"Social support and stressful life events: risk factors for antenatal depression in nulliparous and multiparous women".

Nulliparous (pregnant women who are giving birth for the first time) and multiparous (women who have multiple children) may have different concerns, which may be associated with risk of antenatal depression. This study aims to examine the role of social support and stressful life events as risk factors for antenatal depression in nulliparous and multiparous women. The sample included 1,524 pregnant women recruited from an obstetrics setting at the end of the first trimester of pregnancy from two Spanish tertiary-care public hospitals. The sample completed the Patient Health Questionnaire (PHQ-9), and the "social support" and "stressful life events" subscales of the Postpartum Depression Predictor Inventory-Revised (PDPI-R). Nulliparous women reported a lower prevalence of depressive symptoms (15.6 percent) compared to multiparous mothers (20.1 percent). In both groups, marriage/partner problems (NP: ß = 0.178, p < .01 vs MP: ß = 0.164, p < .01) and a perceived lack of instrumental support from friends (NP: ß = -0.154, p < .01 vs MP: ß = -0.154, p < .01) were significant risk factors for antenatal depression. However, nulliparous women have more risk factors such as unemployment (ß = 0.096, p < .05), job change (ß = 0.127, p < .01), financial problems (ß = 0.145, p < .01) and lack of instrumental support from partner (ß = -0187, p < .01). For multiparous women, moving (ß = 0.080, p < .05) and lack of instrumental support from family (ß = -0.151, p < .01) were risk factors. These results suggest the critical need for screening and designing preventive interventions adapted and taking into consideration parity to provide more effective health care during pregnancy.

Early Association Factors for Depression Symptoms in Pregnancy: A Comparison between Spanish Women Spontaneously Gestation and with Assisted Reproduction Techniques.

Women with assisted reproduction techniques (ART) have a different psychological profile than women with a spontaneous pregnancy. These differences may put the former group at higher risk for depressive symptomatology. Our aim was to determine what sociodemographic factors and psychological variables interact with early depressive symptoms in pregnant women with ART. This is a cross-sectional, non-interventional, and observational study where a total of 324 women were analyzed in the first trimester of pregnancy at the Hospital Universitario Central de Asturias (Spain). Women completed a sociodemographic questionnaire, the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item Scale, the Resilience inventory, the General concerns (ad hoc scale), the Stressful life events, and the prenatal version of Postpartum Depression Predictors Inventory-Revised (PDPI-R), including socioeconomic status, pregnancy intendedness, self-esteem, partner support, family support, friends support, marital satisfaction, and life stress. According to our models, women undergoing ART had significantly increased the PHQ-9 scores (ß = 6.75 ± 0.74; p-value < 0.001). Being single also increased the PHQ-9 score. Related to the psychological variables, anxiety (ß = 0.43 ± 0.06; p-value < 0.001) and stressful life events (ß = 0.17 ± 0.06; p-value = 0.003) increased PHQ-9 scores. In contrast, resilience (ß = -0.05 ± 0.02; p-value = 0.004), self-esteem (ß = -1.21 ± 0.61; p-value = 0.048), and partner support (ß = -1.50 ± 0.60; p-value = 0.013) decreased PHQ-9 scores. We concluded that women undergoing ART need interventions to reduce anxiety and stressful life events, and to improve resilience, self-esteem, and emotional partner support to prevent depressive symptomatology during this important phase in their lives.

Validation of the generalized anxiety disorder screener (gad-7) in Spanish pregnant women / Validación de la Escala de Cribado del Trastorno de Ansiedad Generalizado (GAD-7) en mujeres embarazadas españolas

BACKGROUND: Anxiety during pregnancy is one of the most common mental health problems and a significant risk factor for postpartum depression. The Generalized Anxiety Disorder-7 (GAD-7) is one of the most widely used self-report measures of anxiety symptoms available in multiple languages. This study evaluates the psychometric properties and underlying factor structures of the Spanish GAD-7 among pregnant women in Spain. METHOD: Spanish-speaking pregnant women (N = 385) were recruited from an urban obstetrics setting in Northern Spain. Women completed the GAD-7 and the anxiety subscale of the Symptom Checklist (SCL90-R) at three time points, once per trimester. The reliability, concurrent validity, and factor analyses were conducted to evaluate the psychometric properties and factor structure, respectively. RESULTS: In the first trimester, the GAD-7 demonstrated good internal consistency (a = 0.89). GAD-7 is positively correlated with SCL90-R (anxiety subscale; r = 0.75; p < 0.001). The proposed one-factor structure is found using exploratory factor analysis -FACTOR program - with Unweighted Least Squares procedure and optimal implementation of parallel analysis (GFI = 0.99). CONCLUSIONS: Health providers should screen for anxiety using the GAD-7 during pregnancy among urban Spanish-speaking samples to provide appropriate follow-up care

ANTECEDENTES: la ansiedad durante el embarazo es uno de los problemas de salud más comunes y un factor de riesgo para la depresión posparto. El Trastorno de Ansiedad Generalizada-7 es una de las medidas de autoinforme de síntomas de ansiedad más utilizadas en varios idiomas. Este estudio evalúa las propiedades psicométricas y la estructura factorial del GAD-7 español en mujeres embarazadas. MÉTODO: se reclutaron mujeres embarazadas (N = 385) de un entorno de obstetricia urbana en el norte de España. Las mujeres completaron el GAD-7 y la subescala de ansiedad del SCL90-R en tres puntos temporales. La fiabilidad, la validez concurrente y los análisis factoriales se realizaron para evaluar las propiedades psicométricas y las estructuras factoriales, respectivamente. RESULTADOS: en la primera toma de medidas el GAD-7 demostró una buena consistencia interna (a = 0.89). GAD-7 se correlaciona positivamente con SCL90-R (subescala de ansiedad; r = 0.75; p < 0.001). Mediante análisis factorial exploratorio - programa FACTOR, extracción de factores de mínimos cuadrados no ponderados, análisis paralelo con implementación óptima - se obtiene una estructura unifactorial (GFI = 0.99). CONCLUSIONES: los profesionales deberían evaluar la ansiedad usando el GAD-7 durante el embarazo entre muestras urbanas de habla hispana para brindar atención adecuada

Validation of the Generalized Anxiety Disorder Screener (GAD-7) in Spanish Pregnant Women.

BACKGROUND: Anxiety during pregnancy is one of the most common mental health problems and a significant risk factor for postpartum depression. The Generalized Anxiety Disorder-7 (GAD-7) is one of the most widely used self-report measures of anxiety symptoms available in multiple languages. This study evaluates the psychometric properties and underlying factor structures of the Spanish GAD-7 among pregnant women in Spain. METHOD: Spanish-speaking pregnant women (N = 385) were recruited from an urban obstetrics setting in Northern Spain. Women completed the GAD-7 and the anxiety subscale of the Symptom Checklist (SCL90-R) at three time points, once per trimester. The reliability, concurrent validity, and factor analyses were conducted to evaluate the psychometric properties and factor structure, respectively. RESULTS: In the first trimester, the GAD-7 demonstrated good internal consistency (a = 0.89). GAD-7 is positively correlated with SCL90-R (anxiety subscale; r=0.75; p < 0.001). The proposed one-factor structure is found using exploratory factor analysis -FACTOR program - with Unweighted Least Squares procedure and optimal implementation of parallel analysis (GFI = 0.99). CONCLUSIONS: Health providers should screen for anxiety using the GAD-7 during pregnancy among urban Spanish-speaking samples to provide appropriate follow-up care.

The Psychometric Properties of the Patient Health Questionnaire-4 for Pregnant Women.

Background: Perinatal anxiety and depression are common complications during pregnancy. The purpose of this study was to examine the item characteristics, reliability, validity, and factorial structure of the four-item Patient Health Questionnaire-4 (PHQ-4) and to determine the associations between scale scores and sociodemographic factors in a sample of pregnant women from Spain. Method: A total of 845 pregnant women were recruited from two public hospitals in Spain between 2014 and 2016. Participants completed a self-report questionnaire that included Patient Health Questionnaire-4, including the two-item Patient Health Questionnaire and the two-item Generalized Anxiety Disorder Screener. Results: Exploratory and confirmatory factor analysis and scale inter-correlations between the PHQ-4 and PHQ-9 revealed that the PHQ-4 has a bivariate structure and adequately assesses the dimensions of antenatal anxiety and depression. Conclusion: The PHQ-4 is a reliable and valid instrument to screen for depression and anxiety during pregnancy. The PHQ-4 is an ultra-brief measure that can be used to screen for antenatal depression and anxiety to prevent the negative consequences associated with these mental health conditions among mothers and infants.

The Prevalence and Risk Factors for Antenatal Depression Among Pregnant Immigrant and Native Women in Spain.

Introduction: The aim was to examine the risk factors of anternatal depression among immigrant and native pregnant women in Spain. Method: A total of 1,524 pregnant women completed the Patient Health Questionnaire and the Postpartum Depression Predictors Inventory-Revised form. Results: The native group reported a lower prevalence (15.2%) compared with immigrant group (25.8%). For immigrants, primiparity, moving, and perceived lack instrumental support from friends or emotional support from partners and family members were significant risk factors. Discussion: The study identified risk factors that can be used for preventive interventions during pregnancy. Significance: Screening and interventions for depression during pregnancy should take migration status into account to maximize effective health care. Also, health providers should consider how migration status can result in different risk factors that affect depression during pregnancy.

Preventing perinatal depression in Spain: a pilot evaluation of Mamás y Bebés.

Objective: This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of a cognitive-behavioural intervention to prevent perinatal depressive symptoms in pregnant women at high risk for perinatal depression in Spain. Background: Perinatal depression (PD) can negatively affect maternal and infant outcomes. Mamás y Bebés/The Mothers and Babies Course (MBC) is an evidence-based CBT intervention aimed at teaching women at high risk for depression mood regulation skills to prevent depression in the United States, including Spanish-speaking perinatal women in the United States. However, there is limited research on preventive interventions for PD in Spain. Method: Pregnant women screened for high risk for PD were recruited in their first trimester in an obstetrics clinic at two urban hospitals in Spain. In a non-experimental design, 30 women completed eight weekly group sessions of the MBC. The Patient Health Questionnaire was the main depression outcome at four time points: pre-intervention, post-intervention, and at 3 months and 6 months postpartum. Participants completed an evaluation questionnaire at the end of each session to assess the acceptability of the intervention. Results: The MBC was effective in reducing depressive symptoms from baseline to all three time points: post-intervention, 3 and 6 months postpartum. Attendance was high (76.7% attended all eight sessions). Mothers reported positive feedback from the participating in the MBC. Conclusion: This pilot study suggests that the intervention is feasible, acceptable, and provides promising evidence for reducing depressive symptoms in urban Spanish perinatal women. Larger and rigorous randomised trials are needed to confirm these findings.

Incidence, prevalence and risk factors related to anxiety symptoms during pregnancy / Incidencia, prevalencia y factores de riesgo relacionados con los síntomas de ansiedad durante el embarazo

BACKGROUND: Symptoms of anxiety are one of the most prevalent emotional responses in women during their reproductive phase and especially during pregnancy. Objective: Estimate the incidence and prevalence of anxiety throughout the three trimesters of pregnancy in addition to studying the possible risk factors associated with anxiety symptoms. Method: A sample of 385 pregnant women participated in a longitudinal study in which the GAD-7 questionnaire was used. Results: Anxiety prevalence was 19.5% in the first trimester. In the second trimester, it was 16.8%, with an incidence of 0.048%. In the third trimester, it was 17.2%, with an incidence of 0.068%. The following predictive factors of anxiety symptoms were identified: being a smoker, presence of previous illness and changes in social relationships. Conclusions: High incidence and prevalence of anxiety symptoms occur during pregnancy; consequently, applicable preventive policies should be developed

ANTECEDENTES: Los síntomas de ansiedad son una de las respuestas emocionales más prevalentes en las mujeres durante su fase reproductiva y especialmente en el embarazo. Objetivo: estimar la incidencia y prevalencia de la ansiedad a lo largo de los tres trimestres del embarazo además de estudiar los posibles factores de riesgo asociados a los síntomas de ansiedad. Método: una muestra de 385 gestantes participaron en un estudio longitudinal en el que se utilizó el cuestionario GAD-7. Resultados: la prevalencia fue de 19,5% en el primer trimestre. En el segundo trimestre fue de 16,8%, y una incidencia de 0.048%. En el tercer trimestre fue de 17,2%, y la incidencia de 0.068%. Como factores predictores de los síntomas de ansiedad se han encontrado: ser fumadora, la presencia de enfermedades previas y cambios en las relaciones sociales. Conclusiones: durante el embarazo aparecen unas altas tasas de incidencia y prevalencia en los síntomas de ansiedad, por lo que se deberían desarrollar políticas preventivas al respecto

Incidence, prevalence and risk factors related to anxiety symptoms during pregnancy.

Symptoms of anxiety are one of the most prevalent emotional responses in women during their reproductive phase and especially during pregnancy. OBJECTIVE: Estimate the incidence and prevalence of anxiety throughout the three trimesters of pregnancy in addition to studying the possible risk factors associated with anxiety symptoms. METHOD: A sample of 385 pregnant women participated in a longitudinal study in which the GAD-7 questionnaire was used. RESULTS: Anxiety prevalence was 19.5% in the first trimester. In the second trimester, it was 16.8%, with an incidence of 0.048%. In the third trimester, it was 17.2%, with an incidence of 0.068%. The following predictive factors of anxiety symptoms were identified: being a smoker, presence of previous illness and changes in social relationships. CONCLUSIONS: High incidence and prevalence of anxiety symptoms occur during pregnancy; consequently, applicable preventive policies should be developed.

[PHQ-2 as First Screening Instrument of Prenatal Depression in Primary Health Care, Spain]. / PHQ-2 como primer instrumento de cribado de la depresión prenatal.

OBJECTIVE: Prenatal depression is a major public health problem that is barely treated. Based on existing literature, depression during this period is associated with negative consequences for the mother and the baby. Therefore it is important to make an adequate screening in this population. The aim of this study was to determine the discriminant validity and cut-off of the Patient Health Questionnaire (PHQ-2) as a screening tool to identify the depression in pregnant women living in Spain. METHODS: The sample included 1,019 female participants, aged between 19 and 45 years, who participated voluntarily, and received prenatal care during the first trimester. Participants completed a sociodemographic questionnaire, PHQ-2 andPHQ-9. The research has been developed within the Obstetrics and Gynecology department at two public hospitals in two different Spanish Regions. The research was conducted between 2014 and 2016 performing a ROC curve analysis to determine the discriminative capacity and cut-off for PHQ-2. RESULTS: 11,1 % out of 1019 participants were diagnosed with depression. The area under the curve of PHQ-2 was 0,84 p smaller than 0,001. With the cutoff 2 the sensitivity and specificity of 85,4 % and 79,5% respectively. CONCLUSIONS: A score Equal or greater than 2 is an appropriate cut-off in PHQ-2 to detect depression during pregnancy. The use of PHQ-2 could precede PHQ-9 as a brief screening tool for antenatal depression in obstetric settings.

OBJETIVO: La depresión prenatal es un importante problema de salud pública que apenas recibe tratamiento. La depresión durante este período está asociada con consecuencias negativas tanto para la madre como para el bebé. Por ello, es importante realizar un cribado adecuado en mujeres embarazadas. El objetivo del presente estudio fue conocer la capacidad discriminativa y el punto de corte del cuestionario PHQ-2 como primer instrumento de cribado para identificar la depresión en mujeres embarazadas que viven en España. METODOS: Participaron voluntariamente 1.019 mujeres, de edad comprendida entre los 19 y los 45 años, que acudieron a revisión obstétrica en el primer trimestre del embarazo. Las participantes completaron un cuestionario sociodemográfico y los cuestionarios PHQ9 y PHQ2. La investigación fue desarrollada en dos hospitales públicos de dos comunidades autónomas diferentes. Se llevó a cabo entre los años 2014 y 2016. Se realizó un análisis con curva ROC para determinar la capacidad discriminativa y el punto de corte del PHQ-2. RESULTADOS: De las 1.019 participantes el 11,1% fueron diagnosticadas de depresión. El área bajo la curva del PHQ2 fue de 0,84 p menor que 0,001. Con el punto de corte de 2 la sensibilidad y especificidad fueron de 85,4% y 79,5% respectivamente. CONCLUSIONES: La puntuación de corte mayor o igual 2 es adecuada para la discriminación de la depresión durante el embarazo mediante el cuestionario PHQ2 y podría servir como cribado previo al PHQ-9.

PHQ-2 como primer instrumento de cribado de la depresión prenatal / PHQ-2 as frst screening insstrument of prenatal depression in primary healtg care, Spain

Fundamentos: La depresión prenatal es un importante problema de salud pública que apenas recibe tratamiento. La depresión durante este período está asociada con consecuencias negativas tanto para la madre como para el bebé. Por ello, es importante realizar un cribado adecuado en mujeres embarazadas. El objetivo del presente estudio fue conocer la capacidad discriminativa y el punto de corte del cuestionario PHQ-2 como primer instrumento de cribado para identificar la depresión en mujeres embarazadas que viven en España. Método: Participaron voluntariamente 1.019 mujeres, de edad comprendida entre los 19 y los 45 años, que acudieron a revisión obstétrica en el primer trimestre del embarazo. Las participantes completaron un cuestionario sociodemográfico y los cuestionarios PHQ9 y PHQ2. La investigación fue desarrollada en dos hospitales públicos de dos comunidades autónomas diferentes. Se llevó a cabo entre los años 2014 y 2016. Se realizó un análisis con curva ROC para determinar la capacidad discriminativa y el punto de corte del PHQ-2. Resultados: De las 1.019 participantes el 11,1% fueron diagnosticadas de depresión. El área bajo la curva del PHQ2 fue de 0,84 p<0,001. Con el punto de corte de 2 la sensibilidad y especificidad fueron de 85,4% y 79,5% respectivamente. Conclusiones: La puntuación de corte ≥2 es adecuada para la discriminación de la depresión durante el embarazo mediante el cuestionario PHQ2 y podría servir como cribado previo al PHQ-9 (AU)

Background: Prenatal depression is a major public health problem that is barely treated. Based on existing literature, depression during this period is associated with negative consequences for the mother and the baby. Therefore it is important to make an adequate screening in this population. The aim of this study was to determine the discriminant validity and cut-off of the Patient Health Questionnaire (PHQ-2) as a screening tool to identify the depression in pregnant women living in Spain. Method: The sample included 1,019 female participants, aged between 19 and 45 years, who participated voluntarily, and received prenatal care during the first trimester. Participants completed a sociodemographic questionnaire, PHQ-2 and PHQ-9. The research has been developed within the Obstetrics and Gynecology department at two public hospitals in two different Spanish Regions. The research was conducted between 2014 and 2016 performing a ROC curve analysis to determine the discriminative capacity and cut-off for PHQ-2. Results: 11,1 % out of 1019 participants were diagnosed with depression. The area under the curve of PHQ-2 was 0,84 p <0,001. With the cutoff 2 the sensitivity and specificity of 85,4 % and 79,5% respectively. Conclusions: A score ≥2 is an appropriate cut-off in PHQ-2 to detect depression during pregnancy. The use of PHQ-2 could precede PHQ-9 as a brief screening tool for antenatal depression in obstetric settings (AU)

Person-based contextual therapy applid to a complex case of schizophrenia / Aplicación de la terapia contextual basada en la persona a un caso complejo de esquizofrenia

BACKGROUND: Psychological therapies are becoming more and more important in schizophrenia, and not as mere adjuncts to medication. The psychotherapy of schizophrenia is taking on a new lease of life in the wake of person-based phenomenological and psychological developments. METHOD: The case in question was a complex one, with variegated symptomatology that had persisted over many years. Approaching the case from the perspective of person-based cognitive therapy allowed us to understand the psychotic symptoms in the biographical context and to apply a therapy focused on the patient's recovery of her sense of self and of life. RESULTS: At the end of the therapy and throughout the 12-month follow-up, the psychotic experiences had practically disappeared, or ceased to be disturbing, and the patient had become re-integrated in social life. CONCLUSIONS: Psychotic symptoms take on meaning in the biographical context. Adopting this perspective can aid the psychopathological explanation of the disorder and provide significant therapeutic help, more focused on recovery. Psychological therapy has shown itself to be viable in complex cases treated within the public-sector healthcare context

ANTECEDENTES: las terapias psicológicas están siendo cada vez más importantes en la esquizofrenia, y no como meras adjuntas a la medicación. La psicoterapia de la esquizofrenia está cobrando nueva vida a la luz de desarrollos fenomenológicos y psicológicos centrados en la persona. MÉTODO: se presenta un caso complejo, de abigarrada sintomatología y larga duración, sin que hasta ahora la medicación produjera cambios clínicos significativos. La formulación del caso de acuerdo con la terapia cognitiva basada en la persona permitió entender los síntomas psicóticos en el contexto biográfico y llevar a cabo una terapia centrada en la recuperación del sentido del yo y de la vida. RESULTADOS: al final de la terapia y en el seguimiento de un año las experiencias psicóticas habían desaparecido prácticamente o dejado de ser perturbadoras y la paciente se había reintegrado en la vida social. CONCLUSIONES: los síntomas psicóticos cobran sentido en el contexto biográfico. Esto puede servir a la explicación psicopatológica y a una ayuda terapéutica significativa, más centrada en la recuperación que en el mero sostenimiento, que fácilmente termina en "abandono" asistencial y existencial. La terapia psicológica muestra ser viable en casos complejos atendidos en dispositivos públicos

Person-based contextual therapy applied to a complex case of schizophrenia.

BACKGROUND: Psychological therapies are becoming more and more important in schizophrenia, and not as mere adjuncts to medication. The psychotherapy of schizophrenia is taking on a new lease of life in the wake of person-based phenomenological and psychological developments. METHOD: The case in question was a complex one, with variegated symptomatology that had persisted over many years. Approaching the case from the perspective of person-based cognitive therapy allowed us to understand the psychotic symptoms in the biographical context and to apply a therapy focused on the patient's recovery of her sense of self and of life. RESULTS: At the end of the therapy and throughout the 12-month follow-up, the psychotic experiences had practically disappeared, or ceased to be disturbing, and the patient had become re-integrated in social life. CONCLUSIONS: Psychotic symptoms take on meaning in the biographical context. Adopting this perspective can aid the psychopathological explanation of the disorder and provide significant therapeutic help, more focused on recovery. Psychological therapy has shown itself to be viable in complex cases treated within the public-sector healthcare context.

Metacognitions in patients with hallucinations and obsessive-compulsive disorder: the superstition factor.

On the basis of the analogy between intrusive thoughts and auditory hallucinations established by Morrison et al. [(1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265-280], the present work compares the metacognitive beliefs and processes of five groups of patients (current hallucinators, never-hallucinated people with a diagnosis of schizophrenia, recovered hallucinators, obsessive-compulsive disorder (OCD) patients, and a clinical control group) and a non-clinical group. The results show that of the five metacognitive factors considered in this study, two were found to be different in the current hallucinators group in comparison to any other group in the design. Likewise, it is found that the metacognitive beliefs of the current hallucinators coincide with those of the OCD patients in various factors, particularly that relating to superstition, and this is interpreted as lending support to the model of Morrison et al. (1995). Furthermore, the results are discussed in the light of existing research on Thought-Action Fusion, stressing the role that may be played by superstitious beliefs and magical thinking in auditory hallucinations and OCD.