The effect of dialectic behavioral counseling on depression, anxiety, and postpartum hematocrit levelprotocolo 20210073553284 prefeitura

Abstract Objective Childbirth is a biological, psychological, and sociological event that can be a positive or negative experience, and, without support, this period may be potentially damaging. Parturition may distort maternal emotions and lead to short- or long-term disorders such as postpartum depression and anxiety. The present research aims to study the effects of dialectic behavioral therapy-based counseling on depression, anxiety symptoms, and postpartum hematocrit level. Methods The current research is a clinical trial study, and the sample was selected using parturients who were referred to the Health General Center with a diagnosis of postpartum depression and anxiety. The sample size consisted of 116 subjects who agreed to participate in the study. The patients in intervention group underwent group dialectic behavioral counseling (10 sessions/one session per week) and the control group did not receive any type of intervention. The patients were assessed in the first and last sessions as well as 2 months after the end of the sessions, using the Beck depression scale and Spielberg anxiety scale as well as the results of hematocrit tests. Data were analyzed using the IBMSPSS Statistics for Windows, Version 21.0 (IBMCorp., Armonk, NY, USA) Results The results implied the effectiveness of dialectic behavioral therapy on reduction of the depression score, anxiety symptoms (p-value ≤ 0.0001), and hematocrit level (p-value=0.04). The participants' depression, anxiety, and hematocrit levels decreased in the experiment group compared to the control group, and this decrease has remained until the 2-month follow-up. Conclusion It seems that dialectic behavioral counseling reduces the levels of postpartum depression, anxiety, and hematocrits.

Mild and moderate postpartum depression treated with acupuncture of / 中国针灸

OBJECTIVE@#To observe the clinical therapeutic effect on mild and moderate postpartum depression treated with acupuncture of @*METHODS@#A total of 116 patients with mild and moderate postpartum depression were divided into an acupuncture group (103 cases) and a non-acupuncture group (13 cases) according to treatment regimen provided. In the acupuncture group, acupuncture of @*RESULTS@#The total effective rate of the acupuncture A group was 100.0% (31/31), better than 76.9% (10/13) in the non-acupuncture group and 58.1% in the acupuncture B group (18/31) (@*CONCLUSION@#Acupuncture of

Observation on clinical effect of acupuncture combined with wheat-grain moxibustion for mild to moderate postpartum depression / 中国针灸

OBJECTIVE@#To compare the clinical effect of acupuncture combined with wheat-grain moxibustion and oral sertraline hydrochloride dispersible tablets in the treatment of mild to moderate postpartum depression.@*METHODS@#Sixty patients with mild to moderate postpartum depression were randomly divided into an observation group and a control group, 30 cases in each group. Both groups were treated with psychotherapy. The control group was treated with oral sertraline hydrochloride dispersible tablets, 50 mg each time, once a day; the observation group was treated with acupuncture at Qihai (CV 6), Zusanli (ST 36), Xuehai (SP 10), Hegu (LI 4), Sanyinjiao (SP 6), Taixi (KI 3), etc. combined with wheat-grain moxibustion at Xinshu (BL 15), Pishu (BL 20), Ganshu (BL 18) and Shenshu (BL 23), once every other day, 3 times a week. Both groups were treated for 4 weeks as a course, with 2 consecutive courses of treatment. Before and after treatment and follow-up of 3 months after the end of treatment, the Hamilton depression scale (HAMD), Edinburgh postnatal depression scale (EPDS) and World Health Organization quality of life-BREF (WHOQOL-BREF) score of the two groups were compared, and the clinical effect was assessed.@*RESULTS@#After treatment and during follow-up, the HAMD and EPDS scores of the two groups were lower than before treatment (@*CONCLUSION@#Acupuncture combined with wheat-grain moxibustion can improve the depressive symptoms of patients with mild to moderate postpartum depression and improve their quality of life, and the clinical effect is more lasting and stable than oral sertraline hydrochloride dispersible tablets.

Depresión perinatal: detección, diagnóstico y estrategias de tratamiento / Perinatal depression: a review on diagnosis and treatment strategies

Para las mujeres, experimentar cambios emocionales durante el embarazo y hasta un año posterior al parto puede ser parte del proceso de adaptación a los cambios fisiológicos y emocionales de esta nueva etapa, siendo por lo general manejable por ellas mismas. Diferente es el desarrollo de síntomas depresivos durante este período perinatal que comprende el embarazo y hasta doce meses posterior al parto. La depresión perinatal constituye un trastorno de alta prevalencia que puede tener efectos negativos tanto para la salud de la madre, del hijo y de otros miembros de la familia.

For women it is natural to experience changes in mood and feelings during pregnancy and after twelve months after childbirth, these shifting moods are often manageable by themselves, it differs with depressive symptoms that appear during these period. Perinatal depression constitutes a high prevalence disorder that might have a negative effect not only in the mother, but the child and other familiy members.

Beneficios del mindfulness en mujeres embarazadas / Benefits of mindfulness in pregnant women

Este trabajo tiene el propósito de revisar el efecto de las intervenciones basadas en mindfulness sobre la salud mental perinatal. Se efectuó una búsqueda de la literatura publicada hasta septiembre 2019 en la base de datos Web of Science (WOS). Teniendo en cuenta los criterios de inclusión y exclusión y después de leer el título y abstracts de los artículos encontrados, se han seleccionado 26 de ellos, de los que se han escogido solo ocho por tratarse de ensayos controlados y aleatorizados (RCTs) que estudian datos de ansiedad, depresión, estrés percibido y mindfulness pre y post-intervención y con datos de seguimiento. Los resultados encontrados muestran que las intervenciones basadas en mindfulness (IBMs) son más eficaces que la asistencia sanitaria habitual (TAU) para la mujer embarazada a la hora de reducir la sintomatología depresiva, ansiosa y estrés percibido e incrementar sus niveles de mindfulness post-intervención. Para futuras investigaciones se consideraría interesante realizar el seguimiento de estas variables en el posparto e incluir otras como la calidad del vínculo madre-bebé, la adherencia a la lactancia materna y el desarrollo evolutivo del recién nacido.

This article is intended to review the effect of mindfulness-based interventions on perinatal mental health. A search of the literature published until September 2019 in the Web of Science (WOS) database was carried out. Taking into account the inclusion and exclusion criteria and after reading the title and abstracts of the articles found, 26 of them have been selected. Finally we only analyzed randomized controlled trials (RCTs) that show data on anxiety, depression, perceived stress and mindfulness before and after intervention and with follow-up data. The results found show that mindfulness-based interventions (IBMs) are more effective than the usual healthcare (TAU) that pregnant women receive for the reduction of depressive, anxious and perceived stress symptoms as well as increasing their post-intervention mindfulness levels. For future research, a postpartum follow-up would be considered interesting taking into account variables such as the quality of the mother-baby attachment, adherence to breastfeeding and the evolutionary development of the newborn.

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.

Psychoses puerpérales : aspects épidémiologiques, cliniques et thérapeutiques. A propos de 37 cas colligés dans le service de psychiatrie du CHU-Yalgado Ouédraogo de Ouagadougou, Burkina Faso

Objectif : Etudier les aspects épidémiologiques, cliniques et thérapeutiques des psychoses puerpérales dans le service de psychiatrie du CHU-Yalgado Ouédraogo. Patientes et méthodes : Nous avons mené une étude rétrospective à visée descriptive qui a porté sur 10 ans d'activité hospitalière (de janvier 2005 à décembre 2014). Notre étude a concerné toutes les patientes admises et hospitalisées pour psychoses puerpérales durant la période d'étude. Résultats : La fréquence hospitalière de la psychose puerpérale est de 2,2%. L'âge moyen des patientes était de 26,5 ± 5,3 ans avec des extrêmes de 17 et 37 ans. La tranche d'âge de 25 à 34 ans a représenté 56,8%. Les patientes vivant maritalement ont représenté 70,3% des cas. Les ménagères ont constitué 67,6% des cas. Dans notre série, les patientes primipares ont constitué 56,8% des cas. Nous avons noté chez 23 patientes soit 62,2%, une situation conflictuelle dans la famille. L'agitation et/ou l'agressivité a été constamment évoquée comme motif de consultation suivie de la logorrhée. Le refus d'allaiter a motivé la consultation dans 45,9% des cas. Le délire et les hallucinations ont été retrouvés respectivement chez 54,1% et 37,8% des patientes. Les troubles psychotiques ont représenté 56,8% des cas. La prise en charge thérapeutique des patientes était basée sur le volet psychothérapeutique et le volet chimio-thérapeutique. Conclusion : Un diagnostic précoce des psychoses puerpérales dans les services de maternité améliorerait le pronostic de cette affection

Barriers to access to treatment for mothers with postpartum depression in primary health care centers: a predictive model / Barreiras de acesso a tratamento para mães com depressão pós-parto em centros de atenção primária: um modelo preditivo / Barreras de acceso a tratamiento de madres con depresión posparto en centros de atención primaria: un modelo predictivo

Objective to develop a predictive model to evaluate the factors that modify the access to treatment for Postpartum Depression (PPD). Methods prospective study with mothers who participated in the monitoring of child health in primary care centers. For the initial assessment and during 3 months, it was considered: sociodemographic data, gyneco-obstetric data, data on the services provided, depressive symptoms according to the Edinburgh Postpartum Depression Scale (EPDS) and quality of life according to the Short Form-36 Health Status Questionnaire (SF-36). The diagnosis of depression was made based on MINI. Mothers diagnosed with PPD in the initial evaluation, were followed-up. Results a statistical model was constructed to determine the factors that prevented access to treatment, which consisted of: item 2 of EPDS (OR 0.43, 95%CI: 0.20-0.93) and item 5 (OR 0.48, 95%CI: 0.21-1.09), and previous history of depression treatment (OR 0.26, 95%CI: 0.61-1.06). Area under the ROC curve for the model=0.79; p-value for the Hosmer-Lemershow=0.73. Conclusion it was elaborated a simple, well standardized and accurate profile, which advises that nurses should pay attention to those mothers diagnosed with PPD, presenting low/no anhedonia (item 2 of EPDS), scarce/no panic/fear (item 5 of EPDS), and no history of depression, as it is likely that these women do not initiate treatment.

Objetivo desenvolver um modelo preditivo para avaliar os fatores que modificam o acesso a tratamento para a DPP. Métodos estudo prospectivo com mães que participaram do acompanhamento da saúde da criança em centros de atenção primária. Na avaliação inicial e durante 3 meses, foram registrados: dados sociodemográficos, gineco-obstétricos, dados sobre o uso dos serviços, sintomas depressivos de acordo com a Escala de Depressão Pós-parto de Edimburgo (EPDS) e qualidade de vida de acordo com o Questionário de Saúde SF-36. O diagnóstico de depressão foi feito com o MINI. Foram acompanhadas as mães que tinham DPP na avaliação inicial. Resultados foi construído um modelo estatístico para determinar os fatores que impediram o acesso a tratamento, constituído por: item 2 da EPDS (OR 0,43, IC95%: 0,20-0,93) e 5 (OR 0,48, IC95%: 0,21-1,09), e história prévia de tratamento para depressão (OR 0,26, IC95%: 0,61-1,06). Área sob a curva ROC para o modelo=0,79; valor de p para o teste de Hosmer-Lemershow=0,73. Conclusão foi elaborado um perfil simples, bem padronizado e preciso, que recomenda que os/as enfermeiros/as estejam atentos/as àquelas mães com DPP que apresentem anedonia baixa/nula (item 2 da EPDS), pânico/medo escasso/nulo (item 5 da EPDS) e sem antecedentes de depressão, já que é provável que estas mulheres não entrem em tratamento.

Objetivo desarrollar un modelo predictivo para evaluar los factores que modifiquen el acceso a tratamiento para la DPP. Métodos estudio prospectivo de madres que asistieron a control de niño sano en centros de atención primaria. En evaluación basal y 3 meses, se registraron: datos sociodemográficos, gineco-obstétricos, variables de uso de servicios, síntomas depresivos con la Escala de Depresión Posparto de Edimburgo (EPDS) y calidad de vida con el Cuestionario de Salud SF-36. El diagnóstico de depresión se hizo con el MINI. Se siguió a madres que en evaluación basal tenían DPP. Resultados se construyó un modelo estadístico para determinar los factores que impidieron el acceso a tratamiento, compuesto por: ítems del EPDS 2 (OR 0,43, IC95%: 0,20-0,93) y 5 (OR 0,48, IC95%: 0,21-1,09), e historia previa de tratamiento de depresión (OR 0,26, IC95%: 0,61-1,06). Área bajo la curva ROC para el modelo=0,79; valor de p para la prueba de Hosmer-Lemershow=0,73. Conclusión se elaboró un perfil simple, bien calibrado y discriminante, que sugiere que los/las enfermeros/as estén atentos/as a aquellas madres con DPP que presenten baja/nula anhedonia (ítem 2 EPDS), escaso/nulo pánico/miedo (ítem 5 EPDS), y sin antecedentes de depresión, ya que es probable que estas mujeres no ingresen a tratamiento.

Actualización en depresión postparto: el desafío permanente de optimizar su detección y abordaje / An update on postpartum depression

Postpartum depression (PPD) is a common condition worldwide and most of the available information is about treatment rather than prevention. This paper is an update on prevention and treatment of PPD. A simple review of the literature and a critical review of papers’ methodology and conclusions was carried out. There is a consensus of the preeminence of psychosocial factors in the genesis of PPD. Considering the complications when the condition is not treated, it is of the utmost importance to implement early detection and management strategies. The use of psychosocial preventive interventions is an alternative that has support in the literature and should be seriously considered.

Análisis etnográfico en salas de espera de centros de salud primaria: implicancias para la detección y tratamiento de la depresión posparto / Ethnographic analysis at general practice waiting rooms: implications for postpartum depression detection and treatment

Chile cuenta con tamizaje y acceso universal para el tratamiento de la depresión posparto, no obstante, ésta es una patología sub-detectada y sub-tratada. Con el objetivo de describir y analizar las barreras de acceso para la detección y tratamiento de la depresión posparto implicadas en la producción de cuidados materno-infantiles en las salas de espera de consultorios, se llevó a cabo un estudio etnográfico en seis centros de salud primaria Santiago de Chile. La maternidad, como objeto de discursos y prácticas reproducidos en los espacios comunes del consultorio, se constituye en una condición conflictiva para las puérperas, implicando una sobrecarga diferencial de trabajo doméstico y de cuidados, exigiendo su movilización entre instancias formales e informales del cuidado de la salud. Se problematiza en torno al grado de integración entre trabajo remunerado y el cuidado de la salud en las mujeres.

In Chile, universal screening and treatment for postpartum depression has been implemented at a national level, however it remains under-detected and under-treated. To describe and analyze barriers to postpartum depression detection and treatment implied in maternal-infant health care production at general practice waiting rooms, an ethnographic study was carried out at six primary care clinics belonging to the Metropolitan Area of Santiago, Chile. Discourses and practices on maternity enacted at waiting room, reveals a conflicting condition for postpartum women, implying a differential overburden with domestic work and care tasks, demanding constant mobilization between formal and informal health care sources. The grade of integration between remunerated work and women's self-care is debated.

Barreras de acceso a tratamiento de la depresión posparto en Centros de Atención Primaria de la Región Metropolitana: un estudio cualitativo / Barriers restricting postpartum depression treatment in Chile

Background: In Chile, postpartum depression is a prevalent and disabling condition. Universal screening is available but has not been translated into better treatment rates, suggesting the existence of access barriers. Aim: To describe access barriers to postpartum depression treatment in six primary health care clinics in Metropolitan Santiago, Chile. Material and Methods: Twenty women with postpartum depression and 18 primary health care professionals were subjected to a semi-structured interview. A qualitative methodology based on Grounded Theory was used. Results: There are user associated barriers such as lack of knowledge about the disease, a negative conceptualization and rejection of available treatment options. There are also barriers associated with poor network support and some features of the health care system such as long waiting times and lack of coordination between clinical and administrative decisions. Conclusions: Patient and provider related barriers restricting treatment of postpartum depression were identified.

Terapia de interacción guiada en díadas madre-bebé con sintomatología depresiva materna en el embarazo: un estudio piloto / Guided interaction therapy in mother-infant dyads with maternal depressive symptoms in pregnancy: a pilot study

La depresión perinatal constituye un trastorno del ánimo de alta frecuencia, que afecta negativamente a la madre y al bebé, y requiere una intervención dirigida a ambos miembros de esta díada. Esta investigación evalúa la aplicabilidad y resultados de una intervención piloto dirigida a fortalecer el vínculo y a reducir la depresión en díadas con esta problemática. Se estudian tres díadas madre-hijo/a, con sintomatología depresiva materna y se desarrolla una intervención psicoterapéutica breve utilizando el modelo de Interacciones Guiadas. Los resultados muestran una reducción en la sintomatología depresiva y un aumento en sensibilidad materna, cooperatividad infantil y calidad vincular. La intervención realizada resulta eficaz en las variables estudiadas, requiriéndose nuevas aplicaciones en muestras de mayor tamaño para confirmar estos hallazgos.

Perinatal depression is a high frequency mood disorder which negatively affects mother and baby, and requires an intervention addressing both members of the dyad. This paper evaluates the applicability and results of a pilot intervention to strengthen this bond and reduce depression in dyads with this problem. Three mother-child dyads, with maternal depressive symptoms and a brief psychotherapeutic intervention using the model of Guided Interactions were studied. The results showed a reduction in depressive symptoms and an increase in maternal sensitivity, child cooperativeness and relationship quality. The intervention turned out to be effective in the variables under study. Nevertheless, new applications over larger sample sizes are required to confirm these findings.

Cognitive behavioral therapy in combination with systemic family therapy improves mild to moderate postpartum depression

Objective: To explore the effect of cognitive behavioral therapy (CBT) in combination with systemic family therapy (SFT) on mild to moderate postpartum depression and sleep quality. Methods: 249 primiparous women with mild to moderate postpartum depression were recruited and randomly assigned to a control group (n=128), which received conventional postpartum care, or to a psychological intervention group (n=121), which received conventional postpartum care combined with psychological intervention. The Edinburgh Postnatal Depression Scale (EPDS) and Pittsburgh Sleep Quality Index (PSQI) were employed to evaluate depression and sleep quality, respectively. Results: 104 patients in the intervention group and 109 in the control group completed the study. After intervention, the EPDS score, PSQI score, sleep quality score, sleep latency score, sleep duration score, habitual sleep efficiency score, sleep disturbance score, and daytime dysfunction score were significantly lower in the intervention group than in the control group. The EPDS and PSQI scores of each group at different time points after intervention were markedly decreased compared with those before intervention, and the reduction in the intervention group was more evident than that in the control group. Conclusion: CBT in combination with SFT can improve depression and sleep quality in patients with mild to moderate postpartum depression. .

Relationship between perceived social support and risk of postpartum depression disorder

Postpartum depression [PPD] has negative effects on developmental and behavioral functions of newborn, mother-child relationship and mother's health. The etiology of postpartum depression is very complex. Social support is known as a risk factor for postpartum depression. Accordingly the aim of this study was to determine the relationship between social support and its components and incidence of postpartum depression. It was a cross-sectional study. The sample consisted of 140 mothers at least 5 weeks after their delivery. These mothers had been referred to Shahid Akbary and Shahid Motahhari hospitals in Yazd city to receive postpartum care. Data was collected by Perceived Social Support Scale [PSSS] and Beck Depression Inventory [BDI] and analyzed by SPSS-PC using principal components analysis, zero-rank Pearson correlation and hierarchical multiple regression. The results of the analysis suggest significant negative correlation between postpartum depression and total perceived social support [p < .001], family support [p < .001], significant others' support [p < .001], and friend support [p < .05]. Hierarchical multiple regression analysis showed that the socio-demographic variables [Fetus age and sex] in the first model and social component in the second model explained%5.6,%12.6 of the variance of postpartum depression respectively. Lack or insufficiency of social support in postpartum phase can be seen as a strong risk factor for postpartum depression. To prevent negative outcomes of postpartum depressions, encouragement of families, family networks, significant others and friends to support women in their antenatal and postpartum phase is recommended

Depresión en el embarazo y el puerperio / Depression in pregnancy and the puerperium

Background: Depression, a disorder than mostly affects fertile women, is the leading cause of disease burden in Chilean adult women. Objective: To highlight the main facts currently known about depression in pregnancy and the puerperium. Method: Results of several studies are summarized in the context of a review of the literature. Results: A third of Chilean women have depressive and/or anxiety symptoms during pregnancy, while prevalence figures in the postpartum period increase to more than 40 percent. If strict operational criteria describing well defined depressive disorders are used, one outoftenpregnant/postpartum women is found to be depressed. Persistent depression in pregnant women was shown to be associated with developmental delay in their children at 18 months of age and a 4.7 higher risk of depression in adolescence. Postpartum depression has been associated to lower IQ scores in preadolescents, and to violent behavior. Different types of psychotherapy and antidepressant medication, which can be used at this time of life, are currently available. Conclusions: Pre and postpartum depression are highly prevalent and the impact of both, untreated and treated perinatal depression, must be taken into account when managing depressed childbearing women.

Antecedentes: La depresión, un trastorno que afecta principalmente a mujeres fértiles, es la primera causa de discapacidad en mujeres chilenas. Objetivo: Destacar los conocimientos actuales más importantes acerca de la depresión en el embarazo y el puerperio. Método: Se resumen los resultados de varios estudios en el contexto de una revisión de la literatura. Resultados: Un tercio de las mujeres chilenas presenta síntomas de depresión y/o ansiedad durante el embarazo, mientras que la prevalencia en el posparto supera el 40 por ciento. Si se utilizan criterios operacionales estrictos, se encuentra que una de cada diez embarazadas/puérperas está deprimida. Se ha visto que la depresión persistente en mujeres embarazadas se asocia a retraso en el desarrollo de sus niño (a)s y aun riesgo de depresión 4,7 veces mayor en la adolescencia. La depresión posparto se asocia a coeficientes intelectuales más bajos en la preadolescencia, y a conductas violentas. En la actualidad se dispone de diferentes tipos de psicoterapia y medicamentos que pueden ser utilizados en este período de la vida. Entre los antidepresivos, los inhibidores de la recaptura de serotonina son los más usados. Conclusiones: La depresión pre y posparto son altamente prevalentes y debe considerarse tanto el impacto de no tratar, como de tratar, la depresión grávido/puerperal.

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.

Depressão pós-parto: tratamento baseado em evidências / Postpartum depression: treatment based on evidences

A depressão pós-parto é uma condição clínica séria no puerpério, atingindo aproximadamente 10 a 20% das mulheres nos seis primeiros meses após o parto, sendo muitas vezes não-investigada nem diagnosticada, com impacto negativo para a mãe e a criança. Fatores de risco biológicos e psicossociais têm sido descritos na literatura, relacionados com a depressão pós-parto, porém, seu mecanismo fisiopatológico ainda não é totalmente esclarecido. Objetivou-se com este trabalho avaliar criticamente a literatura científica quanto ao tratamento da depressão pós-parto, com base na literatura disponível. Há evidência de eficácia de algumas intervenções terapêuticas como psicoterapia, antidepressivos e exercício físico no tratamento entre 1 e 12 semanas de duração. Dificuldades para a adesão e continuidade da terapia envolvem o temor de efeitos indesejáveis das medicações sobre os lactentes no início do uso destas e sobre as crianças no longo prazo, além da dificuldade de acesso ao acompanhamento psicológico.

Postpartum depression is a serious clinical condition during the postnatal period, affecting from 10 to 20% of women during the first six months after delivery, being most of the time underscored and undiagnosed, with negative impact on the mother and the infant. Biological and psychosocial risk factors have been described in the literature, but its physiopathology is still unclear. The objective of this article was to critically appraise the literature in regards to the treatment of postpartum depression, based on evidence. There is evidence of some therapeutic interventions efficacy such as psychotherapy, antidepressant medications and physical activity between 1 and 12 weeks of treatment. Barriers to the treatment include fear of adverse effects on the infants at the beginning of the treatment and in the long term and low access to psychotherapy.

Depresión posparto en el embarazo adolescente: análisis del problema y sus consecuencias / Adolescent pregnancy and postpartum depression

El embarazo adolescente es un importante problema de Salud Pública, que se asocia a consecuencias biológicas, psicológicas y sociales negativas tanto para la madre como para el hijo. Uno de los riesgos frente a los que las madres adolescentes están particularmente vulnerables es a la depresión posparto (DPP). Existen extensas investigaciones sobre el fenómeno de la DPP, pero los estudios en madres adolescentes son limitados y suelen provenir de países desarrollados. En Chile no existen estudios publicados que se aboquen específicamente a la DPP en adolescentes. Por lo mismo, es que esta revisión pretende dar cuenta de los principales hallazgos internacionales y nacionales sobre prevalencia, factores de riesgo, consecuencias y abordaje de la DPP en general, y en madres adolescentes en particular, con el propósito de fortalecer el conocimiento de los profesionales que trabajan con estas jóvenes, ya sea en el área de salud mental, obstetricia o pediatría.

Adolescent pregnancy is an important public health issue associated with negative biological, psychological and social consequences for the mother and the child. One of the main risks adolescent mothers is particularly vulnerable to postpartum depression. Literature on postpartum depression is broad, but studies regarding the phenomenon in adolescent mothers are scarce, and come mostly from developed countries. In Chile there are no published studies centered on postpartum depression in adolescents. Therefore, this article aims to describe the main international and national findings on the prevalence, risk factors, consequences and management of postpartum depression in general, and in adolescents in particular, with the goal of strengthening the knowledge of professionals caring for adolescent mothers in mental health, obstetric and pediatric services.

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.