos grupos, el primero de casos integrado con 89 embarazadas con ITS viral y el segundo fue el grupo control integrado también con 89 gestantes, sin ITS. Se obtuvieron diferencias significativas en el nivel socioeconómico. Así mismo hubo una asociación significativa entre los padres de las mujeres con ITS que tuvieron algún problema con la ley por lo que habían sido encarcelados por un determinado periodo de tiempo (la razón de momios fue 3.311); y los que manifestaron leves problemas de alcoholismo (RM 2.073). Hubo una asociación significativa en: abuso pasivo, físico, emocional y sexual, donde destaca que la relación entre estas categorías y padecer una ITS por virus es altamente significativa. El grupo de las gestantes con ITS presentó un mayor número de problemas traumáticos (69.9%) en comparación con el grupo sin ITS que fue de 48.3%. Conclusiones De las experiencias adversas en la infancia y/o adolescencia, que pudieron estar en el origen o haber sido un factor iniciador para adquirir posteriormente una ITS de origen viral en la edad adulta, fueron significativas haber convivido con un adulto cercano con problema de abuso del alcohol y haber sido víctima de descuido, abuso físico, emocional o sexual.

Organización conductual de neonatos hijos de madres con un trastorno del estado de ánimo

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Summary Background: Recent research has found that newborns, whose mothers present a mood disorder, show at this age a profile of dysregulation characterized by an impaired performance according to the Brazelton Neonatal Behavioral Assessment Scale, indeterminate hipersomnia high levels of stress related hormones (norepinephrine and cortisol) right frontal EEG activation deficient responsivity to facial expressions and impairment of sympathetic response characterized by lower vagal tone. Newborns from mothers who were depressed during pregnancy show to be more irritable, more difficult to console, and have less developed motor tone than newborns from nondepressed mothers. The mother's behavior, related to the newborn, is characterized by two predominant interaction styles: withdrawn or intrusive, which seem to have differential negative effects on their infants, due to inadequate stimulation and arousal modulation. The mother's mood and anxiety disorders may affect the newborn due to exposure of the fetus to the maternal biochemical imbalance. Because the longer exposure to an intrauterine environment marked by high levels of cortisol and norepinephrine was likely to result in less optimal outcomes, the newborns of mother who were depressed only at the beginning of pregnancy were likely to show more optimal profiles than those of mothers reporting symptoms of depression and accompanying biochemical imbalances at the middle and at the end of pregnancy. Studies on prepartum health behaviors provide evidence for the indirect effects of maternal depression on the prepartum environment. Depressed mothers are less likely to seek prepartum care and are more likely to smoke, drink, and use cocaine during pregnancy than non depressed mothers. Objective: To compare the systems of behavior organization of those infants born from high neonatal risk mothers with or without mood disorder. Method: An observational, analytical and longitudinal case-control study was designed. A sample of 53 women, 18 to 40 years old and with a 16-35 weeks pregnancy was selected for this study. From this sample, 24 women did not have a mood disorder diagnosis and had a mean age of 27.7 ± 5.3 and 29 women had this diagnosis and a mean age of 30 ± 6.7 years. Mean gestational age of infants at birth was 39.4 ± 1.3 and 39.1 ± 1.2, respectively. This study was carried out from April 2003 to June 2004. Women participated in this study after signing their acceptance. The Neonatal Behavioral Assessment Scale (NBAS), an instrument used to detect the presence of alterations during the first 2 months of life of newborns, was applied to 53 infants at two different moments: 3 days and 27-30 days after birth. Women were assigned to the case (diagnosis of mood disorder) or control group (without mood disorder) after the application of the Edimburgh Postnatal Depression Scale (EDPS) and the structured interview for axis I and II of the DSM-IV. ANOVA tests were used for comparisons between the study groups (cases and controls) as independent variables, and the pretest and post test change, as the dependent variables. Initial values, the interval in days between the evaluations and gestational age were considered covariables in the analysis. This analysis was done for each of the 6 clusters or segments of the NBAS which are: social interaction, motor system, state organization, state regulation, autonomic system, and the cluster of supplementary items. These were also considered for the total score. Results: During the first evaluation, all infants performed satisfactorily, a fact that indicates that at birth they were in good conditions for their future development. When reviewing changes of the 6 analyzed clusters, the only differences found were in motor maturity. Infants from depressed mothers showed a slight difference (adjusted mean 0.971 ± 2.6 points) when compared with babies from non-depressed mothers (adjusted mean 2.033 ± 2.6 points) [F(1,49)=3.83,p=0.05]. The rest of the segments from the NBAS did not show a statistical difference. All results were favorable in all clusters for mothers without mood disorder, independently from the covariables. Conclusion: Behavior organization of infants born to women with mood disorder tends to show delayed motor maturity. Even though we did not find evidence of delayed development in the other clusters, a trend could be observed. Decreased motor tone and lower activity levels, lethargy, and stress behaviors were noted in the infants of depressed mothers, suggesting that infants were floppy, relatively unresponsive, and reminiscent of newborns who are small for date. This behaviors might contribute to the later difficulties noted in the interactions of depressed mothers and their infants. It is important to further study the effects of maternal depression in the development of behavior organization in newborns. It is also important to study the biochemical disturbances in the mother secondary to her depression, and their effect in the biochemical balance of her neonate. Cortisol has a great influence on the cerebral development and it is associated to the inhibition of neurogenesis in hypothalamus. This inhibition perhaps may be the cause of depression in the newborn. The mother's anxiety during pregnancy may have a great influence on the behavior of the newborn. In this study, the mother was undergoing a high risk pregnancy, with some previous abortions, low pregnant age and other perinatal risks. Under this conditions, mothers are likely to present psychological distress.

Indicadores de malestar emocional y depresión en mujeres embarazadas con ITS-VIH/SIDA

Objetivo: Evaluar la presencia de indicadores de malestar emocional y depresión en un grupo de mujeres embarazadas con infecciones de transmisión sexual (ITS) y determinar la validez y confiabilidad del Cuestionario General de Salud (GHQ - 30) y de la Escala de Depresión Perinatal de Edinburgh (EPDS). Material y métodos: Se realizó una investigación de casos (mujeres con ITS de predominio viral o micótico) y controles (mujeres sin ITS) realizada durante los años de 2000-2002, en una institución del tercer nivel de atención. Se estudió una muestra intencional, consecutiva y autoseleccionada por consentimiento informado de 350 embarazadas. Resultados: Se determinó la validez concurrente, los coeficientes de correlación del GHQ y la EPDS (0.628 y 0.547), los cuales mostraron una asociación significativa. La validez de constructo del GHQ en cuatro componentes explicó 51.4% de la varianza total. La consistencia interna tuvo un alfa de Cronbach de 0.911 en la escala global y por factor entre 0.876 y 0.789. Se encontraron diferencias significativas en el factor uno al comparar las medias del grupo control con las de los casos del grupo de ITS de predominio viral. En la EPDS, dos componentes principales explicaron 53.7% de la varianza total; el alfa de Cronbach global fue de 0.847 y por factor de 0.828 y 0.648. Se obtuvieron diferencias significativas al comparar el grupo control con el grupo de casos de ITS de predominio viral. Conclusiones: Ambos instrumentos reúnen las características psicométricas para ser aplicados durante la gestación. Las mujeres con ITS por VPH o VIH mencionaron padecer un número mayor de síntomas de depresión en comparación con las mujeres sin ITS.

Objective: To evaluate the presence of indicators of emotional distress and depression in a group of pregnant women with sexually transmitted infections (STI) and to determine the validity and reliability of the General Health Questionnaire (GHQ - 30) and of the Edinburgh Perinatal Depression Scale (EPDS). Material and methods: Cases (women with an STI, predominantly viral ar mycotic) and controls (women without an STI) research, performed from 2000 to 2002 in a third level of attention institution, with an intentional, consecutive and autoselected, through informed consent, sample of 350 pregnant women. Results: Concurrent validity: the correlation coefficients of the GHQ and the EPDS (0.628 y 0.547) showed a significant association. Conceptual Validity GHQ: four components explained the 51.41% of the total variance. Internal consistency: Cronbach's alpha of 0.911 on the global scale and by factor between 0.876 and 0.789. Significant differences were found in factor 1 by comparing the means of the control group with the ones form the predominantly viral STI cases. EPDS: Two main components explained the 53.738% of total variance; the global Cronbach's alpha was of 0.847 and by factor of 0.828 and 0.648. Significant differences were obtained by comparing the control group with the predominantly viral STI cases group. Conclusions: Both instruments gather the psychometric characteristics required to be applied during gestation; women with an STI by HPV or HIV mentioned that they had a larger number of depression symptoms in comparison to women without a STI.

Prácticas de riesgo para infecciones de transmisión sexual en un grupo de mujeres embarazadas y sus parejas

Objetivo: Identificar los factores de riesgo y de protección involucrados en el riesgo de padecer infecciones de transmisión sexual (ITS) en mujeres embarazadas (y sus parejas) que acudieron a control prenatal. Material y Métodos: Se realizó un estudio de casos y controles, integrado por mujeres embarazadas que convivieran con su pareja. Los casos fueron mujeres con ITS (presencia confirmada de un agente patógeno) y los controles fueron mujeres con diagnóstico negativo para ITS. Se aplicó el Inventario de Prácticas de Riesgo y Redes Sexuales en una entrevista dirigida aplicada en forma individual, con duración de 40 a 120 minutos. Resultados: Del total de invitados 82.4% de las mujeres y 52.6% de los hombres aceptaron participar. El grupo de casos se conformó por 78 mujeres y el control por 97. Tanto en mujeres como en hombres el antecedente de ITS fue un factor de riesgo para presentar nuevamente otra ITS (mujeres RM 27.68 IC 95% 11.69-65.50; hombres 8.69 IC 95% 27.68-27.31). Para las mujeres también resultaron ser factores de riesgo la práctica de relaciones sexuales orales y/o anales (RM 2.21 IC 95% 1.16-4.23 y 2.26 IC 95% 1.08-2.09, respectivamente). Para las mujeres los factores protectores fueron: vivir con su pareja (RM 0.40 IC 95% 0.45-0.91), vivir en el D.F. (RM 0.42 IC 95% 0.21-0.81), tener ocupación remunerada (RM 0.50 IC 95% 0.27-0.94) y sólo una pareja sexual (RM 0.54 IC 95% (0.29-0.98). Conclusiones: En mujeres son factores de riesgo de ITS haber padecido una ITS, haber tenido relaciones sexuales orales y/o anales; son factores protectores vivir con su pareja, tener ocupación remunerada y tener sólo una pareja sexual.

Objective: To identify risk and protection factors to acquire sexually transmitted infections (STI's) in pregnant women (and their partners) that attended prenatal care. Material and methods: A study of cases and controls made out of pregnant women that had a partner. The cases were women with STI's (confirmed presence of a pathogenic agent) and the controls were women with a negative diagnosis for STI's. The Inventory of Risk Practices and Sexual Networks was applied through a directive and individual interview, 40 to 120 minutes long. Results: 82.4% of the women and 52.6% of the men accepted to participate, of those invited to do so. The group of cases with STI's was made out of 78 women and the control group of 97 women. Both in women as well as in men, the antecedent of STI's was a risk factor for presenting an STI once again (women OR 27.68 CI 95% 11.69-65.50; men 8.69 CI 95% 2.76-27.31). For women, the practice of oral and/or anal sex turned out to be a risk factor (OR 2.21 CI 95% 1.16-4.23 y 2.26 CI 95% 1.08-4.34 respectively). For women the protective factors were: to have a partner (OR 0.40 CI 95% 0.45- 0.91), to live in Mexico City (OR 0.42 CI 95% 0.21-0.81), to have a paid occupation (OR 0.50 CI 95% 0.27-0.94) and only one sexual partner (OR 0.54 CI 95% 0.29-0.98). Conclusions: In women risk factors of STI are having had an STI, having had sexual, oral and/or anal intercourse; while having a partner, a paid occupation and only one sexual partner, are protective factors.

Trastorno límite de la personalidad y su asociación con el VIH/SIDA en gestantes

Objetivo: Establecer si las gestantes VIH positivas presentan más síntomas y padecimientos psiquiátricos que las embarazadas sin infecciones de transmisión sexual (ITS). Material y métodos: Se realizó una evaluación diagnóstica psiquiátrica con base en Entrevistas Clínicas Estructuradas (SCID-I y II) del DSM-IV, así como del Cuestionario de Personalidad del Eje II (PQ-II), complementada con el Inventario de Organización de la Personalidad (IPO), el Cuestionario General de Salud (GHQ), la Escala de Depresión Perinatal de Edinburgh (EPDS) y el Test no verbal de inteligencia BETA-IIR. El grupo VIH se integró con 37 mujeres seropositivas y el grupo control con 115 gestantes sin ITS. Se emplearon las pruebas de Kolmogorov Smirnov o de Ji cuadrada, así como la razón de momios con un IC 95%. Resultados: El grupo VIH estaba conformado por mujeres de menor edad (p < 0.048), escolaridad (0.000) y nivel socioeconómico (0.000), solteras (0.000) y con trabajo remunerado (0.051) que el grupo control. El grupo VIH manifestó un mayor número de síntomas de depresión (EPDS, p < 0.005). Padecer un trastorno límite de la personalidad constituye un potencial de riesgo 45 veces mayor de adquirir la infección por VIH (IC 95% 5.40-386.35); si bien en ambos grupos se encontró una alta tasa de depresión (0.444 y 0.322), el potencial de riesgo fue de 17 veces más alto para el grupo VIH (IC 2.18-140.53), padecer algún trastorno de personalidad también fue un factor de riesgo para la infección (RM 14.72 IC 1.40-155.08). Existe una asociación significativa entre el padecer un trastorno mental y la adquisición del VIH/SIDA (RM 23.01 IC 95% 3.021-175.353). Conclusiones: Vulnerabilidades acumuladas tanto sociales (pobreza, menor nivel de escolaridad, sin pareja) como psiquiátricas (trastorno de personalidad), intervienen en la infección por VIH.

Aims: To establish if HIV+ pregnant women present more psychiatric symptoms and illnesses than pregnant women without sexually transmitted infections (STI's). Material and methods: A psychiatric diagnostic assessment was performed, based on the Structured Clinical Interviews (SCID-I and II) for the DSM-IV, as well as the Personality Questionnaire for axis II (PQ-II), complemented by the Inventory of Personality Organization (IPO), the General Health Questionnaire (GHQ), the Edinburgh Perinatal Depression Scale (EPDS) and the Test of nonverbal intelligence BETA-IIR. The HIV group was conformed by 37 HIV+ women and the control group by 115 pregnant women without an STI. The tests used were the Kolmogorov-Smirnov test or the chi-square, as well as odds ratio with a 95% CI. Results: The HIV group was conformed by women in a lower range of age (p < 0.048), schooling (0.000) and socioeconomic level (0.000), they were single (0.000) and had a paid job (0.051) than the control group. The HIV group manifested a higher number of depression symptoms (EPDS, p < 0.005). Having a borderline personality disorder constitutes a potential risk 45 times higher to acquire HIV (CI 95% 5.40 - 386.35); in both groups a high rate of depression was found (0.444 and 0.322) however, the risk potential was 17 times higher for the HIV group (CI 2.18 - 140.53), having a personality disorder was also a risk factor for infection (OR 14.72 CI 1.40 - 155.08). There is a significant association between having a mental disorder and the acquisition of HIV/AIDS (OR 23.01 CI 95% 3.021 - 175.353). Conclusions: Both social (poverty, lower level of education, not having a partner) as well as psychiatric (personality disorders) cumulative vulnerabilities intervene in the infection with HIV.

Evaluación de dos casos de madres con VIH, mediante la entrevista de apego adulto

Objetivo: Identificar el tipo de apego de dos madres con VIH, utilizando la Entrevista de Apego Adulto (AAI, por sus siglas en inglés). Metodología: Aceptaron participar en esta parte de la investigación dos de las 37 mujeres (procedentes de la investigación sobre ETS-VIH/SIDA y trastornos de personalidad en mujeres embarazadas), a quienes se les aplicó la AAI; dicha entrevista fue audiograbada, transcripta verbatim y calificada (después de un proceso de certificación), con base en el sistema de clasificación desarrollado por Main, Goldwyn y Hesse. Las dos mujeres fueron similares en cuanto a variables como edad, ocupación (labores del hogar), estado civil (casadas), ser madres, tener pareja y presentar depresión. Resultados: Se describen los casos de dos mujeres de 23 y 26 años, casadas y dedicadas al hogar. La primera con tres gestaciones y la otra con una; ambas con VIH positivo, al igual que sus parejas. En la experiencia durante la niñez sobresalen los siguientes datos: ambas sufrieron de descuido y un nivel bajo de amor y de cuidados por parte de las figuras parentales. Se encontró también la existencia de rechazo, principalmente en el caso uno. Ambos casos fueron clasificados como Desorganizados/No Resueltos (Ud), estado mental inseguro, por la insuficiente elaboración de experiencias traumáticas; más una clasificación autónoma (Ud/F), por la influencia de una figura de apego sustituta y satisfactoria durante la infancia. Sin esta importante influencia reparativa las características de la autonomía (como una asignación secundaria al tipo de apego) no se hubieran logrado. Conclusiones: Ambas madres tuvieron una infancia adversa con eventos traumáticos no resueltos, lo que probablemente se transmitirá a sus infantes como un apego desorganizado.

Objective: To identify the attachment classification of two women with HIV with the Adult Attachment Interview (AAI). Material and methods: Two women out of a sample of 37 (taken from "HIV/AIDS and Personality Disorders in Pregnant Women" project); who had done the Adult Attachment Interview (AAI), agreed to participate in this part of the project. The AAI was audio-recorded, verbatim transcripted and evaluated -after a through certification process- according to the system developed by Main, Goldwyn and Hesse. The two women were similar in age, occupation, marital status, being mothers, having a couple and a depression. Results: Two women, 23 and 26 years old, both married and working at their home; the first with three pregnancies and the other with one; both with HIV as their couples. In the experience aspect of their childhood: both suffered neglect and a diminished love or care by their parents; rejection was also found mainly in case one. It was found that both cases had a Disoriented/Unresolved classification with an Autonomous second classification, due to unresolved traumatic experiences; and the Autonomous secondary classification, as a result of the compensating influence of a substitute attachment figure, during childhood. Conclusions: Both women had a difficult childhood with traumatic events that were not resolved and that could be transmitted to their infants as a Disorganized Attachment.

Evaluación familiar y del desarrollo de dos niñas, hijas de padres con VIH/SIDA

Objetivos: Describir las pautas de interacción de dos familias con VIH/SIDA con la infección ubicada en los padres y evaluar a dos niñas de estas familias en su organización conductual alrededor de los cuarenta días de vida y el desarrollo mental y motor a los seis y doce meses de edad. Material y métodos: A través del genograma se evaluaron los sistemas familiares de dos niñas, hijas de padres infectados por VIH/SIDA; las pequeñas, a su vez, fueron evaluadas con la Escala de Conductas Neonatales de Brazelton (NBAS) entre los 39 y 44 días después del nacimiento y a través de las Escalas de Desarrollo de Nancy Bayley (BSID-II) a los seis y doce meses de edad. Resultados: En los dos casos la organización familiar corresponde a una pareja de adultos-jóvenes con VIH positivo en etapa de bebés y con hijos no enfermos; en el primer caso la madre se define como la transmisora; en el segundo el padre. Hay un debilitamiento en el subsistema de los padres. Las relaciones de parejas de los padres presentan ambivalencias. A medida que la VIH/SIDA avanza, las alianzas dividen a las familias y excluyen de la colaboración contra la enfermedad a varios miembros, lo que sobrecarga a las abuelas maternas. Las jerarquías y los límites son difusos, lo cual impide una contención estable y firme a los hijos. Las dos familias se encuentran estancadas en la etapa de estrés situacional. En el NBAS las dos lactantes obtuvieron una ejecución de buena a excelente (puntajes 7, 8 y 9) en los diferentes conglomerados; en el BSID-II, se advirtió que en ambos casos, en los primeros seis meses el desarrollo mental y motor cursó dentro de los límites normales; mientras que a los 12 meses el primer caso continuó con un desarrollo normal y en el segundo no fue posible evaluar con precisión el desarrollo, debido a una conducta de oposicionismo. Conclusiones: Ambos sistemas familiares presentan una organización con enfermo crónico y en particular con VIH-SIDA. Este estudio nos muestra que la evaluación en el desarrollo motor y mental de las dos niñas cursa conforme a lo esperado y que en la organización actual existe la estructura familiar con un proceso de parentalización (inversión de roles) y desamparo para las niñas.

Objective: To describe the family patterns of interaction of two girls born to parents infected with AIDS/HIV, and their behavioral organization around forty days, also the mental and motor development at six and twelve months. Methodology: The two family systems of the two girls with both parent infected by AIDS/HIV, were evaluated using a genogram; they were also appraised with the Brazelton Neonatal Behavioral Assesment Scale (NBAS), between days 39 and 44; and with the Bayley Scale of Infant Development (BSID-II) at six and twelve months of age. Results: In the two cases, the family organization belongs to a young adult couple with HIV positive and two healthy sons; in the first case, the mother is identified as the transmitter; in the second, the father is the spreading agent. There is a weakening effect in the parental subsystem. The couples relations are ambivalent. As the HIV/AIDS advances, the alliances divide the family, excluding several members from the collaboration effort against the illness; this overloads the maternal grandmothers. Hierarchies and limits become diffused, resulting in a lack of a firm and stable emotional contention for the children. The two families are stalled in a situational stress period. In respect to the NBAS the two infants obtained performance from good to excelent (scores 7,8,9) across the clusters; in the BSID-II both cases had a normal score in the first six months of their mental and motor development, while at twelve months of age, the first case continued with a normal development, but the second case was not precisely evaluated due to oppositional behavior. Conclusions: Both family systems are identified with an organization affected by the HIV presence, their structure is promoting a parentalization (role reversal) process and neglect for the children; though the motor and mental development of the two girls were found according to the expected norm for their age.

Prevalencia de depresión, a través de la Escala de depresión perinatal de edinburgh (EPDS), en una muestra de mujeres mexicanas embarazadas / Depression prevalence, through the depression perinatal depression scale (EPDS) in a sample of pregnant mexican women

Objetivo: Determinar la prevalencia de depresión durante el último trimestre del embarazo y determinar la validez y la confiabilidad de la Escala de Depresión Perinatal de Edinburgh (EPDS). Material y Métodos: Se llevó a cabo una investigación en la consulta externa del Instituto Nacional de Perinatología, en una muestra de 360 mujeres, en las semanas 28-34 de gestación, que aceptaron libre e informadamente participar en el estudio. Se aplicó una batería de pruebas psicológicas, entre ellas, la EPDS. Resultados: En relación con la validez de constructo de la versión en español, se identificaron dos factores con valores eigen superiores a 1.00, que dan cuenta del 50.3 por ciento de la varianza total: el primer factor agrupó los reactivos 1,2,7-10, que están más relacionados con "sentimientos depresivos"; y el segundo factor, se integró con los reactivos 3-6, más relacionados con ansiedad y/o transición hacia la maternidad. Respecto de la confiabilidad, se obtuvo un alfha de Cronbach de 0.818 en la escala global, un alpha estandarizada de 0.822 y un coeficiente de 0.75, por el método de mitades de Guttman. En el retest con 97 mujeres, a las seis semanas postparto, se obtuvieron coeficientes de correlación adecuados (0.792; 0.656 y 0.625). Se encontró que el 21.7 por ciento de las mujeres de la muestra, podrían estar experimentado "un probable episodio depresivo".Conclusiones: Se considera importante aplicar el EPDS como parte de los procedimientos diagnósticos habituales en el control prenatal, con objeto de identificar tempranamente a las mujeres en riesgo y hacer las indicaciones pertinentes para su atención y tratamiento.