Smartphone-assisted online brief cognitive behavioral therapy to treat maternal depression: findings of a randomized controlled trial

Objective: To test the efficacy of smartphone-assisted online brief cognitive behavioral therapy (b-CBT) to treat maternal depression compared to online brief CBT plus an active control app. Methods: A randomized controlled trial was conducted. Assessments were performed at baseline (T0), midpoint (T1, week 4-5), post-treatment (T2, week 8), and follow-up (T3, 2-month postnatal follow-up) by blinded interviewers. The primary outcome was depression measured by the Edinburgh Postnatal Depression Scale (EPDS) at T2. We also assessed anxiety, stress, sleep quality, well-being, physical activity, treatment response, and offspring child behavior problems. Results: Eighty-one participants were randomized to the intervention (n=37) or active control (n=44) groups. Seventy-one participants completed the post-treatment assessment or reported primary outcome data. No differences were found between the intervention and active control groups regarding maternal depression or other mental health outcomes. Overall, we found large within-group effect sizes, with 80% of the total sample responding to treatment. Conclusions: Our data showed no difference between the groups, suggesting that adding apps to psychotherapy treatment may not enhance treatment effects on prenatal depression. A within-groups analysis showed that most participants with depression responded to treatment; however, future studies are needed to confirm whether this effect is related to factors other than the intervention.

Maternal depression and offspring mental health at age 5: MINA-Brazil cohort study / Depressão materna e saúde mental infantil aos cinco anos de idade: Estudo de coorte MINA-Brasil

ABSTRACT OBJECTIVE: To identify longitudinal patterns of maternal depression between three months and five years after child's birth, to examine predictor variables for these trajectories, and to evaluate whether distinct depression trajectories predict offspring mental health problems at age 5 years. METHODS: We used data from the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) study, a population-based birth cohort in the Western Brazilian Amazon. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at 3 and 6-8 months, and 1 and 2 years after delivery. Mental health problems in 5-year-old children were evaluated with the Strengths and Difficulties Questionnaire (SDQ) reported by parents. Trajectories of maternal depression were calculated using a group-based modelling approach. RESULTS: We identified four trajectories of maternal depressive symptoms: "low" (67.1%), "increasing" (11.5%), "decreasing" (17.4%), and "high-chronic" (4.0%). Women in the "high/chronic" trajectory were the poorest, least educated, and oldest compared with women in the other trajectory groups. Also, they were more frequently multiparous and reported smoking and having attended fewer prenatal consultations during pregnancy. In the adjusted analyses, the odds ratio of any SDQ disorder was 3.23 (95%CI: 2.00-5.22) and 2.87 (95%CI: 1.09-7.57) times higher among children of mothers belonging to the "increasing" and "high-chronic" trajectory groups, respectively, compared with those of mothers in the "low" depressive symptoms group. These differences were not explained by maternal and child characteristics included in multivariate analyses. CONCLUSIONS: We identified poorer mental health outcomes for children of mothers assigned to the "chronic/severe" and "increasing" depressive symptoms trajectories. Prevention and treatment initiatives to avoid the adverse short, medium, and long-term effects of maternal depression on offspring development should focus on women belonging to these groups.

RESUMO OBJETIVO: Identificar padrões longitudinais de depressão materna entre três meses e cinco anos após o nascimento de seus filhos, analisar variáveis preditoras dessas trajetórias e avaliar se trajetórias distintas de depressão predizem problemas de saúde mental infantil aos cinco anos de idade. MÉTODOS: Utilizou-se dados do estudo sobre saúde e nutrição materno infantil no Acre (MINA-Brasil), uma coorte de nascimentos de base populacional na Amazônia ocidental brasileira. Os sintomas depressivos maternos foram avaliados pela Escala de Depressão Pós-parto de Edimburgo (EPDS) aos 3 e 6-8 meses e 1 e 2 anos após o parto. Problemas de saúde mental em crianças com cinco anos de idade foram avaliados pelo Questionário de Capacidades e Dificuldades (SDQ- Strengths and Difficulties Questionnaire), respondido pelos pais. As trajetórias de depressão materna foram calculadas usando uma abordagem de modelagem baseada em grupos. RESULTADOS: Foram identificadas quatro trajetórias de sintomas depressivos maternos: "baixa" (67,1%), "crescente" (11,5%), "decrescente" (17,4%) e "alta-crônica" (4,0%). As mulheres na trajetória "alta/crônica" eram mais pobres, menos escolarizadas, mais velhas e multíparas e relataram tabagismo com maior frequência e menor número de consultas de pré-natal durante a gestação do que as demais. Nas análises ajustadas, a razão de chances de qualquer transtorno do SDQ foi 3,23 (IC95%:2,00-5,22) e 2,87 (IC95%: 1,09-7,57) vezes maior entre os filhos de mães nos grupos de trajetória "crescente" e "alta-crônica", respectivamente, do que de mães do grupo de sintomas depressivos "baixos". As características maternas e infantis incluídas nas análises multivariadas foram incapazes de explicar essas diferenças. CONCLUSÕES: Identificou-se piores desfechos de saúde mental para filhos de mães atribuídas às trajetórias "crônica/grave" e "crescente" de sintomas depressivos. Iniciativas de prevenção e tratamento para evitar os efeitos adversos a curto, médio e longo prazo da depressão materna sobre o desenvolvimento de seus filhos devem se concentrar principalmente nas mulheres nesses grupos.

Analysis of Motherhood Constellation among Adolescent Mothers With and Without Depressive Symptoms / Análise da Constelação da Maternidade em Mães Jovens com e sem Sintomas Depressivos

ABSTRACT This study analyzed the Motherhood Constellation in two young mothers (19 and 22 years old), with and without depressive symptoms. Through qualitative content analysis of the interviews, information was categorized according to four themes of this construct: life-growth, primary relating, support matrix, and identity reorganization. There were no differences between mothers in the first theme. In the others, despite the similarities with the asymptomatic mother, the young woman with depressive symptoms had difficulty to get involved with her baby, restricted social support, and an impasse related to the organization of her maternal identity and internal reorganization in the face of developmental demands. These findings indicate the need for attention to the mental health of young mothers during the complex process of becoming a mother.

RESUMO Este estudo investigou a Constelação da Maternidade em duas mães jovens (19 e 22 anos), com e sem sintomas depressivos. Através da análise de conteúdo qualitativa das entrevistas, as informações foram categorizadas conforme os quatro temas desse constructo: vida-crescimento, relacionar-se primário, matriz de apoio e reorganização da identidade. Não foram observadas diferenças entre as mães no primeiro tema. Nos demais, apesar das semelhanças com a mãe assintomática, a jovem com sintomas depressivos apresentou dificuldade no envolvimento com seu bebê, apoio social restrito e impasse relacionado à organização da identidade materna e reorganização interna perante as demandas desenvolvimentais. Esses achados indicam a necessidade de atenção à saúde mental de mães jovens durante o complexo processo de tornar-se mãe.

Association of maternal depression, family composition and poverty with maternal care and physical health of children in the first year of life / Associação da depressão materna, composição da família e pobreza com os cuidados maternos e a saúde física de crianças no primeiro ano de vida

INTRODUCTION: The child's overall health depends on several factors, including the quality of the environment in which it lives and the care it receives. Child well-being early in life has an impact on its future and future generations' health. OBJECTIVE: Analyze the association of maternal depression, family composition, and socioeconomic conditions with the indicator of maternal care and physical health of children. METHODS: Retrospective cohort that analyzed data from 120 children during their first year of life. A Health and Maternal Care Indicator (ISCM) was created, aggregating information on growth, breastfeeding, vaccination, prophylaxis of iron deficiency anemia, illnesses, and accidents. The socioeconomic and health conditions were obtained through a structured interview. The Edinburgh Postnatal Depression Scale assessed maternal depression. Quasipoisson Regression examined the association between the ICSM and the predictors. The initial model considered p<0.25 in the univariate analysis and p<0.05 in the final model. RESULTS: The mothers were adults (83.3%), studied for an average of 10 years, and 36% had depressive symptoms. About 37% of the families were single-parent female, 59% were from Class C1-C2 of ABEP, and 12% received the "Bolsa Família" benefit. ISCM was 8% lower in children whose mothers were depressed (p = 0.04) or had no partner (p = 0.03), and was 14% higher in families receiving Bolsa Família (p = 0.02) in relation to their peers. CONCLUSION: Maternal depression and female single-parent family arrangements negatively impacted child health and care, while the conditional cash transfer program represented a protective factor.

INTRODUÇÃO: A saúde integral da criança depende de vários fatores, entre eles a qualidade do ambiente em que vive e dos cuidados que recebe. O bem-estar da criança no início da vida tem impacto na sua saúde futura e das próximas gerações. OBJETIVO: Analisar a associação da depressão materna, composição da família e condições socioeconômicas com o indicador de cuidados maternos e saúde física de crianças. MÉTODO: Coorte retrospectiva que analisou dados de 120 crianças no primeiro ano de vida. Foi criado um Indicador de Saúde e Cuidados Maternos (ISCM), agregando informações sobre crescimento, aleitamento materno, vacinação, profilaxia de anemia ferropriva, adoecimentos e acidentes. A condição socioeconômica e de saúde foram obtidas por entrevista estruturada. A depressão materna foi avaliada pela Edinburgh Postnatal Depression Scale. A associação entre o ICSM e os preditores foi examinada pela Regressão de Quasipoisson. O modelo inicial foi composto por variáveis com p<0,25 na análise univariada e p<0,05 no modelo final. RESULTADOS: As mães eram adultas (83,3%), estudaram, em média, por 10 anos e 36% delas apresentaram sintomas depressivos. Cerca de 37% das famílias eram do tipo monoparental feminino, 59% eram da Classe C1-C2 da ABEP e 12% recebiam o benefício "Bolsa Família". O ISCM foi 8% menor nas crianças cujas mães eram deprimidas (p=0,04) ou não tinham companheiro (p=0,03), e foi 14% maior nas famílias que recebiam o Bolsa família (p=0,02) em relação aos seus pares. CONCLUSÃO: A depressão materna e o arranjo familiar monoparental feminino impactaram negativamente a saúde e os cuidados com a criança, enquanto o programa de transferência condicionada de renda representou um fator de proteção.

Intervención grupal para díadas madre- infante privadas de libertad: efectos sobre la depresión materna y el desarrollo infantil / Group Intervention for Imprisoned Mother-Infant Dyads: Effects on Mother's Depression and on Children's Development

Resumen La sintomatología depresiva es frecuente en las mujeres durante el período periparto, impacta negativamente el desarrollo infantil y puede mostrar un incremento cuando la maternidad se desarrolla en contextos carcelarios. Objetivo: realizar intervenciones grupales en dos grupos, uno conformado por mujeres embarazadas y otro por díadas madre-infante, que se encontraban cumpliendo condena en cárceles chilenas, y evaluar su efecto en la sintomatología depresiva materna y en el desarrollo socioemocional infantil. Método: Participaron 60 madres recluidas en recintos carcelarios chilenos, 30 embarazadas y 30 díadas (madres-infante). Se realizaron análisis de regresión multinivel para medidas repetidas de la sintomatología depresiva materna (BDI) en ambos grupos y del desarrollo socioemocional (ASQ-SE) en los niños/as participantes en la intervención para díadas. Resultados: se observó una reducción significativa de la sintomatología depresiva en las mujeres embarazadas (b=-3.60, t(29)=-2.66, p=.031) y en las madres con hijos/as nacidos (b=-0.1499, t(93)=-5.3, p=<.001), así como una reducción de las dificultades en el desarrollo socioemocional infantil (b=-15.26, t(18)=-4.107, p=.001). Conclusión: se discute la relevancia de contar con alternativas psicoterapéuticas para el abordaje de la depresión en madres privadas de libertad y la promoción de un desarrollo socioemocional saludable de sus hijos/as.

Abstract Women may frequently present depressive symptomatology during the peripartum period, it impacts negatively child development and may show an increase when motherhood takes place in prison contexts. Furthermore, the negative effects of maternal depression on children's development have been demonstrated by research findings. Aim: To evaluate the effect of two group interventions for pregnant women and mother-infant dyads with children under 2 years of age, on maternal depressive symptomatology and on the children's development. Method: The sample considered 60 incarcerated women from Chilean prisons all over the country; 30 pregnant women and 30 mothers with children under 2 years of age. Multilevel regression analysis for repeated measures were performed for maternal symptomatology (BDI) in both groups and for children's development (ASQ-SE) in the dyad's group. Results: It was observed Significant reductions in the depressive symptomatology frequencies in the pregnant women (b=-3.60, t(29)=-2.66, p=.031) and in the mothers who participated in the dyad's intervention group (b=-0.1499, t(93)=-5.3, p=<.001), as well as a reduction in child social-emotional development difficulties (b=-15.26, t(18)=-4.107, p=.001). Conclusion: The discussion section addresses the relevance of providing psychological support to imprisoned mother/child dyads, to treat maternal depression and to promote a healthy development of the children who grow up in prison contexts.

Behavioral problems and their relationship to maternal depression, marital relationships, social skills and parenting

Abstract Behavioral problems have been associated with multiple variables; however, studies simultaneously investigating parenting practices, marital relationships in bi-parental families, maternal depression, and child behavior remain a gap in the literature. The objective was to verify associations between positive and negative parenting practices, marital relationships, social skills, and behavioral problems among children from bi-parental families with and those without maternal depression; to identify the predictive effect of positive and negative parenting practices, marital relationships, children's social skills, and maternal depression, for internalizing, externalizing behavior problems and internalizing and externalizing comorbidities. A case-control study with a cross-sectional design was adopted to ensure the groups were homogeneous in regard to the children's, mothers', and families' sociodemographic characteristics. A total of 35 mothers currently with depression and 35 without depression indicators participated in the study, while the children were 25 preschoolers and 23 school-aged children. The mothers responded to instruments addressing depression, child behavior, parenting practices, and marital relationships. The results reveal maternal depression associated with marital relationships, positive parenting, and context variables. Maternal depression and marital relationship were found to influence externalizing problems; maternal depression, childrearing practices, marital relationships, and the children's behavioral repertoires influence internalizing and externalizing comorbidities; and none of the independent variables influenced the occurrence of internalizing problems.

Mother-child interaction: implications of chronic maternal anxiety and depression

Abstract Background: The literature has few studies on the quality of the mother-child interaction when mothers suffer from chronic anxiety and depression. This study aimed to compare characteristics of the interaction between 14-month-old children and their mothers who presented symptoms of chronic anxiety or depression with those of 14-month-old children and their mothers who did not present mental problems. Method: The sample consisted of 40 mother-infant dyads selected from a prospective cohort study. They were assessed using the State-Trait Anxiety Inventory and the Beck Depression Inventory, at three time points: during pregnancy and at 6 months and 14 months of the infant's life. Three groups were formed: 10 mothers with symptoms of chronic anxiety, 8 mothers with symptoms of chronic depression, and a control group of 22 mothers without mental health problems. The mothers responded to a socioeconomic questionnaire, and then a 7-min episode of the dyad interaction was recorded and assessed using categories indicated in a dyadic interaction assessment protocol. This consisted of six categories that evaluate the behavior of the caregiver and four categories that evaluate the child's behavior. Results: A significantly higher percentage of mothers with chronic depressive symptoms had not completed high school and did not live with a partner. When comparing the interaction behaviors of the three groups, mothers with symptoms of chronic depression were significantly less sensitive, were more disengaged, and showed less positive affect than those in the control group. They also engaged in significantly fewer stimulations and displayed more negative affect compared with both the control group and mothers with chronic anxiety symptoms. Anxious mothers presented greater intrusiveness compared with mothers in the control group. Regarding the children, those with mothers showing symptoms of chronic depression interacted significantly less than those with mothers showing symptoms of chronic anxiety and the control group. Conclusions: The results indicate that mother-infant interaction is most severely compromised among mother-infant dyads comprised of mothers with chronic depressive symptoms, compared with dyads of mothers with chronic anxiety symptoms and dyads of control group mothers without mental health problems.

Depressão materna e ajustamento conjugal de mães jovens e sua relação com a sintomatologia psicofuncional do bebê / Maternal depression and marital adjustment of young mothers and its relationship with baby's psychofunctional symptoms

Este estudo investigou a depressão materna e a percepção de ajustamento conjugal de mães jovens, para compreender a sua repercussão sobre a sintomatologia psicofuncional do bebê. Trata-se de estudo de casos contrastantes, transversal, no qual foram entrevistadas duas mães (20 a 21 anos) porto-alegrenses, cujos bebês tinham 8 e 11 meses. Foram aplicados também o R-DAS, a EPDS e o Symptom Check List, para avaliar, respectivamente, ajustamento conjugal, depressão materna e sintomas psicofuncionais do bebê. Os dados foram integrados na análise dos casos. Os resultados apontam que a percepção de ajustamento conjugal ruim e a presença de depressão materna podem repercutir sobre a sintomatologia psicofuncional do bebê, por meio de um processo de spillover, isto é, transbordamento dos desajustes conjugais sobre a relação parental. Esses achados são relevantes para a prática clínica, na busca de intervenções psicológicas que promovam a saúde mental de casais e bebês.(AU)

This study investigated maternal depression and perception of marital adjustment of young mothers, to understand its impact on the baby's psychofunctional symptoms. It is a transversal contrasting cases study, in which two mothers (20 and 21years), whose babies were 8 and 11 months old, from Porto Alegre/RS, were interviewed. R-DAS, EPDS and Symptom Check List were also applied to evaluate, respectively, marital adjustment, maternal depression and baby's psychofunctional symptoms. Data were integrated in the case analysis. The results suggest that perception of poor marital adjustment and presence of maternal depression may contribute to baby's psychofunctional symptoms, through a spillover process, i.e., the overflow of marital maladjustment on parental relationship. These findings are relevant to clinical practice, in searching for psychological interventions that promote the mental health of couples and babies.(AU)

Associação da posição socioeconômica e da depressão materna com a saúde das crianças: avaliação da PNAD 2008, Brasil / Associating socioeconomic position and maternal depression with the health of children: an evaluation of the 2008 Brazilian household survey

Resumo O estudo analisou a associação entre posição socioeconômica (renda), depressão materna e saúde da criança no Brasil, utilizando informações da Pesquisa Nacional por Amostra de Domicílios 2008 (PNAD/IBGE). A análise considerou o delineamento amostral da pesquisa e incluiu 46.874 indivíduos com idade até 9 anos. Modelos Poisson foram estimados para três desfechos de saúde da criança: saúde reportada pelos pais ou responsáveis, restrição das atividades habituais por motivo de saúde e episódios de acamamento nas duas semanas anteriores à entrevista. Os resultados apontaram associação entre a depressão da mãe e os três desfechos, mesmo após o ajuste para posição socioeconômica, características maternas (saúde autorreferida, idade, escolaridade e tabagismo), idade, sexo e cor da pele da criança, além de região geográfica, situação censitária e número de moradores do domicílio. Constatou-se ainda que a associação entre depressão materna e saúde da criança independe da posição socioeconômica. Assim, políticas de saúde pública que objetivem atenuar os efeitos adversos da depressão materna sobre a saúde da criança, precisam considerar também os estratos mais elevados de renda da sociedade.

Abstract The study analyzed the association between socioeconomic position (income), maternal depression and the health of children in Brazil, using information from the 2008 National Household Survey (PNAD/IBGE). The analysis considered the sampling design for the research and included 46,874 individuals up to the age of nine. The Poisson models were estimated for three health outcomes for children: health as reported by the parents or the responsible person, restrictions on habitual activities for health reasons and periods when they were confined to bed two weeks before the interviews in the study. The results showed an association between the mothers' depression and the three health outcomes, even after taking into account the following: socioeconomic position, maternal characteristics (health self-referral, age, level of education and smoking), age, gender, the child's race, geographical region, the situation as noted in the census and the number of residents in a household. It was found that there still exists an association between maternal depression and children's health irrespective of socioeconomic position. Therefore public policies that aim to reduce the adverse effects of maternal depression on the health of children need to also take into account the higher income segments of society.

Predictors of social skills and behavioral problems in children / Preditores de habilidades sociais e problemas de comportamento em crianças / Predictores de habilidades sociales y problemas de conducta en niños

Social skills and behavioral problems are influenced by multiple variables. Objective was to compare groups of children distinguished by social skill deficits and behavioral problems, according to sociodemographic variables, educational practices, family environment resources, and indicators of maternal depression, verifying the predictive value of those variables. Participants were 151 mothers of children, and data were compared and treated by binary logistic regression. On the regression models, the following influences were observed: a) in case of social skills related to the positive and negative educational practices - behavioral problems and low income; b) in case of behavioral problems related to the negative practices - child social skills, mother's schooling, mother's marital state and child's gender. In comparisons, environmental resources and maternal depression differentiated the groups. Simultaneous evaluation of the variables emphasizes intersections and differences of the constructs

Habilidades sociais e problemas de comportamento são influenciados por múltiplas variáveis. Objetivou-se comparar grupos de crianças diferenciados por déficits de habilidades sociais e problemas de comportamento quanto aos aspectos sociodemográficos, práticas educativas, recursos do ambiente familiar e indicadores de depressão materna, verificando o valor preditivo dessas variáveis. Participaram 151 mães de crianças e os dados foram comparados e tratados por regressões logísticas binárias. Nos modelos de regressão constataram-se as influências: a) para habilidades sociais das práticas positivas e negativas - problemas de comportamento e renda familiar; e b) para problemas de comportamento das práticas negativas - habilidades sociais infantis, tempo de educação materna, estado civil e sexo da criança. Nas comparações, os recursos do ambiente e depressão materna diferenciaram os grupos. A avaliação simultânea das variáveis evidenciou intersecções e diferenciações dos construtos

Las habilidades sociales y los problemas de comportamiento están influenciados por múltiples variables. Se objetivó comparar grupos de niños diferenciados por déficit de habilidades sociales y problemas de comportamiento en cuanto a los aspectos sociodemográficos, prácticas educativas, recursos del ambiente familiar e indicadores de depresión materna, verificando el valor predictivo de esas variables. Participaron 151 madres de niños y los datos fueron comparados y tratados mediante regresión logística binaria.. En los modelos de regresión, se observaron las siguientes influencias: a) en el caso de las habilidades sociales relacionadas con las prácticas educativas positivas y negativas: problemas de conducta y bajos ingresos; b) en caso de problemas de comportamiento relacionados con las prácticas negativas: habilidades sociales del niño, educación de la madre, estado civil de la madre y género del niño. En las comparaciones, los recursos ambientales y la depresión materna diferenciaron a los grupos. La evaluación simultánea de las variables enfatiza las intersecciones y las diferencias de los constructos

Association of maternal depression with dietary intake, growth, and development of preterm infants: a cohort study in Beijing, China / 医学前沿

This study aimed to explore the association of maternal depression with nutrient intake, growth, and development of preterm infants. A cohort study of 201 infants was conducted in Beijing. Based on the gestational age of an infant and status of the mother, the infants were divided into four groups: non-depression-fullterm (64), non-depression-preterm (70), depression-fullterm (36), and depression-preterm (31). Data on sociodemographic characteristics, nutritional intake, growth, and developmental status of children at 8 months (corrected ages) were collected using a quantitative questionnaire, a 24-Hour Dietary Recall, anthropometric measurements, and the Bayley-III scale. A multivariate analysis was used to evaluate the effects of maternal depression and preterm birth on infant growth and development. The energy, protein, and carbohydrate intake in the depression group was lower than the recommended amounts. The depression preterm groups indicated the lowest Z-scores for length and weight and the lowest Bayley-III scores. Preterm infants of depressed mothers are at high risks of poor growth and development delay.

Maternal Depression and Children's Screen Overuse

BACKGROUND: It is known that there are various factors associated with children's screen overuse. The aim of this study was to examine the effect of maternal depression on 2–5-year-old children's overuse of various household screen devices. METHODS: Participants were from the Internet-Cohort for Understanding of internet addiction Risk factors/Rescue in Early livelihood (I-CURE) study, an observational prospective cohort study in Korea. Screen time for six types of screen devices (smartphone, television, computer, tablet, video gaming console, and portable gaming console) were assessed by parental questionnaire. Maternal depression was measured by the Korean version of the Beck Depression Inventory II. Logistic regression models were run to determine the association between maternal depression and children's screen overuse. RESULTS: Maternal depression was associated with children's television overuse after adjusting for other factors (odds ratio, 1.954; P = 0.034). Contrary to expectation, the relationship between maternal depression and screen time was not present on other devices such as smartphones, computers and tablets. CONCLUSION: Maternal depression is related with 2–5-year-old children's television overuse. Interventions in maternal depressive symptoms and the associated changes in parent-child relationship can be useful for preventing children's television overuse.

Sintomas psicofuncionais e depressão materna: um estudo qualitativo / Psychofunctional symptoms and maternal depression: a qualitative study / Síntomas psicofuncionales y depresión materna: un estudio cualitativo

Esta pesquisa objetivou compreender a manifestação de sintomas psicofuncionais em bebês entre seis e 12 meses, cujas mães apresentaram depressão. Assim, realizaram-se qualitativamente estudos de casos múltiplos, com três duplas mãe-bebê, sendo aplicados: entrevista de dados sociodemográficos e de dados clínicos, MINI PLUS, Questionário Symptom Check-List, EPDS, entrevista sobre gestação, parto e experiência da maternidade e IAP. Os resultados apontaram a presença de diversos fatores de riscos à depressão comuns a todas as mães, como também de aspectos psicodinâmicos singulares relacionados à história de vida delas. Também, identificou-se dificuldade na interação mãe-bebê em todos os casos, indicando que a depressão prejudica a mãe no exercício da maternidade e nas tarefas que esse período demanda, sobretudo interpretar ao bebê o que seu corpo manifesta. Portanto, o sintoma psicofuncional pode ser visto como uma resposta defensiva do bebê às dificuldades maternas de compreender suas manifestações corporais e interpretá-las. (AU)

This study aimed to understand the manifestation of psychofunctional symptoms in infants between six and 12 months, whose mothers presented depression. For this purpose, multiple case studies with three mother-infant pairs were qualitatively performed, and the following instruments were administered: interviews on socio-demographic and clinical data, M.I.N.I. PLUS, Symptom Checklist Questionnaire, EPDS, interview about pregnancy, childbirth and maternity experience, as well as IAP. The results showed the presence of several risk factors for depression common to all mothers, as well as singular psychodynamic aspects related to their life story. Also, we identified difficulty in the mother-infant interaction in all cases, indicating that depression damages the mother in the exercise of motherhood and in the tasks that this period demands, especially in interpreting to the baby what his/her body is expressing. Therefore, the psychofunctional symptom can be seen as a defensive response by the infant to maternal difficulties of understanding the baby's body manifestations and interpreting them. (AU)

Esta investigación tuvo como objetivo comprender manifestaciones de síntomas psicofuncionales en bebés entre 6 y 12 meses cuyas madres presentaron depresión. Se han realizado estudios de casos múltiples,con tres duplas madre-bebé, siendo aplicados: entrevista de datos sociodemográficos y datos clínicos, M.I.N.I. PLUS, Cuestionario Symptom Check-List, EPDS, entrevista sobre embarazo, parto y experiencia de maternidad e IAP. Los resultados mostraron presencia de diversos factores de riesgo para la depresión, comunes a todas las madres, así como también aspectos psicodinámicos singulares relacionados con la historia de vida de ellas. Además, se identificaron dificultades en la interacción madre-bebé en todos los casos, lo que indica que la depresión perjudica a la madre en el ejercicio de la maternidad y en las tareas que ese período demanda, principalmente interpretar lo que el cuerpo del bebé manifiesta. Por lo tanto, síntoma psicofuncional puede ser visto como una respuesta defensiva del bebé a las dificultades maternas para comprender sus manifestaciones corporales e interpretarlas. (AU)

Behavioral problems of school children: impact of social vulnerability, chronic adversity, and maternal depression

This study's objective was to identify the predictive effect of indicators concerning social vulnerability, chronic adversity, and maternal depression on behavioral problems among school-aged children, according to the perceptions of mothers and teachers, considering the presence or absence of difficulties in the contexts of family and school. A total of 85 pairs of mothers and school children were distributed into three groups according to the behavioral problems identified. A General Questionnaire, the PHQ-9, the Chronic Adversity Scale, and the (Strengths and Difficulties Questionnaire) SDQ were applied to the mothers; the Raven's Colored Progressive Matrices were applied to the children; and the SDQ was applied to the teachers. Data were analyzed with descriptive, predictive, and comparative statistical procedures (p ≤ 0.05). The results reveal the presence of cumulative risks for children with behavioral problems; mothers more frequently identified behavioral problems than teachers; and maternal depression was a predictor for behavioral problems. Such findings are relevant for devising mental health programs.

O comportamento materno e a depressão pós-parto no desenvolvimento prossocial em crianças de 36 meses de idade / The maternal behavior and the post-partum depression in the development of language and prossocial behavior of 3-year-old children / El comportamiento materno y la depresión posparto en el desarrollo del lenguaje y comportamiento prosocial de niños de 3 años de edad

Esta pesquisa teve como objetivo verificar a influência da depressão pós-parto no comportamento materno no desenvolvimento da linguagem e comportamento prossocial de crianças de 3 anos de idade. Participaram desta pesquisa 61 díades mães-crianças atendidas pelo Sistema Público de Saúde do Município de São Paulo, no qual 28 mães apresentaram indicativos de depressão em algum momento após o nascimento do filho, em uma das avaliações realizadas (puerpério, 8, 24 e aos 36 meses) no projeto longitudinal. Avaliou-se o aspecto pragmático do desenvolvimento de linguagem (por atos e meios comunicativos) e a interação mãe e criança na tarefa de recolher os brinquedos, em filmagens de vinte minutos de brincadeira livre. Os dados, analisados por meio de testes estatísticos paramétricos, apontam que os fatores da depressão que influenciam o comportamento materno na relação com seu filho são sutis, pois as crianças apresentaram um desempenho linguístico dentro dos padrões esperados para a idade, verbalizaram mais e usaram mais gestos para se comunicar, exibiram mais objetos às suas mães e comentaram mais. As mães sem depressão explicam mais a seus filhos as razões e os motivos e seus filhos fornecem menos ajuda às suas mães, demonstrados por meio de recusas e desafios.

This study aimed at verifying the influence of post-partum depression on the maternal behavior in the development of language and prossocial behavior of 3-year-old children. A total of 61 mother-child dyads being attended by the Public Health System in the Municipality of São Paulo took part in this study, where 28 mothers presented signs of depression at some point after childbirth in one of the assessments performed (puerperium, 8, 24 and 36 months) during the longitudinal project. During twenty minutes of free play between mother and child, pragmatic aspect of language development (through communicative actions and means) and the clean-up task were assessed. The data, analyzed through parametric statistical tests, showed that depression factors influencing maternal behavior in relation to the child are subtle, insofar as the children presented a linguistic performance within the standards expected for the age, verbalized more and used more gestures to communicate, exhibiting more objects to their mothers and made more comments. Mothers without depression explain the reasons and motives of things to their children and they, in turn, provide less help to their mothers, which is demonstrated through defiance and refusals.

Esta investigación tuvo por objetivo verificar la influencia de la depresión posparto en el comportamiento materno en el desarrollo del lenguaje y comportamiento prosocial de niños de 3 años de edad. En el presente estudio, 61 mujeres murieron atendidas por el Sistema Público de Salud del Municipio de São Paulo, en las cuales 28 madres presentaron indicativos de depresión en algún momento después del nacimiento del hijo en una de las evaluaciones realizadas (puerperio, 8, 24 y 36 Meses) en el diseño longitudinal. Se evaluó el aspecto pragmático del desarrollo del lenguaje (por actos y medios comunicativos) y la interacción madre y niño en la tarea de recoger los juguetes, en filmaciones de vinte minutos de juego libre. Los datos, analizados a través de pruebas estadísticas paramétricas, apuntan que los factores de la depresión que influencian el comportamiento materno en la relación con su hijo son sutiles, pues los niños presentaron un desempeño lingüístico dentro de los estándares esperados para la edad, verbalizaron más y utilizaron más gestos para comunicarse, exhibieron más objetos a sus madres y comentaron más. Las madres sin depresión explican más a sus hijos las razones y los motivos y sus hijos proporcionan menos ayuda a sus madres, demostradas por medio de rechazos y desafíos.

Maternal depression and anxiety and fetal-neonatal growth / Depressão e ansiedade maternal e crescimento fetal-neonatal

Abstract Objective: Maternal depression and anxiety have been found to negatively affect fetal and neonatal growth. However, the independent effects of maternal depression and anxiety on fetal-neonatal growth outcomes and trajectories remain unclear. This study aimed to analyze simultaneously the effects of maternal prenatal depression and anxiety on (1) neonatal growth outcomes, and (2), on fetal-neonatal growth trajectories, from the 2nd trimester of pregnancy to childbirth. Methods: A sample of 172 women was recruited and completed self-reported measures of depression and anxiety during the 2nd and 3rd trimesters of pregnancy, and at childbirth. Fetal and neonatal biometrical data were collected from clinical reports at the same assessment moments. Results: Neonates of prenatally anxious mothers showed lower weight (p = 0.006), length (p = 0.025), and ponderal index (p = 0.049) at birth than neonates of prenatally non-anxious mothers. Moreover, fetuses-neonates of high-anxiety mothers showed a lower increase of weight from the 2nd trimester of pregnancy to childbirth than fetuses-neonates of low-anxiety mothers (p < 0.001). Considering maternal depression and anxiety simultaneously, only the effect of maternal anxiety was found on these markers of fetal-neonatal growth outcomes and trajectories. Conclusion: This study demonstrates the independent longitudinal effect of maternal anxiety on major markers of fetal-neonatal growth outcomes and trajectories, simultaneously considering the effect of maternal depression and anxiety.

Resumo Objetivo: Foi constatado que a depressão e ansiedade materna afetam negativamente o crescimento fetal e neonatal. Contudo, o efeito independente da depressão e ansiedade materna sobre os resultados e as trajetórias de crescimento fetal e neonatal continua incerto. Este estudo visou a analisar simultaneamente o efeito da depressão e ansiedade materna pré-natal (1) sobre os resultados de crescimento neonatal e (2) sobre as trajetórias do crescimento fetal-neonatal a partir do 2° trimestre de gravidez até o parto. Métodos: Uma amostra de 172 mulheres foi recrutada e elas relataram graus de depressão e ansiedade no 2° e 3° trimestre de gravidez e parto. Os dados biométricos fetais e neonatais foram coletados dos prontuários clínicos nas mesmas ondas de avaliação. Resultados: Os neonatos de mães ansiosas no período pré-natal mostraram menor peso (p = 0,006), comprimento (p = 0,025) e índice ponderal (p = 0,049) no nascimento do que os neonatos de mães não ansiosas no período pré-natal. Além disso, os neonatos de mães muito ansiosas mostraram um menor aumento de peso do 2° trimestre de gravidez até o parto que os fetos-neonatos de mães pouco ansiosas (p < 0,001). Considerando simultaneamente a depressão e a ansiedade maternal, apenas o efeito da ansiedade materna foi constatado nesses marcadores de resultados e trajetórias de crescimento fetal-neonatal. Conclusão: Este estudo demonstra o efeito longitudinal independente da ansiedade materna sobre os principais marcadores de resultados e trajetórias de crescimento fetal-neonatal, considerando simultaneamente o efeito da depressão e ansiedade materna.

As relações entre depressão materna e relatos maternos acerca do envolvimento paterno: um estudo longitudinal / The relations between maternal depression and maternal reports about father involvement: a longitudinal study / Las relaciones entre la depresión materna y los informes maternos sobre el envolvimiento paterno: un estudio longitudinal

Este estudo longitudinal avaliou as relações entre indicadores de depressão da mãe e sua percepção acerca do envolvimento paterno. Participaram 19 mães de meninos, recrutadas em maternidades públicas da cidade de Salvador. A depressão materna foi avaliada no primeiro e no 18º mês da criança (Inventário de Depressão de Beck - BDI) e no 30º mês foi realizada uma entrevista estruturada sobre a percepção da mãe acerca do envolvimento paterno. Os escores de depressão materna no primeiro mês de vida do bebê estiveram positivamente correlacionados à percepção da mãe acerca da disponibilidade paterna aos 30 meses, particularmente, em relação aos cuidados de rotina, lazer e saúde da criança. Discute-se o impacto da depressão pós-parto sobre esta dimensão específica do envolvimento paterno, enfatizando as mudanças que podem ocorrer na dinâmica das interações familiares no período da transição para a parentalidade. Sugere-se a realização de novos estudos sobre depressão materna e envolvimento paterno, tendo como informantes tanto os pais quanto as mães.

This longitudinal study evaluated the relationship between indicators of mother's depression and their perception of paternal involvement. Nineteen mothers of boys, recruited at public maternity hospitals in Salvador, Bahia, were assessed for maternal depression with the Beck's Depression Inventory (BDI) at the first and 18th month of the child. The participants responded a structured interview regarding maternal perceptions about paternal involvement at the 30th month of the child. The maternal depression scores at the first month of the baby's life were positively correlated to maternal perceptions of paternal availability at the 30th month, particularly concerning to routine care, leisure and child health. The impact of postpartum depression on this specific dimension of paternal involvement are discussed, emphasizing the changes that may occur in the dynamics of family interactions during the transition to parenthood. Further studies are suggested concerning the relation between maternal depression and paternal involvement, with reports of both fathers and mothers.

Este estudio evaluó la relación entre los indicadores de depresión materna y la percepción de la madre respecto al envolvimiento paterno. Participaron 19 madres de niños varones. La depresión materna fue evaluada en el primero y en el 18º mes del niño (Inventário de Depressão de Beck - BDI). En el trigésimo mes, se realizó una entrevista estructurada sobre la percepción de la madre sobre el envolvimiento paterno. Los escores de depresión materna en el primer mes de vida del bebé se correlacionaron positivamente con la percepción de la madre respecto a la disponibilidad paterna a los 30 meses, en particular, la disponibilidad para los cuidados básicos y la salud, y para jugar con el niño. Se discute el impacto de la depresión posparto en esta dimensión particular del envolvimiento paterno, con énfasis en los cambios que pueden ocurrir en la dinámica de las interacciones familiares durante la transición a la parentalidad. Se sugieren más estudios sobre la relación entre la depresión materna y la participación de los padres, con los informes de los padres y de las madres.

Maternal depression and child development: Evidence from São Paulo's Western Region Cohort Study

Summary Introduction: While a growing body of evidence has investigated the relationship between maternal mental health and child development, evidence on children’s early life outcomes remains mixed. We analyze the empirical relationship between maternal depression and children’s development at age one using data from the São Paulo Western Region Cohort project. Method: Seven hundred and ninety-eight (798) mother-child dyads living in the Butantã-Jaguaré’ region of São Paulo were assessed through a home visit between January and March 2015. Maternal mental health was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Mothers were classified as “possibly depressed” if their EPDS score was between 10 and 13 and as “likely depressed” if their EPDS score was > 13. The child outcomes analyzed were height, weight, and overall development as assessed by the Ages and Stages Questionnaire (ASQ). Height and weight were age-normalized using WHO growth standards. Stunting was defined as height-for-age z-score (HAZ) < -2. Obesity was defined as body mass index z-score (BMIZ) > 2. Adjusted and unadjusted linear regression models were used to assess the associations between Edinburgh scores and child outcomes. Results: No association was found between maternal depression variables and children’s height, weight, stunting, and obesity. Positive associations were found between possible depression and ASQ (delta = 0.33; 95CI 0.11-0.54; p-value<0.01); no associations were found between likely depression and any of the outcomes analyzed. Conclusion: The results from this study suggest that symptoms of maternal depression are not associated with delays in child development in the study setting analyzed. Further research will be needed to understand this lack of association: while it is possible that caregivers’ mental health did not affect caregiving behavior, it is possible that the effect of maternal depression can vary according to timing, persistence, and intensity. It is also possible that the EPDS instrument may fail to identify mothers with clinical depression, or that children with depressed mothers get increased support from other family members or public early childhood focused programs.

Depressão e maternidade à luz da psicanálise: uma revisão sistemática da literatura / Depression and maternity in the light of psychoanalysis: a systematic review of literature / La depresión y la maternidad desde la perspectiva psicoanalítica: una revisión sistemática de la literatura

Este artigo realizou uma revisão sistemática da produção científica nacional sobre depressão e maternidade na perspectiva psicanalítica. Os descritores empregados foram depressão pós-parto OR depressão materna OR depressão puerperal AND psicanálise, sendo incluídos artigos, dissertações ou teses publicados entre 2004 e 2014, disponibilizados na íntegra, advindos da psicologia, psicanálise e psiquiatria ou multidisciplinares. Foram encontrados 37 trabalhos, sendo a maioria derivada da psicologia. Observou-se uma carência de estudos empíricos e, entre os encontrados, destacaram-se trabalhos qualitativos, com estudos de caso, tendo como participantes mães, duplas mãe-bebê, tríades pai-mãe-bebê e pediatras. Os principais resultados encontrados foram: a importância da detecção precoce de sinais de risco, o impacto da depressão na interação mãe-bebê e no desenvolvimento infantil, a etiologia multifatorial do transtorno, a vulnerabilidade do contexto familiar a psicopatologias e algumas hipóteses acerca dos aspectos psicodinâmicos da depressão. Por fim, considerando o funcionamento psicodinâmico próprio à maternidade nos dois primeiros anos após o parto, defende-se a conceituação desse transtorno como depressão materna e a elaboração de um constructo diferenciado.

This article has performed a systematic review of the scientific national research about depression and maternity on the psychoanalytical perspective. The descriptors employed were post-partum depression OR maternal depression OR puerperal depression AND Psychoanalysis; including articles, dissertations or theses published between 2004 and 2014, available in full, from Psychology, Psychoanalysis and Psychiatry or multidisciplinary fields. There were 37 papers, the majority being from Psychology. We could observe a scarcity of empirical studies and, among these, include the qualitative studies, such as case studies having as participants mothers, pairs: mother-baby, triad: father-mother, baby and pediatricians. The main results found were: the importance of the early detection of risk signs, the impact of depression in the interaction of mother-baby and in the child development, the multifactorial etiology of the disorder, the vulnerability of the familiar context and psycopathologies and some hypotheses on the psychodynamic aspects of depression. Finally, considering the psychodynamic functioning of maternity itself in the next two years after birth, it is defended the conceptualization of this disorder as maternal depression and the elaboration of a differentiated construct.

En este artículo se realizó una revisión sistemática de la producción científica sobre la depresión y la maternidad en la perspectiva psicoanalítica. Los descriptores fueron depresión posparto materna OR la depresión OR la depresión posparto AND el psicoanálisis, y se incluyeron artículos, disertaciones o tesis publicados entre 2004 y 2014, disponibles en su totalidad, que surge de la psicología, el psicoanálisis y la psiquiatría o multidisciplinar. Fueron encontrados 37 obras, en su mayoría derivados de la psicología. Hubo una falta de estudios empíricos y entre las que se encuentraran, se destacó el trabajo cualitativo, con estudios de casos, teniendo como participantes las madres, las parejas madre-hijo, las tríadas padre-madre-bebé, y los pediatras. Los principales resultados fueron: la importancia de la detección temprana de signos de riesgo, el impacto de la depresión en la interacción madre-hijo y en el desarrollo infantil, la etiología multifactorial de la enfermedad, la vulnerabilidad del contexto familiar de la psicopatología y algunas hipótesis sobre los aspectos psicodinámicos de la depresión. Por último, teniendo en cuenta el funcionamiento psicodinámico propio de la maternidad en los dos primeros años después del nacimiento, se defiende nombrar este trastorno como la depresión materna y o desarrollar de una construcción diferenciada para definirla.

Factors Influencing Maternal Depression in Low-Income Families with Young Children

PURPOSE: This study aimed to investigate the factors influencing maternal depression in low-income families with young children. METHODS: The study consisted of 376 mothers in low-income families from participants enrolled in the population-based study of 2011 PSKC by Korea Institute of Child Care and Education. The factors including depression, self-esteem, parenting stress, marital conflict, father involvement in child rearing, social support, and family life event were assessed with questionnaires. Data analysis was conducted by description analysis, partial correlation, and hierarchical regression using SPSS 22.0 program. RESULTS: The results showed that 10.6% of mothers were in severe depressive group in this study. Also the result revealed that marital conflict was the strongest predictor of maternal depression. CONCLUSION: The results suggest that mothers with young children in low-income families especially had difficulty with depression due to family related factors. Implications included the need to support mothers and develop intervention programs focusing on family relationships in order to improve and sustain mental health.