Síntomas depresivos perinatales: prevalência y factores psicosociales asociados / Perinatal Depressive Symptoms: Prevalence and Associated Psychosocial Factors

RESUMEN La depresión perinatal es el episodio depresivo mayor que se inicia durante el embarazo o en las primeras 4 semanas posparto y genera importantes riesgos de salud para la madre y para el bebé. Se realiza un estudio descriptivo transversal a partir de 112 registros de mujeres embarazadas o en el posparto inmediato, a quienes se aplicó la escala de Edimburgo para depresión perinatal y se exploró la posible asociación con factores de riesgo psicosocial ocurridos en el último ario. La prevalencia de síntomas depresivos perinatales de importancia clínica usando la escala de Edimburgo fue del 22,36%. El modelo de regresión logística encontró asociación entre síntomas depresivos perinatales clínicamente significativos (escala de Edimburgo ≥ 12) y los siguientes factores psicosociales: finalización de la relación de pareja (OR = 6,26; IC95%, 1,91-20,49), dificultades económicas graves (OR = 6,61; IC95%, 1,86-23,45) y muerte de un familiar (OR = 3,79; IC95%, 1,12-12,74). En este estudio, 1 de cada 4 mujeres había roto con la pareja y tenía problemas económicos graves durante la gestación; además, 1 de cada 10 había sufrido la muerte de un ser querido en el último año. Estos hallazgos ofrecen la oportunidad de identificar precozmente algunos eventos psicosociales negativos como factores de riesgo de depresión perinatal, lo que permitiría dar acompañamiento y tratamiento oportuno a quienes lo requieran. © 2017 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.

ABSTRACT Perinatal depression is a major depression episode that starts during pregnancy and the postpartum period; and is an important cause of health risks in women and infants. A cross-sectional observational study was conducted with information from the records of 112 pregnant women or in the immediate postpartum period who were surveyed to determine the possible association between perinatal depressive symptoms and psychosocial factors occurring in the last year. The prevalence of clinically significant perinatal depressive symptoms using the Edinburgh scale was of22.36%. The logistic regression model found association between clinically significant perinatal depressive symptoms (score on the Edinburgh scale ≥12 and the following psychosocial factors: end of the couple's relationship (OR = 6.26; 95% CI, 1.91-20.49), severe economic problems (OR = 6.61; 95% CI, 1.86-23.45), and the death of a family member (OR = 3.79; 95% CI, 1.12-12.74). In this study one in four women had broken up with their partner and had severe economic problems during pregnancy, also one of ten had suffered the death of a loved one in the past year. These psychosocial factors were strongly associated with the presence of depressive symptoms with clinical importance. These finding offer the opportunity to consider psychosocial factors as a source of maternal stress that could be easily identified in the prenatal controls that pregnant women receive to identify women at risk of experiencing depressive symptoms in the perinatal period, which will enable appropriate treatment to be given to those who need it.

Gestation-related psychosocial factors in women from Medellin, Colombia / Factores psicosociales asociados con la gestación en mujeres de Medellín, Colombia

ABSTRACT Introduction: Perinatal stress and the impact generated by adverse conditions could affect fetal development negatively with long term and short term manifestations and could increase the risk of maternal depression. Objective: To determine the psychosocial risk factors present in women with high-obstetric risk and hospitalized in a high complexity institution. Methods: A cross-sectional study that included 112 pregnant or immediate postpartum women, who were evaluated using a scale designed by the researchers and the Edinburgh Postnatal Depression Scale. Results: Median age was 24 (RIC 9) years; 39.3% of the women were pregnant, and 65.9% had a gestational age of more than 28 weeks. The main reason for hospitalization was threat of preterm delivery in 39.2%. 52.4% planned the pregnancy and 22.3% had depressive symptoms compatible with depression. Suicidal ideas and suicide attempts were more prevalent in the first trimester (7.2% and 3.6%). Discussion: The high prevalence of depressive symptoms in the population studied coincides with what was reported in similar studies in Latin America. The fact that pregnancy does not protect against suicide was confirmed. Conclusions: Psychosocial screening is recommended in every pregnant woman and women in immediate postpartum to detect symptoms and risk factors for depression.

RESUMEN Introducción: El estrés perinatal y el impacto generado por condiciones adversas, podrían afectar negativamente el desarrollo fetal con manifestaciones a corto y largo plazo, y aumentaría el riesgo de desarrollar depresión materna. Objetivo: Determinar los factores de riesgo psicosocial presentes en mujeres con alto riesgo obstétrico hospitalizadas en una institución de alta complejidad. Metodología: Estudio transversal que incluyó 112 mujeres embarazadas o en posparto inmediato, evaluadas a través de una escala diseñada por las investigadoras y la Escala de Depresión Posparto de Edimburgo. Resultados: La mediana para la edad fue 24 anos (RIC 9). El 39,3% de las mujeres estaban embarazadas. El 65,9% tenía una edad gestacional mayor de 28 semanas. El principal motivo de hospitalización fue la amenaza de aborto en el 39,2%. El 52,4% planeó el embarazo y 22,3% tenía síntomas depresivos compatibles con depresión. Las ideas e intentos suicidas, fueron más prevalentes en el primer trimestre (7,2% y 3,6%). Discusión: Las características sociodemográficas y clínicas de la población estudiada coinciden con lo reportado previamente. La alta prevalencia de síntomas depresivos en la población estudiada coincide con lo reportado en estudios similares en Latinoamérica. Se confirma que el embarazo no protege contra el suicidio. Conclusiones: Se recomienda incluir tamización psicosocial a toda mujer en embarazo y post parto inmediato para detectar síntomas y factores de riesgo susceptibles de ser intervenidos precozmente y evitar desenlaces negativos tanto para la madre como para el neonato.

Hombres cuidadores de vida: formación en masculinidades género-sensibles para la prevención de las violencias hacia las mujeres en Medellín / Men caretakers of life: Training in gender-sensitive masculinities for the prevention of violence towards women in Medellin

Las estrategias de formación dirigidas a hombres para reflexionar sobre los patrones culturales del patriarcado son una alternativa para la promoción de los derechos humanos, la prevención de la violencia hacia las mujeres y transversalizar la equidad de género en las políticas públicas. Con un enfoque pedagógico crítico social, se llevó a cabo una diplomatura de formación en equidad de género y masculinidades género-sensibles, dirigida a un grupo de 76 hombres servidores públicos y líderes sociales de la ciudad colombiana de Medellín, con el propósito de cuestionar su socialización de género en el modelo patriarcal, dirigido a la formulación y ejecución de proyectos sociales, educativos o comunicacionales. Los proyectos planteados por los participantes critican la construcción androcéntrica, sexista y discriminatoria de los discursos sobre las mujeres que circulan de forma predominante en sus ámbitos educativos, laborales y familiares, con un compromiso político de género y respeto por la diversidad.

The training strategies targeted at men so as to reflect on the cultural patterns of patriarchy are an alternative in the promotion of human rights, the prevention of violence towards women and the mainstreaming of gender equality in public policies. With a socio-critical pedagogical approach, we conducted a Training Certification Program in gender equality and gender-sensitive masculinities, for a group of 76 male civil servants and civic leaders in the Colombian city of Medellin, for the purpose of questioning their gender socialization in the patriarchal model, directed towards the development and execution of social, educational or communications projects. The projects proposed by the participants criticize the andro-centric, sexist and discriminatory discourses regarding women that circulate in a manner predominant in their academic, workplace and family ambits, with a gender political commitment and respect for diversity.

Prevalencia de abuso y dependencia de alcohol en adultos con fobia social en Medellín / Prevalence of Alcohol Abuse and Dependence in Adults With Social Phobia in Medellin

Introducción: Presentar fobia social podría inducir al consumo de alcohol para tener mayor asertividad social, corriendo el riesgo de convertir dicho consumo en trastorno por abuso o dependencia al alcohol. El objetivo del estudio es estimar la prevalencia de comorbilidad entre fobia social y consumo patológico de alcohol en adultos de la ciudad de Medellín y el comportamiento de la comorbilidad según el género, edad, presencia de figura paterna en la niñez y nivel educativo. Metodología: Análisis secundario de la base de datos del Primer Estudio Poblacional de Salud Mental realizado en la ciudad de Medellín en los años 2011-2012 basado en la metodología que guió al Estudio Mundial de Salud Mental coordinado por la OMS-HARVARD. Resultados: La prevalencia de vida para abuso y dependencia en quienes tienen fobia social fue del 24,1% y 11,2% respectivamente. Para personas sin fobia social las prevalencias fueron del 13% para abuso y 4,4% para dependencia (OR = 2,11 para abuso; OR = 2,46 para dependencia). La prevalencia anual de personas con fobia social que abusen o dependan de alcohol, fue de 7,8% y 5,9% respectivamente frente a los que no padecen del trastorno con prevalencias del 3,4% y 1,7% (OR = 2,39 para abuso y OR = 3,57 para dependencia). Discusión: Se encontró asociación muy significativa en las prevalencias de vida y anual entre fobia social y el consumo patológico de alcohol. De igual manera se encontró relación estadísticamente significativa respecto a las variables asociadas a la fobia social; sin embargo, se necesitan más estudios para confirmar o rechazar estas asociaciones.

Introduction: Having a social phobia may lead to consuming alcohol for greater social assertiveness, running the risk of leading to an abuse disorder or alcohol dependence. The aim of the study was to estimate prevalence of pathological comorbidity between social phobia and alcohol consumption in adults of the city of Medellin, and the behavior of comorbidity by gender, age, presence of a father figure in childhood, and education. Methods: Secondary analysis of the database of the first Mental Health Population Survey conducted in the city of Medellin in 2011 and 2012 based on the methodology of the World Mental Health Survey guidelines and coordinated by WHO-HARVARD. Results: The lifetime prevalence of abuse and dependence in people with social phobia was 24.1% and 11.2%, respectively. For people with social phobia the prevalence was 13% for abuse and 4.4% for dependence (OR = 2.11 for abuse, OR = 2.46 for dependence). Annual prevalence of people with social phobia who abused or were dependent on alcohol was 7.8% and 5.9%, respectively, compared to those who do not suffer from this disorder, with a prevalence of 3.4% and 1.7%, respectively (OR = 2.39 for abuse and OR = 3.57 for dependence). Discussion: There was significant correlation in the annual and lifetime prevalence between social phobia and the pathological consumption of alcohol. Statistically significant relationships were found for the variables associated with social phobia, however, more work is needed to confirm or refute these associations.

Quemaduras intencionales con ácido. Nuevas expresiones de violencia contra la mujer en Medellín, Colombia. Serie de casos / [Deliberate burning with acid. New expressions of violence against women in Medellín, Colombia. Series of cases].

INTRODUCTION: The deliberate burns with acid are recognized as violence against women described in the 17th century. However, in the second half of the 20th Century this practice becomes frequent in South East Asia, Africa and Middle East. In Latin America is a recent phenomena over which little has been published in the scientific literature. OBJECTIVE: To describe the clinical and psychic-pathological characteristics of 8 Colombian women burned with acid in the context of violence based on gender. METHOD: retrospective series of cases, patients admitted at a university hospital in a period of 7 years after being burned with acid within the context of hetero-aggression. The patients were attended by a group of interdisciplinary health professionals, including the psychiatrists. The psychiatric analyses were carried out parting from the non structured psychiatric interview complying with diagnostic criteria of the Statistic and Diagnostic Manual. RESULTS: Eight women with an average age of 29.5 years were attacked with acid in a period of 8 years. The context for the aggression was violence based on gender. All the attackers were males. The body surface burned was 24

in average. The ocular involvement was present in 80

of the cases, two of them with bilateral blindness. The direct aggressor was the partner in three cases. The reason for the attack was jealousy and revenge due to rejection to sexual or love advancements or pretensions. CONCLUSIONS: The burns with acid constitute a new expression of the violence based on gender in Colombia. This type of aggressions generates suffering, rejection and social isolation and although, it does not have the intent to cause death to the victim, it does leave permanent scars of the aggression.

Esquizofrenia después de los 40 y su relación con los estrógenos: una revisión / [Schizophrenia after forty and its relation with estrogens].

There has been a lot of interest in the many aspects of women’s mental health especially after Kraepelin’s description of gender differences in 1896 and the implication of gonad hormones in explaining these differences. Studies on the effects of hormonal changes in mental health have mainly been focused on the various phases of the menstrual cycle, pregnancy and postpartum period; however, there is little research regarding menopause. During this period women are at risk of developing a new schizophrenic illness the so-called ’second peak’. Research has shown that estrogen acts as a protective factor due to its anti-dopaminergic properties, thus providing an explanation for the risk increase of a new psychotic disorder during menopause. This review article highlights the importance of a clear understanding of this phase of life in patients suffering from or who present a risk of developing schizophrenia.

Psicopatología y género: visión longitudinal e histórica a través del DSM / Psychopathology and gender: longitudinal and historical view through DSM

Introducción: El estudio del género y sus efectos en la salud mental es un fascinante y creciente campo de la investigación clínica. La exclusión de mujeres en la mayoría de estudios clínicos ha dado lugar a vacíos importantes sobre las enfermedades mentales y su tratamiento. Objetivos: (a) Examinar áreas relevantes de la relación entre el género y la vulnerabilidad a los trastornos mentales; (b) a la luz de investigaciones recientes, revisar la historia del uso del género en las cuatro versiones del Manual diagnóstico y estadístico de los trastornos mentales (DSM), y (c) evidenciar posibilidades, ventajas y desventajas de la activa consideración de género en DSM-V, que se va a publicar dentro de los próximos cuatro o cinco años. Método: La búsqueda de estudios fue realizada a través de las bases de datos: PubMed, Medline, Ovid, LILACS y SciELO. Resultado y conclusión: La enfermedad mental es el resultado de una compleja matriz de factores, como perfil genético, experiencias recientes y eventos vitales tempranos, apoyo social, creencias religiosas y, por supuesto, el género...

Introduction: The study of gender and its effects on mental health is a fascinating and growing field of clinical research. The exclusion of women in most clinical studies has generated significant gaps in our knowledge about mental illnesses and their treatments. Objectives: (a) First, to examine relevant areas of the relationship between gender and vulnerability to mental disorders; (b) on the basis of recent research, to review the history of the use of gender in the four versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and, finally, (c) to show the possibilities, advantages and disadvantages of an active consideration of gender in DSM-V, to be published within the next four or five years. Method: The search for studies was conducted through the following databases: PubMed, Medline, Ovid, LILACS, and SciELO. Results and conclusion: Mental illness is the result of a complex matrix of factors such as genetic profile, recent experiences and early life events, social support, religious beliefs, and, of course, gender...