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.

Review of suicidal ideation during pregnancy: risk factors, prevalence, assessment instruments and consequences.

BACKGROUND: Pregnancy is a period when women are particularly vulnerable to suicidal ideation and a great opportunity for suicide risk prevention. AIMS: This study aimed to establish a comprehensive understanding of suicidal ideation prevalence, risk factors, screening tools, consequences and management during pregnancy. METHOD: A literature search was performed in MEDLINE and PsycInfo databases from 2016 to 2021. A narrative synthesis of the literature and a critical overview of the current issues/questions to be addressed within the topic of suicidal ideation during pregnancy was performed. RESULTS: The prevalence of suicidal ideation during pregnancy was between 2.73 and 18% internationally. The risk factors identified were major depressive disorder, anxiety disorder, difficulties with sleep, previous suicide attempts, high rumination, low incomes, being black, being young, low educational level, partner violence, having poor support, food insecurity, history of child abuse, high obstetric risk, multiparity, previous induced abortion and exposure to tobacco or human immunodeficiency virus diagnosis. The screening tools used for suicidal ideation during pregnancy were item 10 of the Edinburgh Postpartum Depression Scale and item 9 of the Patient Health Questionnaire. Results showed that suicidal ideation during pregnancy is associated with poor cognitive development in children and low birth weight. No case management studies on suicidal ideation were found. LIMITATIONS: The main limitation of the available studies was the lack of articles with a high degree of methodological rigour on this subject. CONCLUSIONS: This narrative review is a state-of-the-art paper about suicidal ideation during pregnancy. Further research is needed, and researchers should carry out systematic reviews and meta-analyses, leading to Clinical Practice Guidelines in this area. This effort would improve our evidence-based practice in Perinatal Psychology and prevent associated suicidal behaviour.

Psychological implications of risk-reducing mastectomies in BRCA1/2 mutation carriers.

Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.

Psychological, Psychosocial and Obstetric Differences between Spanish and Immigrant Mothers: Retrospective Observational Study.

This study analyzed the influence of psychological and psychosocial factors of pregnant women at an obstetric level. The possible differences between Spaniards and immigrants were studied. This was a retrospective observational study. The sample has been divided into two study cohorts, one consisting of Spanish pregnant women and one consisting of foreign pregnant women. Both completed the Revised Postpartum Depression Predictors Inventory and the Patient Health Questionnaire-9. A total of 15.9% of Spanish women and 23.2% of immigrants had depressive symptoms. Immigrants claim to have less support at the partner, family, and friendship levels than Spaniards. Moreover, 16.4% of Spaniards vs. 8.1% of immigrants had pregnancy complications; Cesarean section was performed in 16.2% of Spaniards vs. 7.9% of immigrants. A greater number of premature births were detected in immigrants than in Spaniards. Access to universal healthcare is a protective factor against socioeconomic and cultural conditions affecting the mental and obstetrical health of immigrants.

Psychological implications of risk-reducing mastectomies in BRCA1/2 mutation carriers. / Aspectos psicológicos en las mastectomías reductoras de riesgo en mujeres portadoras de mutación patogénica BRCA1/2.

Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.

Breast Cancer Management During COVID-19 Pandemic in Madrid: Surgical Strategy.

BACKGROUND: From the first case of SARS-CoV-2 infection in Wuhan (China), the infection spread all around the world causing a pandemic of coronavirus disease-2019 (COVID-19). Spain has been one of the most severely affected countries, and Madrid has reported a high number of cases and deaths. We discuss our strategies for optimal breast cancer management during COVID-19 pandemic. PATIENTS AND METHODS: This was a retrospective observational study at Clínico San Carlos Hospital to analyze the management of patients with breast cancer during the pandemic outbreak and the surgical strategy after the pandemic outbreak. We created a practical and dynamic tool based on a "traffic light" system for prioritizing surgical time. Every patient was contacted by telephone with a preoperative COVID-19 protocol. After surgical procedures, patient satisfaction was assessed using the European Organisation for Research and Treatment of Cancer in-patient satisfaction with cancer care questionnaire (EORTC IN-PATSAT32). RESULTS: Patients with breast cancer actively treated with surgical procedures were put on a waiting list and received systemic therapy. Telemedicine was used to evaluate any side effects and to avoid unnecessary hospital visits. Surgery was only considered after the pandemic outbreak, and then, only those procedures designed to minimize surgical complications and, therefore, reduce hospital stay. We also measured patients' satisfaction with medical and nursing scales that resulted in a "very good" evaluation tending to "excellent". CONCLUSION: It is necessary to adapt management of oncology treatment and surgical strategy to optimize resources during the COVID-19 pandemic. Patients' perception of care quality and the degree of patients' satisfaction with health services has potential relevance in the absence of outcome data.

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.

The structure of the Patient Health Questionnaire-9 in pregnant women in Spain.

OBJECTIVE: To evaluate psychometric properties and the factor structure of the Spanish version of the Patient Health Questionnaire (PHQ-9) in pregnant women received care in an urban public hospital in Spain. RESEARCH DESIGN/SETTING: In a cross-sectional study, the reliability and factor structure were examined. Exploratory and confirmatory factor analyses were conducted to examine the latent structure of the PHQ-9 with a pregnant Spanish-speaking sample (n = 445) recruited during the first trimester in an obstetrics clinic in Madrid. MEASUREMENTS AND FINDINGS: The Spanish version of PHQ-9 had moderate internal consistency (α = 0.81). Exploratory factor analysis revealed a two-factor (cognitive-affective, somatic) and three-factor (cognitive-affective, somatic, pregnancy-related) structure of the PHQ-9, whereas confirmatory factor analyses support a three-factor model (cognitive-affective, somatic, pregnancy-related) as the best fit to the data. KEY CONCLUSIONS: The Spanish version of PHQ-9 is reliable and can be used to screen for depression during pregnancy. A three-factor model structure is adequate to evaluate the components and symptoms of depression for Spanish pregnant women. IMPLICATION FOR PRACTICE: Midwives can screen for depression during the PHQ-9 and can tailor interventions to minimize the adverse effects on mothers and infants, before and after birth.

Review of suicidal ideation during pregnancy: risk factors, prevalence, assessment instruments and consequences

Abstract Background: Pregnancy is a period when women are particularly vulnerable to suicidal ideation and a great opportunity for suicide risk prevention. Aims: This study aimed to establish a comprehensive understanding of suicidal ideation prevalence, risk factors, screening tools, consequences and management during pregnancy. Method: A literature search was performed in MEDLINE and PsycInfo databases from 2016 to 2021. A narrative synthesis of the literature and a critical overview of the current issues/questions to be addressed within the topic of suicidal ideation during pregnancy was performed. Results: The prevalence of suicidal ideation during pregnancy was between 2.73 and 18% internationally. The risk factors identified were major depressive disorder, anxiety disorder, difficulties with sleep, previous suicide attempts, high rumination, low incomes, being black, being young, low educational level, partner violence, having poor support, food insecurity, history of child abuse, high obstetric risk, multiparity, previous induced abortion and exposure to tobacco or human immunodeficiency virus diagnosis. The screening tools used for suicidal ideation during pregnancy were item 10 of the Edinburgh Postpartum Depression Scale and item 9 of the Patient Health Questionnaire. Results showed that suicidal ideation during pregnancy is associated with poor cognitive development in children and low birth weight. No case management studies on suicidal ideation were found. Limitations: The main limitation of the available studies was the lack of articles with a high degree of methodological rigour on this subject. Conclusions: This narrative review is a state-of-the-art paper about suicidal ideation during pregnancy. Further research is needed, and researchers should carry out systematic reviews and meta-analyses, leading to Clinical Practice Guidelines in this area. This effort would improve our evidence-based practice in Perinatal Psychology and prevent associated suicidal behaviour.

[Psychometric properties of postpartum depression predictors inventory- revised- prenatal version in a sample of spanish pregnant women.] / Propiedades psicométricas del Postpartum Depression PredictorsIinventory- revised- versión prenatal en una muestra española de mujeres embarazadas.

OBJECTIVE: Prenatal depression is a major public health problem, therefore predicting and preventing it is a relevant objective for public health agendas. Consequently, it is important to have adequate screening tools to detect risk factors associated with prenatal depression. The aim of this study was to evaluate the psychometric properties reliability and factor structure of the Spanish version of the Postpartum Depression Predictors Inventory- Revised- Prenatal Version (PDI-R) in pregnant women who attend prenatal care in an urban hospital in Spain. METHODS: The sample was formed of 445 women receiving prenatal care in an obstetrics clinic in an urban public hospital in Madrid, Spain. The internal consistency of PDPI-R was assessed by measuring Cronbach's Alfa index, calculating the COR curve and percentiles for this sample. RESULTS: The PDPI-R showed good internal consistency in this sample (Cronbach's Alfa = 0,855). The area under the COR curve is 0,84 p≤0,001. Sensibility and specificity values were 62,3% and 69,5% respectively, and the cut-off point with greatest sensibility and specificity was 4. CONCLUSIONS: The PDPI-R is reliable and can be used to screen for risk factor for depression during pregnancy.

OBJETIVO: La depresión postparto es un importante problema de salud pública por lo que su predicción y prevención es un objetivo relevante de las agendas de salud pública. Para ello es importante disponer de herramientas de cribado de los factores de riesgo asociados a la depresión post-parto. El objetivo de este trabajo fue evaluar las propiedades psicométricas del Inventario Predictor de la Depresión Postparto-Versión Revisada-Prenatal (PDI-R) en su versión en lengua española en relación con la fiabilidad de sus puntuaciones en mujeres embarazadas que acuden a la atención prenatal en un hospital urbano de España y en cuanto a su estructura factorial. METODOS: Se dispuso de una muestra de 445 mujeres que reciben atención prenatal en una clínica de obstetricia en un hospital público urbano de Madrid, España. En esta muestra se analizó la consistencia interna del PDI-R mediante el coeficiente alfa de Cronbach además de realizar un análisis de curva ROC y percentiles de la muestra. RESULTADOS: Los resultados del PDPI-R en esta muestra indicaron satisfactorios valores de consistencia interna (alfa de Cronbach = 0,855). El área bajo la curva del PDPI-R fue de 0,84 p≤0,001. Con el punto de corte de 4 la sensibilidad y especificidad fueron de 62,3% y 69,5% respectivamente. CONCLUSIONES: El PDPI-R es adecuado y puede utilizarse para detectar el factor de riesgo de depresión durante el embarazo.

[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.