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Santos IS, Blumenberg C, Munhoz TN, Matijasevich A, Salum C, Santos Júnior HG, Dos Santos LM, Correia LL, de Souza MR, Lira PIC, Bortolotto CC, Barcelos R, Altafim E, Chicaro MF, Macana EC, da Silva RS. Maternal depression and child development at 3 years of age: a longitudinal study in a Brazilian child development promotion program. Pediatr Res 2024; 95:1139-1146. [PMID: 37952057 PMCID: PMC10920190 DOI: 10.1038/s41390-023-02876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/30/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND We tested the hypothesis that children of non-depressed mothers perform better in a developmental test at 3 years than children of depressed mothers. METHOD Longitudinal analysis from a trial to assess the impact of a child development promotion program in 30 Brazilian municipalities. Mothers and children were appraised at first-year post-partum, 1 and 3 years after enrollment. Child development was assessed through the Ages and Stages Questionnaire (ASQ3) and maternal depression through the Edinburgh Postnatal Depression Scale (EPDS). Crude and adjusted beta coefficients were obtained by linear regression before and after multiple imputation. RESULTS In total, 2098 mother/child dyads were included and 8.2% of the mothers had persistent depressive symptoms. There was a decrease in ASQ3 as the number of follow-ups with EPDS ≥ 10 increased (p for trend <0.001). In adjusted analysis, the direction of the association persisted but lost statistical significance. After multiple imputation, children from mothers with EPDS ≥ 10 in three follow-ups presented a decrease of about 14 points in ASQ3 (adjusted beta coefficient = -13.79; -22.59 to -5.00) (p for trend = 0.001). CONCLUSIONS Identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil. IMPACT In our population study, almost one in every ten women presented persistent depression symptoms across the first 3 years postpartum. In adjusted analysis there was a detrimental impact of persistent maternal depression on child development at 3 years of age. The persistent exposure to maternal depression across early childhood negatively influences children's development. Considering its prevalence, identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil.
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Affiliation(s)
- Iná S Santos
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
| | - Cauane Blumenberg
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
- Causale Consultoria, Pelotas, Brazil
| | - Tiago N Munhoz
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
- Curso de Psicologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Cristiane Salum
- Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, Santo André, SP, Brazil
| | | | - Letícia Marques Dos Santos
- Instituto de Humanidades Artes de Ciências da Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Luciano L Correia
- Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | | | - Pedro I C Lira
- Departamento de Nutrição do Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PB, Brazil
| | - Caroline C Bortolotto
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Raquel Barcelos
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Elisa Altafim
- Programa de Pós-Graduação em Saúde Mental, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | - Ronaldo Souza da Silva
- Secretaria de Avaliação e Gestão da Informação (SAGI), Ministério da Cidadania, Brasília, DF, Brazil
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Kawai K, Tomioka H, Yamada H, Mamiya S, Kato A, Iwanami A, Inamoto A. Effects of Parity and Postpartum Depression on Mother-Infant Bonding in the First Month Postpartum: A Retrospective Study. Cureus 2023; 15:e45585. [PMID: 37868565 PMCID: PMC10587794 DOI: 10.7759/cureus.45585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Objective This study aimed to examine the relationship between parity, postpartum depression (PPD), and mother-infant bonding (MIB) failure in the first month postpartum. Methods The study included 1,509 Japanese patients (748 primiparous and 761 multiparous). MIB was assessed using the Mother-to-Infant Bonding Scale Japanese version (MIBS-J), which was translated in 2012, and its subscales, including lack of affection (LA) and anger and rejection (AR). Postpartum depression (PPD) was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) and its subscales, including anxiety (ANX), anhedonia (ANH), and depression (DEP). Multiple regression analyses using interaction terms were performed to examine the association of parity with the MIBS-J and EPDS. Results Parity was significantly associated with AR. ANX and ANH were strongly associated with LA, and ANX and DEP were strongly associated with AR. The interaction term "parity×EPDS total" was significantly associated with MIBS-J total, LA, and AR scores. Conclusions Primiparas and mothers with high ANX had more negative emotions toward their children during the first month postpartum, and mothers with high ANX or ANH had less interest in their children.
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Affiliation(s)
- Keita Kawai
- Mental Care Center, Showa University Northern Yokohama Hospital, Kanagawa, JPN
- Department of Psychiatry, Showa University, Tokyo, JPN
| | - Hiroi Tomioka
- Mental Care Center, Showa University Northern Yokohama Hospital, Kanagawa, JPN
- Department of Psychiatry, Showa University, Tokyo, JPN
| | - Hiroki Yamada
- Mental Care Center, Showa University Northern Yokohama Hospital, Kanagawa, JPN
- Department of Psychiatry, Showa University, Tokyo, JPN
| | - Sho Mamiya
- Department of Psychiatry, Showa University, Tokyo, JPN
| | - Azumi Kato
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, JPN
| | - Akira Iwanami
- Department of Psychiatry, Showa University, Tokyo, JPN
| | - Atsuko Inamoto
- Mental Care Center, Showa University Northern Yokohama Hospital, Kanagawa, JPN
- Department of Psychiatry, Showa University, Tokyo, JPN
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Santos IS, Blumenberg C, Munhoz TN, Matijasevich A, Santos Júnior HG, Dos Santos LM, Correia LL, de Souza MR, Lira PI, Bortolotto CC, Barcelos R, Altafim E, Chicaro MF, Macana EC, da Silva RS, Victora CG. Course of depression during the first 2 years postpartum among Brazilian women enrolled in a conditional cash transfer program. Int J Soc Psychiatry 2023; 69:1193-1201. [PMID: 36938959 DOI: 10.1177/00207640231154376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Women living in low- and middle-income countries are more exposed to known risk factors for depression occurrence and persistency over time. AIM Our aim was to investigate the course of depression in the first 2 years postpartum among Brazilian women enrolled in a cash transfer program. METHOD Longitudinal analysis of baseline (T0; mean 3.7 months postpartum) and first follow-up data (T1; mean 18.6 months postpartum) from a trial to assess the impact of a child development promotion program in 30 municipalities from six Brazilian states. The program does not include any interventions against maternal depression. The Edinburgh Postnatal Depression Scale (EPDS) at cutoff ⩾10 was applied. Women were categorized into four groups based on EPDS at T0 and T1: absence of depression, persistence, discontinuity, or emergence pattern. Adjusted Poisson regressions were run using a multilevel hierarchical model. RESULTS Two thousand eight hundred sixty-three women were assessed. Prevalence of depression was 26.4% [24.8, 28.1] at T0 and 24.4% [22.8, 26.0] at T1. Persistence, discontinuation, and emergence were found in 14.1% [11.3, 17.6%], 12.8% [11.4, 14.3%], and 10.2% [8.0, 13.0], respectively. In adjusted analyses, the persistence pattern was directly associated with parity and inversely associated with schooling of the woman and of the child's father. Living with husband/partner and support from the child's father and family members during pregnancy were protective against persistence. The discontinuity and the emergence patterns were not associated with any of the exposure variables. CONCLUSIONS Depressive symptoms were highly prevalent during the first 2 years postpartum. About half of the women with depression at T1 were persistent cases that could have been detected earlier. Screening for maternal depression should be an essential component in every encounter of women with health professionals in primary health care settings.
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Affiliation(s)
- Ina S Santos
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Cauane Blumenberg
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Tiago N Munhoz
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
- Curso de Psicologia, Universidade Federal de Pelotas, Rio Grande do Sul, Brasil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Letícia Marques Dos Santos
- Instituto de Humanidades Artes de Ciências da Universidade Federal da Bahia (UFBA); Salvador, Bahia, Brazil
| | - Luciano L Correia
- Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Marta Rovery de Souza
- Departamento de Saúde Coletiva, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Pedro Ic Lira
- Departamento de Nutrição do Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Caroline C Bortolotto
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Raquel Barcelos
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Elisa Altafim
- Fundação Maria Cecília Souto Vidigal, São Paulo, São Paulo, Brazil
| | | | | | - Ronaldo Souza da Silva
- Secretaria de Avaliação e Gestão da Informação (SAGI), Ministério da Cidadania; Brasília, Federal District, Brazil
| | - Cesar G Victora
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Avila WS, Rivera MAM, Rivera IR. Depression, Cardiovascular Disease, and Female Gender: An Underestimated Triad. Arq Bras Cardiol 2023; 120:e20220858. [PMID: 37466622 PMCID: PMC10364992 DOI: 10.36660/abc.20220858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/13/2023] [Accepted: 04/05/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- Walkiria Samuel Avila
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Maria Alayde Mendonça Rivera
- Universidade Federal de AlagoasFaculdade de MedicinaMaceióALBrasilUniversidade Federal de Alagoas – Faculdade de Medicina, Maceió, AL – Brasil
| | - Ivan Romero Rivera
- Universidade Federal de AlagoasFaculdade de MedicinaMaceióALBrasilUniversidade Federal de Alagoas – Faculdade de Medicina, Maceió, AL – Brasil
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Santos IS, Munhoz TN, Barcelos RS, Blumenberg C, Bortolotto CC, Matijasevich A, Salum C, Santos Júnior HGD, Marques L, Correia L, Souza MRD, Lira PICD, Pereira V, Victora CG. Evaluation of the Happy Child Program: a randomized study in 30 Brazilian municipalities. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-812320222712.13472022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract The Happy Child Program (Programa Criança Feliz - PCF, in Portuguese) reaches 1.4 million Brazilian children under three years of age with home visits aimed at promoting neuropsychomotor development. Based on a conceptual model, PCF implementation and impact were evaluated in a randomized study in 30 municipalities. A total of 3,242 children were allocated to the intervention (IG) or control (CG) group, 80.0% of whom were prospectively followed up from late 2018 to late 2021. Development was assessed by the Ages and Stages Questionnaire (ASQ3). During the three-year study period, visits were replaced by virtual contacts for an average of 12 months due to COVID-19. At the endline survey, intent-to-treat analyses showed mean scores of 203.3 in the IG and 201.3 in the CG. Additional analyses using instrumental variables and propensity scores matching also showed no effect, since the number of contacts with the program was not associated with ASQ3 scores. No impact was observed on stimulation, responsive interactions or psychological attributes of children. The implementation study revealed low coverage in the IG, contamination of the CG, deficiencies in management and low quality of visits in many municipalities. The study did not demonstrate an impact of PCF implemented under routine conditions, but provides elements for its improvement.
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Santos IS, Munhoz TN, Barcelos RS, Blumenberg C, Bortolotto CC, Matijasevich A, Salum C, Santos Júnior HGD, Marques L, Correia L, Souza MRD, Lira PICD, Pereira V, Victora CG. Avaliação do Programa Criança Feliz: um estudo randomizado em 30 municípios brasileiros. CIENCIA & SAUDE COLETIVA 2022; 27:4341-4363. [DOI: 10.1590/1413-812320222712.13472022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 12/23/2022] Open
Abstract
Resumo O Programa Criança Feliz (PCF) atinge 1,4 milhão de crianças brasileiras menores de três anos com visitas domiciliares visando o desenvolvimento neuropsicomotor. Com base em modelo conceitual, avaliou-se implementação e impacto do PCF em estudo randomizado, em 30 municípios. Ao todo 3.242 crianças foram alocadas para o grupo intervenção (GI) ou controle (GC), sendo 80,0% acompanhadas prospectivamente durante três anos. O desenvolvimento foi avaliado pelo Ages and Stages Questionnaire (ASQ3). Análises por intenção de tratar mostraram escores médios de 203,3 no GI e 201,3 no GC. Análises adicionais com variáveis instrumentais e emparelhamento por escores de propensão tampouco mostraram efeito, uma vez que o número de contatos recebidos não esteve associado aos escores ASQ3. Tampouco foi observado impacto sobre estimulação, interações responsivas ou atributos psicológicos das crianças. As visitas foram interrompidas durante 12 meses devido à COVID-19, sendo substituídas por contatos virtuais. O estudo de implementação revelou baixa cobertura no GI, contaminação do GC, deficiências na gestão e baixa qualidade das visitas em muitos municípios. O estudo não demonstrou impacto do PCF implementado sob condições de rotina e fornece elementos para seu aprimoramento.
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Esquivel Lauzurique M, Vera Fernández Y, Dennis CL, Rubén Quesada M, Álvarez Valdés G, Lye S, Tamayo-Pérez V. Prevalence, Incidence, and Persistence of Postpartum Anxiety, Depression, and Comorbidity: A Cohort Study Among Women in Havana Cuba. J Perinat Neonatal Nurs 2022; 36:E15-E24. [PMID: 36288446 DOI: 10.1097/jpn.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To estimate the prevalence, incidence, and persistence of postpartum anxiety, depression, and comorbid symptoms over the first 6 months postpartum in a cohort of Havana women and to evaluate the sensitivity, specificity, and predictive power of the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI) at 4 weeks postpartum on depressive and anxiety symptoms at 12 and 24 weeks. METHOD A cohort study with 273 women in Havana, Cuba. Participants were assessed at 4, 12, and 24 weeks postpartum for anxiety, depression, and comorbid symptoms. RESULTS Prevalence rates were highest at 4 weeks postpartum: 20.0% women reported elevated levels of anxiety and 16.4% reported depressive symptoms. The prevalence of comorbid anxiety and depression was 5.8%. While rates of anxiety steadily decreased to 13.8% at 24 weeks, rates of depression persisted to 24 weeks postpartum with 14.5% still experiencing elevated symptoms. Comorbid anxiety and depression decreased across time. There were limited sensitivity and poor predictive values for both the STAI and the EPDS. CONCLUSION This study is the first to examine perinatal mental illness in Cuba. While anxiety and depression rates found among Cuban women are lower than those reported in other low-income countries, the rates paralleled high-income countries.
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Affiliation(s)
- Mercedes Esquivel Lauzurique
- Faculty of Medical Sciences Victoria de Girón (Dr Rubén Quesada), University of Medical Sciences of Havana, Havana, Cuba; School Health Department, Institute of Hygiene, Epidemiology and Microbiology, Havana, Cuba (Drs Esquivel Lauzurique and Tamayo-Pérez); Lunenfeld-Tanenbaum-Research Institute, Sinai Health System, Toronto, Ontario, Canada (Drs Vera Fernández and Lye); Department of Psychiatry, University of Toronto, and Li Ka Shing Knowledge Institute, St Michael's Hospital Toronto, Toronto, Ontario, Canada (Dr Dennis); and Polyclinic Julián Grimau, Havana, Cuba (Dr Álvarez Valdés)
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Lin J, Zhou Y, Gu W. The synergistic effects of short inter-pregnancy interval and micronutrients deficiency on third-trimester depression. Front Nutr 2022; 9:949481. [PMID: 36245527 PMCID: PMC9554465 DOI: 10.3389/fnut.2022.949481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To explore the effect of inter-pregnancy interval (IPI) and micronutrients on depression in the third trimester of pregnancy. Materials and methods A total of 5,951 eligible pregnant women were included in this single-center retrospective cohort study. Variables with potential effects on third-trimester depression were collected. These variables included: maternal factors [age, pregnancy interval, body mass index (BMI), BMI change, gravidity, native place, education, smoking, and alcohol consumption], previous delivery outcomes [preterm birth, preeclampsia, intrahepatic cholestasis of pregnancy (ICP), gestational diabetes mellitus (GDM), fetal growth restriction (FGR), and delivery mode], and micronutrients in early pregnancy (folic acid, 25-hydroxy vitamin D, vitamin B12, calcium, and ferritin). Univariate and multivariate analyses were used to screen the factors affecting the occurrence of depression. Based on these factors, the nomogram model was established. At the same time, the interaction between IPI and micronutrients was verified. Results The incidence of depression in the third trimester of pregnancy was 4.3%. Univariate and multivariate analysis showed that there were five independent risk factors for third-trimester depression: gravidity, previous cesarean section delivery, folic acid, and vitamin D levels in early pregnancy and IPI. According to the multivariate logistic regression analysis, the prediction model and nomogram were established. The prediction cut-offs of the corresponding factors were calculated according to the Youden index. Finally, the synergistic effect of short IPI and micronutrient deficiency was verified. Conclusion There is a synergistic effect between short IPI and micronutrient deficiency in early pregnancy, which can aggravate the occurrence of depression in late pregnancy.
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Affiliation(s)
- Jing Lin
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Ye Zhou
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Wei Gu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- *Correspondence: Wei Gu,
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Pinheiro RT, Trettim JP, de Matos MB, Pinheiro KAT, da Silva RA, Martins CR, da Cunha GK, Coelho FT, Motta JVDS, Coelho FMDC, Ghisleni G, Nedel F, Ardais AP, Stigger RS, Quevedo LDA, Souza LDDM. Brief cognitive behavioral therapy in pregnant women at risk of postpartum depression: Pre-post therapy study in a city in southern Brazil. J Affect Disord 2021; 290:15-22. [PMID: 33989925 PMCID: PMC8220301 DOI: 10.1016/j.jad.2021.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postpartum depression (PPD) affects a high number of women, often the first manifestation of a mood disorder that will occur later in life, bringing serious consequences for the patient and her offspring. Depression today is the leading cause of disability worldwide. The aim of this study was to evaluate the effectiveness of a preventive cognitive behavioral therapy (CBT) for PPD. METHODS Pre-post therapy study, as part of a population-based cohort study. Pregnant women without a diagnosis of depression participated, who were divided into two groups: risk of depression (CBT) and a control group (without therapy). The preventive therapy consisted of six sessions of CBT, administered weekly. The Outcome Questionnaire (OQ-45) was used in all sessions. The Mini International Neuropsychiatric Interview and Beck Depression Inventory-II were used on three occasions. The final statistical analyses were performed by Poisson regression. RESULTS The prevalence of PPD in the risk group was 5.5% and in the control group 2.2%, with no difference between the groups (PR 1.66 95% CI 0.44-6.18). The OQ-45 averages gradually reduced during the therapy sessions, indicating therapeutic progress. Schooling was an associated factor, both with the manifestation of PPD and with the greater effectiveness of the therapy. LIMITATIONS Rate of 40.5% refusal to preventive treatment and absence of a group with similar characteristics in another therapy model. CONCLUSIONS Brief cognitive behavioral therapy applied by mental health professionals with basic training was effective in preventing the manifestation of PPD.
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