Depresión posparto: tamizaje, uso de servicios y barreras para su tratamiento en centros de atención primaria / Screening and barriers for treatment of postpartum depression in Chilean public primary health care centers

Background: Postpartum depression (PPD) is a public health issue, and appropriate screening may lead to clinical gains. Aim: To describe the screening for PPD, its relationship with the use of health care services, and treatment access barriers in Chilean public primary health care (PHC) centers. Material and Methods: Puerperal women attending PHC centers for a well-child check-up were assessed for the presence of PPD using the Edinburgh Postnatal Depression Scale and a structured psychiatric interview. PPD cases were assessed by telephone three months later. Also, women with PPD and PHC workers were interviewed to explore treatment barriers. Results: Of the 305 women assessed, 21% met diagnostic criteria for PPD. Sixty five percent of assessed women were previously screened for PPD while attending well-child check-ups. The results of the screening were communicated to 60% of them and 28% received some management indication. After three months of follow up, 70% of PPD cases continued to be depressed, and two thirds of them did not consult a health care provider and most of them rejected psychotherapy or medical treatment. Conclusions: Management of postpartum depression should be substantially improved in public PHC from screening to treatment.

Distorsión de la imagen corporal en madres hacia sus hijos con sobrepeso u obesidad / Distorted body image of overweight or obese children among mothers

Pediatric obesity is a major public health problem in the country. The imbalance between caloric intake and expense has been recognized as a major contributing factor, however, despite many strategies to combat this pathology the results remain discouraging. The mother is an important treatment intermediary that can have a distorted motherly perception (DMP) about their child's nutritional status. The purpose of this study was to assess motherly perception of body image (MPBI) of their school-age children. We selected mothers with children between 7 and 17 years old from schools in Santiago, Chile. We assessed nutritional status with body index mass (BMI) and pubertal growth (Tanner) and compared MPBI with actual nutritional status. We observed that 54.8% of mothers of obese children and 78.3% of mothers of overweight children had DMP, estimating their child as thinner. DMP among mothers of overweight and obese children could affect treatment adherence and is a key point for intervention.

La obesidad pediátrica es un importante problema de salud pública en el país. El desequilibrio entre ingesta y gasto energético ha sido reconocido como la principal causa, pero pese a las múltiples estrategias para enfrentar esta patología los resultados continúan siendo desalentadores. La madre es un mediador importante en el tratamiento, pudiendo influir la distorsión de la imagen corporal (DIC) en el estado nutricional (EN) de sus hijos. El propósito de este trabajo fue evaluar en población escolar la percepción de la imagen corporal (PIC) de la madre hacia su hijo. Se seleccionaron madres con hijos con edades de 7 a 17 años de colegios de Santiago de Chile. Se determinó el EN según índice de masa corporal (IMC) y desarrollo puberal (Tanner). Se evaluó la PIC de la madre comparándose con lo real. Se observó que el 54,8% de las madres de niños obesos y el 78,3% de las madres de niños con sobrepeso presenta DIC, evaluando a su hijo más delgado. La DIC de la madre con su hijo con sobrepeso u obeso, podría repercutir en la escasa adherencia al tratamiento, siendo un punto clave en el cual intervenir.

Comorbilidad en personas con depresión que consultan en centros de la atención primaria de salud en Santiago, Chile / Comorbidity in people with depression seeking help at primary health care centers in Santiago, Chile

Background: International evidence has shown the complex interaction between depression and chronic physical diseases. Depression in scenarios involving multiple comorbidities has not received enough attention in Chile. Aim: To characterize the depressed people who consult at Primary Health Care Centers (PHCCs), taking into account the presence of chronic physical or psychiatric comorbidity. Materials and Methods: A secondary analysis of databases used in a clinical trial. Two hundred fifty six adults seeking professional help were recruited in four PHCCs located in the Metropolitan Region. These people had a major depressive episode, identified with a structured psychiatric interview (MINI), and gave their informed consent to participate. Socio-demographic information was collected, depressive symptomatology was measured with the patient health questionnaire 9 (PHQ-9), psychiatric morbidity was assessed using the Mini International Neuropsychiatric Interview (MINI), and chronic physical diseases were self-reported by the patients. Descriptive analyses of all the variables were conducted. Results: Seventy percent of patients had a history of depression, with a median of two prior depressive episodes. Depressive symptoms were mostly considered as moderate to severe and severe and 31% of the patients had high suicide risk. Seventy eight percent displayed a physical or psychiatric comorbidity. Of these patients, 29% only had a chronic physical comorbidity, while 46% suffered from an additional psychiatric disorder. Conclusions: Depressed individuals who seek help at PHCCs constitute an especially complex population that must be treated taking into account multiple comorbidities.

Programa colaborativo a distancia para el tratamiento de la enfermedad depresiva / Assessment of a distant collaborative program for the treatment of depression in primary care

Background: In the treatment of depression, primary care teams play an important role, whose effectiveness improves when inserted into a collaborative model of disease management. Aim: To report the results of a clinical trial carried out to test the effectiveness of a collaborative program between primary health teams and specialists supported by an electronic platform. Material and Methods: Physicians from four community hospitals belonging to the Reloncavi Health Service network, recruited 81 patients with depression aged 37 to 43 years, 84% of whom were female. Participants were divided in an active group, which participated in the collaborative program and a control group, which received the usual care, according to the Ministry of Health’s Guidelines for Depression. The main outcome was the Beck Depression Inventory (BDI-I) score at three months of intervention. Results: Participants had an average of 29.6 points (95% CI: 27.6-31.6) in the BDI-I and 38% of them had a high suicide risk. There were no statistically significant baseline differences between active and control group. In the intervention group, the BDI-I score changed from 30.0 (95% CI 27.0 to 32.8) to 15.3 (95% CI 11.8 to 18.8). In the control group the score changed from 29.2 (95% CI: 26.4-31.9) points to 20.8 (95% CI 16.8 to 24.7). The decrease was significantly higher in the intervention groups. Conclusions: A program of this kind may be useful to assist primary care teams in remote areas of the country to improve treatment outcomes for depression.

Ideas autolíticas, violencia autoinfligida, y síntomas depresivos en escolares chilenos / Suicidal ideation, self-directed violence and depression among Chilean school adolescents

Background: Suicidal behaviors and depression are prevalent phenomena among adolescents, and are considered a public health problem. Aim: To determine the prevalence of depressive symptoms and suicidal behaviors and the relationship between both phenomena, in a representative sample of students from ninth grade in Santiago, Chile. Material and Methods: We recruited a probability sample of 2,597 adolescents who answered a questionnaire with questions about suicidal behavior and the Beck Depression Inventory (BDI-II). Results: The lifetime prevalence of suicidal ideation and planning was 21 and 14%, respectively. The prevalence for the past two weeks was 6.7 and 4.4% for suicidal ideation and planning, respectively. Autolytic behaviors, once in lifetime and in the past week were referred by 26 and 4% of respondents, respectively. In one third of these, self-harm coincided with recent suicide ideation or planning. All levels of suicidal behavior were more frequently reported by women. Clinically significant depressive symptoms were present in 23.5% of adolescents. Females doubled male rates. Severe depressive symptoms were present in 9.4% of the sample. A higher level of suicidal behavior correlated with more severe forms of depression. Sixty percent of adolescents who reported recent self-harm, had clinically relevant depressive symptoms. Two thirds of them had severe symptoms. Conclusions: Suicidal behavior in Chilean adolescents is prevalent, and there is an association between this behavior and the level of depression. The school is a good place to identify and develop preventive measures for teenagers.

Telepsiquiatría: una revisión sistemática cualitativa / Feasibility of implementing tele-psychiatry in Chile

Background: The objective of this review was to search the literature on the use of telemedicine in mental health and evaluate if it can play a role in Chile. A systematic, qualitative review was carried out to compile systematic reviews, meta-analysis, and clinical controlled trials (CCT) that were in English or Spanish and that applied information technologies for the treatment of psychiatric diseases. Excluded from the review were articles without summaries or articles that included only the trial design, without results. The references of each selected article were critically evaluated. Of the 265 articles found, 224 were excluded for failing to comply with the inclusion criteria. Therefore, 41 articles were left for analysis, 30 reporting CCT and 11 systematic reviews. It is concluded that the use of information technologies to provide mental health care is widespread. It can be implemented in geographically remote places, without access to specialized mental health care and be a part of complex interventions that integrate several components.

Consumo de sustancias y síntomas depresivos en escolares de liceos municipales de Santiago / Association between drug consumption and depression among high school students

Background: The presence of emotional problems may trigger drug abuse. Aim: To determine the association between illicit drug use and severity of depression symptoms among students of public secondary schools in Santiago, Chile. Material and Methods: A probabilistic sample of2,597 adolescents aged between 12 and 18 years (45% women), attending first year in public high-schools in Santiago, answered self-report questionnaires about consumption, during the last 30 days ,of alcohol, tobacco and marihuana, and the Beck Depression Inventory - II. Logistic regression models were used to study the association between drug use and severity of depression symptoms, adjusting by sex. Results: Tobacco and marihuana use was reported by 38 and 13% of students, respectively. Frequency of consumption was significantly higher among women. Mild, moderate or severe depressive symptoms were found among 16%, 14% and 9% of students, respectively. Depressive symptoms were more common among women. There was a significant association between drug use and severity of depression among participants of both genders. Conclusions: The association between depressive symptoms and drug use should be considered on the design of treatment guidelines for these health problems in Chile.

Trastornos mentales comunes y uso de servicios de salud en población inmigrante / Mental disorders among immigrants in Chile

Background: Chile is receiving immigrant populations coming from other Latin-American countries. Aim: To determine the prevalence of Common Mental Disorders (CMD) among immigrants who live in Independencia, a quarter in Santiago, Chile. Material and Methods: A cross sectional study was carried out in the primary health care clinic and in the state-funded school of Independencia. A representative sample of 282 adults and 341 children were interviewed. Mental disorders were diagnosed using CIS-R and MINI structured interviews. Results: The interviewed immigrants came mostly from Peru. The prevalence of mental disorders in the adult population was 17.8 percent and among children, it was 29.3 percent. Conclusions: The adult immigrants have a lower prevalence of mental disorders than the Chilean population but it increases among children. Barriers of access to health services, that should be solved, were detected.

Caracterización de madres deprimidas en el posparto / Characterization of depressed mothers in the postpartum

Background: Postpartum depression (PPD) is a mood disorder that occurs during a specific period of women’s lifetime: puerperium. The prevalence of PPD ranges from 8 percent to 30 percent, and a three-fold increase is seen in emerging as compared to developed countries. Aim: To characterize women consulting in primary care facilities for PPD. Material and Methods: Social and demographic features, obstetrical history, clinical symptoms and puerperal care of 440 postpartum women that sought help in primary care and were diagnosed as depressed, are described. Results: These women had no paid employment (82.7 percent), had unplanned pregnancies (62.5 percent) and lacked adequate social support (59.4 percent). From the clinical viewpoint, most of these puerperal women had a family history of depression (64.2 percent) and 31 percent had suffered from previous depressive episodes. The clinical symptoms of these patients consisted of depressed mood (93.2 percent), anhedonia (87.9 percent) and fatigue (87 percent). Conclusions: Women depressed postpartum form a group that requires more clinical attention due to its great biological vulnerability, active depressive symptoms, and enormous psychosocial risk. The mother and child program, which benefits them, needs to be combined with a mental health component that can offer them a treatment adapted to their psychosocial context.

Formative research: estudio exploratorio en una población escolar adolescente / Formative research: an exploratory study in adolescent school population

Los estudios exploratorios (FR) son investigaciones que se llevan a cabo antes o durante la formulación o ejecución de un proyecto de investigación científica o de un programa determinado para asegurar que el programa o estudio que se realizará sea pertinente y aceptable desde el punto de vista cultural. Objetivos: En el marco del proyecto “Intervención Escolar para mejorar la Salud Mental de jóvenes de Enseñanza Media” se exploró las condiciones para la implementación de una intervención para prevenir la aparición de sintomatología depresiva en escolares de primero medio de establecimientos educacionales municipales en Santiago de Chile.Metodología: El estudio se realizó en cuatro establecimientos educacionales pertenecientes al universo del marco muestral de la investigación. Se llevaron a cabo entrevistas semiestructuradas a actores claves, observaciones directas estructuradas y grupos focales. El análisis de los resultados de los contenidos de los grupos focales fue de tipo fenomenológico y categorial. Además se realizaron visitas a terreno, evaluando aspectos físicos de los establecimientos. Resultados: Sobre el significado de la depresión se evidencia como un problema que debe ser evaluado y tratado según la opinión de los alumnos, profesores y apoderados. Se planteó aprobación y disposición para realizar el taller para prevenir la depresión con una serie de sugerencias, como la confidencialidad, la participación de los padres, entre otras. Los directores y orientadores hacen hincapié en la red de apoyo asistencial de salud que cuentan los alumnos con problemas de salud mental, y el bajo interés de los padres en asistir a actividades de los establecimientos. Se observa una heterogénea disponibilidad física material para realizar una intervención en alumnos de primero medio.

Formative research (FR) is a study carried out before or during the formulation or implementation of a scientific research project or a particular program to ensure that the program or study being conducted is relevant and culturally acceptable. Objectives: In the framework of the “School-based intervention to improve the mental health of low-income, secondary school students in Santiago, Chile” we explored the conditions for the implementation of an intervention to prevent depression in adolescent attending to the first class of secondary public schools in Santiago, Chile. Methodology: The study was conducted in four secondary public schools belonging to the universe of the research sampling frame. Were conducted semi-structured interviews to key informants, direct observations and focus groups. The analysis of the results of focus group content was phenomenological and categorical. Site visits, assessing physical aspects of facilities were also carried out. Results: According to the opinion of students, teachers and parents, depression is a problem that must be evaluated and treated. Approval and provision was made for the intervention to prevent depression with a series of suggestions, such as confi dentiality, parental involvement, among others. Principals and counsellors emphasize the support network of health care that have students with mental health problems, and low parental interest in attending the activities of schools. The physical facilities available for the intervention were heterogeneous. Conclusion: The FR was a useful and necessary tool in the development and implementation of the research “School-based intervention to improve the mental health of low-income, secondary school students in Santiago, Chile” and provided the necessary inputs to model the intervention to prevent depression.

Características de los programas de prevención en depresión en adolescentes asociados a mayor eficacia / Characteristics of prevention programs in adolescent depression associated with greater efficacy

Es de gran relevancia la investigación en prevención de depresión adolescente debido a su alta prevalencia y a las graves consecuencias asociadas. Los programas de prevención en depresión en adolescentes han sido diseñados principalmente en países desarrollados. En Chile la investigación en este tema está recién iniciándose. Las intervenciones preventivas se denominan universales cuando se aplican a toda la población, y específicas cuando se aplican a un grupo considerado de riesgo. El objetivo de este artículo es revisar las características que se han asociado a mayor eficacia de estos programas en otros países, discutiendo algunos elementos a considerar para su implementación en Chile. Los programas específicos producen tamaños de efecto mayores que los universales. Sin embargo, las intervenciones universales no deben desestimarse prematuramente, ya que tienen algunas ventajas teóricas y prácticas. Existe mayor eficacia en muestras con mayor proporción de mujeres y en adolescentes de mayor edad. Los programas implementados por profesionales de salud mental son más eficaces que los implementados por profesores, especialmente en el caso de los específicos. Se debe invertir esfuerzos en la investigación en: la necesidad de intervenir de manera diferencial de acuerdo a la edad y al género, los componentes activos que hacen que un programa sea efectivo, el costo-efectividad de estos programas, el uso de nuevas metodologías que incentiven a la participación, favorezcan la incorporación de conocimientos y la mantención de resultados.

Research in prevention of adolescent depression is highly relevant due to its high prevalence and seriously related consequences. Prevention programs in adolescent depression have been designed mainly in developed countries. In Chile, research on this topic is just beginning. Preventive interventions are called universal when they are applied to the entire population and targeted when they are applied to a group considered to be at risk. The aim of this paper is to review the features that have been associated with increased effectiveness of these programs in other countries and discussing some elements that have to be considered for their implementation in Chile. Specific programs produce larger effect sizes than universal. However, universal interventions should not be dismissed prematurely because they have some theoretical and practical advantages. There is greater efficacy in samples with higher proportion of women and older teens. The programs implemented by mental health professionals are more effective than those implemented by teachers, especially in the targeted prevention programs. It is necessary to invest research efforts in: the need to intervene differentially according to age and gender, the active components that make a program effective, cost-effectiveness of these programs, the use of new methodologies that encourage participation, promoting the incorporation of knowledge and the maintenance of long-term positive.

Yo pienso, siento, actúo: una intervención universal para la prevención de la depresión en escolares chilenos / I think, sit, act: a universal intervention for prevention of depression in chilean students

Este artículo tiene por objetivo describir la intervención realizada en colegios municipalizados, para prevenir la aparición de depresión en alumnos de 1° medio. Se trató de una intervención de tipo Universal, es decir, aplicada a todos los alumnos de la sala de clases, que constó de 12 sesiones de frecuencia semanal. La teoría Cognitiva-Conductual fue utilizada para desarrollar los contenidos de esta intervención que contó con un bloque introductorio, en el que se presentó el modelo cognitivo-conductual, las distorsiones cognitivas y estrategias para enfrentarlas (sesiones 1 a 3). Luego un bloque de detección de estilos atribucionales “depresiógenos” y estrategias para enfrentarlos (sesiones 4 a 6). El siguiente bloque fue acerca de las emociones y cómo modularlas (sesión 7). Siguió el módulo de aprendizaje de estrategias para reconocer y resolver problemas (sesiones 8 a 10), finalizando con una sesión de integración de todo lo aprendido (sesión 11) y una de convivencia y proyección del taller hacia el futuro (sesión 12). El programa fue bien recibido y aceptado por alumnos y profesores. Los problemas más significativos en su aplicación fueron los relacionados con la disciplina. Se realizaron sesiones semanales de supervisón a los facilitadotes a cargo de una psicóloga especializada en teórica cognitiva-conductual. Los resultados de esta intervención se enmarcan dentro de un ensayo clínico randomizado, que busca demostrar la efectividad en la prevención de la depresión en los escolares que asistieron al taller en comparación a un grupo control de escolares que no tuvieron el taller.

The article’s aim is to describe the Intervention made in municipal schools, to prevent the occurrence of depression in students in 9th degree. It was a Universal-type intervention that is applied to all students in the classroom, which consisted of 12 weekly sessions. Cognitive-Behavioral theory was used to develop the contents of this intervention, that had an introductory block, where was presented the cognitive-behavioral model, cognitive distortions, and it’s coping strategies (sessions 1-3). Then a unit with detection of “depressiogenic” attributional style and it’s coping strategies (sessions 4-6). The next block was about emotions and how to modulate it (session 7). Then followed, the module of learning strategies to recognize and solve problems (sessions 8-10), ending with a session to integrate what we have learned (session 11) and with a meeting with a projection of the workshop in the future (meeting 12). The program was well received and accepted by students and teachers. The most significant problems in its implementation were related to the discipline of the students in to the classroom. Sessions were weekly supervised, with the facilitators by cognitive-behavioral theory well trained senior psychologist. The results of this intervention are part of a randomized clinical trial that wants to demonstrate the effectiveness in preventing depression in students who attended the workshop compared to a control group of students who did not have the workshop.

Evaluación cualitativa desde la perspectiva de los participantes de un taller piloto diseñado para prevenir la depresión en adolescentes / Qualitative assessment from the perspective of participants of a pilot workshop designed to prevent adolescent depression

El estudio consistió en una evaluación cualitativa de la versión piloto del taller “Yo Pienso, Yo Siento, Yo Actúo”. Este taller está destinado a prevenir la depresión en adolescentes y está basado en el enfoque cognitivo-conductual. La versión piloto fue realizada el 2008 en cuatro cursos de Primero Medio, correspondientes a dos colegios de la Comuna de San Bernardo. El objetivo del estudio fue conocer las percepciones de los estudiantes que participaron en el taller piloto sobre la experiencia vivida y sus sugerencias sobre posibles modificaciones al diseño, con la finalidad de generar insumos para elaborar la versión definitiva del taller. La metodología consistió en la realización de grupos focales en cada curso intervenido, centrados en la evaluación de los componentes fundamentales del taller. Los principales resultados fueron que los participantes realizaron una evaluación general positiva del taller, que les pareció acertada la metodología de trabajo grupal y que le asignaron una gran importancia al control disciplinario en las sesiones y al vínculo que establecieron con los monitores. Los aprendizajes más significativos fueron en relación a la técnica de resolución de problemas. El espacio del taller fue valorado también como instancia de comunicación y mejoría de las relaciones interpersonales en los cursos. Las principales conclusiones fueron que el taller muestra una buena aceptación por parte de los participantes, que es importante reforzar el manejo de la disciplina durante las sesiones y que se debe garantizar la calidad del vínculo con los monitores.

The study consisted of a qualitative assessment of the pilot version of the workshop “Yo Pienso, Yo Siento, Yo Actúo” (“I think, I feel, I do”). This workshop is intended to prevent depression in adolescents and is based on the cognitive-behavioral approach. The pilot version was carried out in 2008 in four classes of Primero Medio (ninth grade) in two schools of the San Bernardo borough. The objective of the study was to understand the perceptions of students who participated in the pilot workshop on their experience and their suggestions for changes to the design with the objective of generating inputs to produce the final version of the workshop. The methodology included conducting focus groups in each class involved, focusing on the evaluation of the main components of the workshop. The main results were that participants held an overall positive assessment of the workshop; they found group work methodology successful; they attributed great importance to disciplinary control during sessions and to the relationship established with the monitors. The most significant learning was related with the technique of solving problems. The workshop environment was also related as an instance of communication and improvement of interpersonal relationships within the classes. The main findings were that the workshop showed good acceptance by the participants; it is important to strengthen the management of discipline during the sessions and to ensure the quality of the relationship with the monitors.

Un ensayo clínico aleatorizado de farmacoterapia con monitorización telefónica para mejorar el tratamiento de la depresión en la atención primaria en Santiago, Chile / A randomized trial of pharmacotherapy with telephone monitoring to improve treatment of depression in primary care in Santiago, Chile

Background: Depression is a public health problem, due to its high prevalence and its associated disability. Aim: To compare a pharmacological intervention for depression controlled by phone from a central level (TM) and the usual treatment (TH) in a randomized clinical trial. Material and methods: Three hundred and forty five women, aged 22 to 59 years were studied. They were randomly assigned to receive the usual therapy or a pharmacological intervention with periodical telephone contacts with medical collaboration personnel, to reinforce compliance with treatment and educate about the disease. Women were blindly evaluated at 3 and 6 months with the Hamilton depression rating score (HDRS) and the SF-36 to assess depressive symptoms and quality of life, respectively. Results: In both evaluations, improvement was significantly greater in the TM group than the TH group. At 3 months, improvement was higher in the TM group in the subscales of physical function, pain, general health, energy, emotional role, mental health and standardized physical and psychic scales of SF-36. At 6 months, this significant difference in favour of TM was maintained for energy, mental health and the standardized psychic scale. Conclusions: A telephone reinforcement improves the outcomes of treatments for depression.

Efectividad de un programa de tratamiento de la depresión posparto en la atención primaria a tres y seis meses de seguimiento / Effects of a treatment programme postpartum depression in primary care to three and six month follow-up

La depresión posparto (DPP) corresponde a un trastorno del ánimo que ocurre en el puerperio. Es un problema frecuente en los servicios de atención primaria en la mayoría de los países. Hipótesis. La intervención programada para el tratamiento de la DPP es más efectiva que el tratamiento actual de dicha patología en la atención primaria a los tres y seis meses de seguimiento. Metodología. Ensayo clínico controlado y randomizado. Participaron 230 mujeres que sufrieron un episodio depresivo en el posparto. Se realizó una intervención multicomponente que incluyó un grupo psicoeducativo, tratamiento médico y farmacoterapia para los casos más graves. Ésta se comparó con el tratamiento habitual en los consultorios. La principal variable a evaluar fue el puntaje en la Escala de Depresión posparto de Edimburgo (EPDS) que se aplicó basalmente a los3 y 6 meses después de la randomización. Secundariamente se evaluó la calidad de vida de las mujeres. Resultados. Las mujeres tuvieron una mejor respuesta cuando recibieron el tratamiento multicomponente en comparación con el tratamiento habitual (8,5 v/s 12,7), a los 3 meses, siendo esta diferencia significativa. La diferencia entre ambos grupos fue menor a los 6 meses(10,9 v/s 12,5 respectivamente) pero igualmente significativa. Conclusiones. La intervención con el tratamiento multicomponente es considerablemente mejor que el tratamiento habitual a los3 meses de seguimiento. Esta diferencia disminuye después de los tres meses. Las mujeres que reciben tratamiento farmacológico interrumpen el tratamiento después de los 3 meses por diversos factores. Se requieren futuras investigaciones para evaluar el manejo de la DPP después de estos tres meses de tratamiento.

Postnatal Depression (PND) is a mood disorder that occurs in the puerperium. It is a common problem in primary care services in most countries. Hypothesis: The planned intervention for the treatment of PND is more effective than the current treatment of this disease in primary care at three and six months of follow-up. Methods: Randomized controlled trial. Two hundred and thirty mothers with major depression attending postnatal clinics were randomly allocated to either a multi-component intervention or usual care. The multi-component intervention involved a psycho educational group, treatment adherence support, and pharmacotherapy if needed. The main outcome measure was the Edinburgh Postnatal Depression Scale (EPDS) at 3 and 6 months after randomization. Women quality of life was assesed as a secondary issue. Results: Women had a better response when receiving the multicomponent treatment (8.5 v/s the usual treatment 12.7) at 3 months, which is a significant difference. Even though the difference between the two groups was less at 6 months (10.9 v / s 12.5 respectively) it´s considered equally significant. Conclusions: This intervention improved considerably the outcome of depressed low-income mothers compared to usual care for the first 3 months. However, some ofthese clinical gains were not maintained thereafter, most likely because a large portion stopped taking medication. Further refinements to this intervention are needed to ensure treatment compliance after the three months of the treatment.

Opciones terapéuticas en depresión posparto / Therapeutics alternatives in postpartum depression

La depresión posparto es una enfermedad del ánimo que constituye una complicación médica frecuente en el puerperio. Su diagnóstico y adecuado manejo son importantes debido a que tienen consecuencias a corto y largo plazo, tanto en la madre como en el/la hijo/a. El objetivo de este artículo es describir las opciones terapéuticas disponibles en la actualidad. Específicamente, se ha demostrado la eficacia de intervenciones psicoterapéuticas interpersonales, cognitivo-conductuales y consejería no directiva en el tratamiento de esta patología. Pese a que la eficacia de la farmacoterapia en la enfermedad depresiva está ampliamente demostrada, son escasos los ensayos clínicos controlados llevados a cabo en DPP. Se han estudiado los efectos de los fármacos antidepresivos siguiendo las indicaciones generales para el tratamiento de la depresión, se recomienda el uso de fármacos antidepresivos para los casos más severos. Con el conocimiento disponible se podría con cautela utilizar sertralina o nortriptilina, sin necesidad de suspender la lactancia materna. Se hacen necesarias investigaciones bien diseñadas para evaluar diferentes componentes del tratamiento además de combinaciones y programas de tratamiento que sean costo efectivos.

Diferencias de género en el malestar psíquico de estudiantes universitarios / Gender differences in psychic distress in university students

Existen numerosos estudios que muestran que los trastornos mentales comunes son enfermedades frecuentes y discapacitantes. Se ha observado que los estudiantes universitarios constituyen un grupo de riesgo. El objetivo de esta investigación es estudiar la salud mental de estudiantes de la Universidad de Chile y las posibles variables asociadas a malestar psíquico. Se aplicó una encuesta estructurada-que incluía el Cuestionario de Salud de Goldberg, el APGAR familiar de Smilkenstein, y otras variables- a los alumnos de cuatro facultades que eran beneficiarios del Programa de Atención Económica (PAE). Resultados: del total de 1.704 alumnos se obtuvo una tasa de respuesta del 88,8por ciento, correspondiendo a 1.514 estudiantes; 54,5 por ciento eran mujeres y 45,6 por ciento hombres; la edad promedio fue 21,8 años (IC21,8-22,1); el ingreso familiar promedio fue 273.151 pesos (IC263.552-282.749); el tiempo promedio de traslado de la casa a la facultad era de 62,1 minutos (IC 60,6-63,6) el APGAR familiar promedio fue de 7,4 (IC7,3-7,5) y un 34,8 por ciento (IC32,4-37,3)tenía un puntaje positivo para malestar psíquico. El malestar psíquico se asoció en forma significativa a ser mujer y a tener una disfunción familiar según APGAR familiar. Se comentan los resultados y la importancia de estos trabajos.

Inequidad social y salud mental en Chile / Social inequity and mental health in Chile

Objetivo. Comparar las diferencias en la salud mental y el uso de servicios en relación a ella entre personas con distintos tipos de seguros en Santiago. Método. Se llevó a cabo un estudio transversal con una muestra probabilística polietápica. Los trastornos mentales comunes fueron medidos usando la Entrevista Clínica Estructurada- Revisada (CIS-R). Resultados. Se entrevistó a 3.870 adultos. La prevalencia de morbilidad psiquiátrica encontrada fue de 26,9 por ciento un 20 por ciento de las personas con patología psiquiátrica había consultado por su problema. Las personas con seguro público (FONASA) de salud presentaban las prevalencias mayores pero las tasa de consulta más baja. Las personas con seguros privados (ISAPRES) presentaban prevalencias más elevadas pero las tasa más altas de consulta. Conclusiones. El sistema de salud chileno es inequitativo en la satisfacciónde las necesidades de salud mental.

Calidad de la vida familiar y armonía matrimonial en parejas de madres deprimidas / Life quality of family and partner relation in depressed women

La depresión representa un gran problema de salud pública, especialmente entre las mujeres pobres. Se asocia a una gran discapacidad, afectando al entorno, que incluye sus parejas e hijos. El objetivo de la presente comunicación es describir la salud mental y la armonía matrimonial en las parejas de madres deprimidas que han consultado en la atención primaria. Se seleccionó una muestra de mujeres con depresión según el DSM-IV y que estuvieran viviendo con una pareja. Se entrevistó ambos miembros de la pareja por separado mediante cuestionario sociodemográfico, Escala de Ajuste Diádico, Apgar Familiar y, en el caso de los hombres, con el Cuestionario de salud de Goldberg. Se encontró una alta prevalencia de malestar psicológico entre los varones (33 por ciento). Se observó una valoración más negativa de la calidad de vida familiar y en relación de pareja por parte de las mujeres, existiendo, en general, una correlación entre las respuestas de los cónyuges. Esto podría estar explicado por la depresión de las mujeres; sin embargo, se hace necesario realizar más estudios para poder aclarar la relación entre su psicopatologia y su calidad de vida familiar conyugal.

Tratamiento de la depresión en la atención primaria / Treatment of depression in primary care

La Depresión es una enfermedad de alta prevalencia. En atención primaria se peportan cifras entre el 7 y 10 por ciento en estudios internacionales y de 30 ppor ciento en Chile. La mayor parte de los pacientes recibe tratamiento en atención primaia, lo cual corresponde a alrededor del 75 por ciento de los casos en nuestro pais. Existen problemas en el diagnóstico y tratamiento de la depresión lo cual ha llevado a diversos grupos de investigación a estudiar una serie de estrategias para mejorar el tratamiento de la depresión en atención primaria. Este artículo presenta una revisión de estas estrategias y aporta elemenos que permiten valorar los componenetes activos de mayor impacto clínico presentes en ellas.