What does Chilean research tell us about postpartum depression (PPD)?

BACKGROUND: In Chile, a country with a so called emerging market-economy, where rapid social and life style changes are taking place, women and the more socially disadvantaged are more at risk of becoming depressed. METHODS: 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 midpregnancy, while prevalence figures both in the early and the late postpartum period increase up to 50% in most studies. If strict operational criteria describing well defined depressive disorders are used postnatally, differences in prevalence and incidence figures arise depending on socioeconomic status. Whereas incidence rates for postpartum depression (around 9%) are very similar to those found in the northern hemisphere and do not appear to vary across different socioeconomic levels, higher prevalence rates are found among women from lower socioeconomic status. LIMITATIONS: The studies focused on current diagnostic entities and did not consider different clusters or dimensions. CONCLUSION: A shared biological etiology may be triggered by the physiology of childbirth and account for similarities in incidence across different socioeconomic levels. In turn, we hypothesize that the higher prevalence of postpartum depression (PPD) in Chilean women from lower socioeconomic status is the result of pre-existing depression and is not caused by more new cases of the illness.

Expressed emotion in the families of young people with epilepsy.

The parents of 41 young people with epilepsy who were living in the same household as the patients were interviewed using the Camberwell Family Interview, and ratings of expressed emotion (EE) carried out according to standard criteria. The presence of any seizures in the 6 months prior to interview was found to be a predictor of EE (p= 0. 0017). Absolute seizure frequency, as well as presence or absence of seizures was also found to vary with the EE score. Fathers may exhibit high EE by critical comments, mothers by emotional over involvement. Although it is unclear whether high EE is the result of seizures, or whether high EE makes seizures more likely to occur, an intervention study aimed at assessing the effect of lowering parental EE levels on young people's seizure frequency might be worth pursuing.

Validation of the Edinburgh Postnatal Depression Scale (EPDS) in Chilean postpartum women.

A validity study of the Edinburgh Postnatal Depression Scale (EPDS) against the Research Diagnostic Criteria (RDC) was carried out on a sample of women attending a health care center in Santiago. One hundred and eight middle-class mothers filled in the EPDS and were later interviewed by the main author using the Psychiatric Assessment Schedule (PAS). The internal consistency of the EPDS was reasonably good (Cronbach's alpha 0.77). Validity coefficients for the scale were calculated to determine the best case/non-case threshold which was found to be 9/10. Sensitivity, specificity and positive predictive value for this threshold were 100%, 80% and 37% correspondingly. The same best cut-off point (9/10) was found by other Chilean investigators in a sample of working-class women. The EPDS was shown to be a useful screening instrument for postnatal depression in these settings.

[Prevalence of postpartum depression and associated factors in Santiago, Chile]. / Prevalencia de depresión postparto y factores asociados en Santiago, Chile.

The aim of this study was to estimate the prevalence and factors associated to postpartum depression (PPD) in a sample of women attending clinics representative of different socioeconomic levels in Santiago. A total of 542 mothers selected from five health centres filled in the Edinburgh Postnatal Depression Scale which was used as the diagnostic criteria, a score of 10 and above being considered diagnostic of depression. Based in our findings, the prevalence of PPD would be 36.7% after adjusting for socioeconomic distribution in Santiago. An inverse relationship was found between socioeconomic status and prevalence of PPD. Mothers with lower incomes had a three-fold increase in prevalence of PPD in comparison to mothers with higher incomes. Single mothers (unmarried, separated and widows) were twice more likely to be cases of PPD.

[Depression in pregnancy and puerperium: study of risk factors]. / Depresión en el embarazo y el puerperio: estudio de factores de riesgo.

This study was aimed at determining risk factors associated to depression in pregnancy and/or the puerperium. By means of both observer-rated, and self-rated scales a 108-expectant mother sample was assessed by the co-investigators, interviewed by the principal investigator later on. The Psychiatric Assessment Schedule was used to obtain an RDC diagnosis. The same procedure was repeated 2 to 3 months after delivery. A greater exposure to life events, prior consultation for emotional problems as well as economic difficulties arising of late were all associated to depression in pregnancy and the puerperium. Getting separated from significant persons in a woman's life, and/or difficult relationships with either husband or mother have been strongly associated to depression at both periods. As regards puerperium depression, several associations directly related to childbirth (having had a low-weight baby) or the postnatal period (lactation problems) were detected. Anxiety and depressive symptoms during pregnancy have been also clearly linked to postpartum depression. The predictive value of such risk factors is discussed. It is suggested that questions on these factors should be included into ordinary health assessments of both pregnant and puerperal women.

Depresión en el embarazo y el puerperio: estudio de factores de riesgo. / [Depression in pregnancy and puerperium: study of risk factors]

This study was aimed at determining risk factors associated to depression in pregnancy and/or the puerperium. By means of both observer-rated, and self-rated scales a 108-expectant mother sample was assessed by the co-investigators, interviewed by the principal investigator later on. The Psychiatric Assessment Schedule was used to obtain an RDC diagnosis. The same procedure was repeated 2 to 3 months after delivery. A greater exposure to life events, prior consultation for emotional problems as well as economic difficulties arising of late were all associated to depression in pregnancy and the puerperium. Getting separated from significant persons in a womans life, and/or difficult relationships with either husband or mother have been strongly associated to depression at both periods. As regards puerperium depression, several associations directly related to childbirth (having had a low-weight baby) or the postnatal period (lactation problems) were detected. Anxiety and depressive symptoms during pregnancy have been also clearly linked to postpartum depression. The predictive value of such risk factors is discussed. It is suggested that questions on these factors should be included into ordinary health assessments of both pregnant and puerperal women.

Medical students' attitudes to psychiatry in Chile.

There is controversy about the influence of psychiatric clerkships on medical students' attitudes to psychiatry. In general, studies in developed countries have found a short-lasting improvement in attitudes to psychiatry after a psychiatric clerkship. The present study was designed to measure changes in medical students' attitudes following a psychiatric clerkship in a developing country. Medical students from the Faculty of Medicine, University of Chile were interviewed before and after a psychiatric clerkship using a translation into Spanish of an attitude-to-psychiatry questionnaire used previously in the UK. The results were similar to those reported from developed countries. There was a marked early improvement in students' attitudes following their psychiatric clerkship which gradually faded over 3 years. There is scope for improvement in psychiatric undergraduate medical teaching in Chile and this might help to make more lasting improvements in attitudes to psychiatry among medical students.

HLA in Chileans with intrahepatic cholestasis of pregnancy.

A possible association between intrahepatic cholestasis of pregnancy (ICP) and human-leukocyte histocompatibility (HLA) antigens--used as genetic markers--was studied in 100 women with ICP compared to 100 multiparous women without a past history of the disease. Because we previously found a higher frequency of ICP in women with an overt Araucanian Indian descent than in Chilean Caucasoids, women from both ethnic groups were studied. Among the 37 specificities of the HLA system studied (17 of HLA-A, 16 of HLA-B, and 4 of HLA-C series), only HLA-BW16 showed a tendency to be more frequent in women with ICP rather than in control women. This finding appears to be related with ethnic origin and not ICP, HLA-BW16 was significantly more frequent in women with Araucanian Indian descent (43.4%) than in Chilean Caucasoids (16.3%) (p less than 0.01). The high frequency of HLA-BW16 in the predominantly Caucasoid population in Chile, in comparison with Caucasians in Europe and in North America, may be another indicator of their ethnic admixture with aborigine groups. The high frequency of HLA-BW16 reported in North American Indian-admixed groups (16%) suggests that HLA-BW16 may be a genetic characteristic common to some aboriginal populations in North and South America.