Depression, pregnancy-related anxiety and parental-antenatal attachment in couples using preimplantation genetic diagnosis.

STUDY QUESTION: Do preimplantation genetic diagnosis (PGD) couples experience higher levels of stress during pregnancy and the perinatal period compared with couples who conceive spontaneously (SC) or with ICSI? SUMMARY ANSWER: PGD couples did not experience more psychological stress during pregnancy and beyond than ICSI or SC couples. WHAT IS ALREADY KNOWN: Previous studies have shown that assisted reproduction technology (ART) couples are more prone to pregnancy-related anxieties than SC couples, but display depressed feelings to an equal or lesser extent. However, only one study has focused on a female PGD sample, which may be a more vulnerable group than other ART groups, due to the potentially complex hereditary background, adverse childhood experiences and losses. In that study, PGD women experienced a reduction in state anxiety, and maternal-antenatal attachment did not differ from normative data. Unfortunately, no data exist on pregnancy-related anxiety, depression and parental-antenatal attachment. Valuable information from both parents (e.g.: couples) is also lacking. STUDY DESIGN, SIZE, DURATION: For this longitudinal prospective study questionnaire, data from 185 women and 157 men (157 couples) were collected between February 2012 until April 2014. Data were analysed using multilevel analysis. The couples conceiving after PGD, ICSI or SC were followed from the first trimester of the pregnancy until the third month post-partum. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 60 PGD, 58 ICSI and 69 SC couples were initially recruited by various departments of Universitair Ziekenhuis Brussel (UZ Brussel). At each trimester (T1: 12-14 weeks, T2: 20-22 weeks, T3: 30-32 weeks) of pregnancy, depression (EPDS), pregnancy-related anxieties (PRAQ) and parental-antenatal attachment (M/PAAS) were recorded. At T4 (3 months post-partum), depression (EPDS) was assessed again. In the first trimester (T1) broad socio-demographic data and at T4 perinatal health data of both mother and child were recorded. Differences between conception groups over time were analysed using multilevel analyses, taking into account covariation between measurements and within couples. Several perinatal covariates as well as social desirability, coping and adult attachment style were controlled for. MAIN RESULTS AND THE ROLE OF CHANCE: All three conception groups had similar scores for depression during pregnancy and beyond. Also, pregnancy-related anxiety scales did not differ among the three groups. All groups also followed a similar trajectory in time regarding their scores for anxiety, depression and parental-antenatal attachment. ART groups did not give more socially desirable answers than SC controls. The subsequent moderators: coping and adult attachment style did not add any relevant information. No interaction effects occurred between gender and conception groups. LIMITATIONS, REASONS FOR CAUTION: The participants were Caucasian, Dutch-speaking couples, with medium to high socio-economic status, from a single centre. Our data should be replicated by multicultural and multicentre studies. Furthermore, the inclusion of an additional control group of couples who did not opt for PGD but for prenatal diagnosis may point to the most beneficial strategy for the couple. WIDER IMPLICATIONS OF THE FINDINGS: PGD parents invest a similar amount of time and emotion in their future children compared with controls. This implies that successful PGD treatment makes an important psychological contribution towards the well-being of couples given their complex hereditary and family backgrounds. STUDY FUNDING/COMPETING INTERESTS: This research project was funded by grants from the internal research council of the Vrije Universiteit Brussel (OZR), the Flemish Fonds Wetenschappelijk Onderzoek (FWO) and the Wetenschappelijk Fonds Willy Gepts (WGFG). UZ Brussel and the Centre for Medical Genetics have received several educational grants for organizing the data collection, from IBSA, Ferring, Organon, Shering-Plough, Merck and Merck Belgium. M.B. has received consultancy and speaker's fees from Organon, Serono Symposia and Merck.

A coisa em psicanálise e o objeto no lísis de Platão / The thing in psychoanalysis and object in Plato's lysis / La cosa en psicoanálisis y el objeto en lisis de Platón

Este artigo propõe o estudo sobre o conceito de outro como semelhante e como objeto. Partindo de textos que interpelam a alteridade na psicanálise e remetendo aos temas do complexo semelhante, da satisfação, da perda, do luto, da negativa, da repetição; avalia o conceito de outro articulando textos de diversos autores. A partir da psicanálise freudiana, estuda o das Ding e a negação, discriminando com estes termos um objeto estruturante na origem do psiquismo. Aborda textos técnicos da psicanálise para delimitar o tema da repetição. Também a recordação e a repetição são vinculadas ao objeto e estudadas na perspectiva da filosofia moderna. São retomados temas do diálogo platônicos para definir o lugar do erótico e da amizade. No fim do presente artigo, propomos o termo clássico grego Oikos com valor equivalente ao da Coisa freudiana e como esta aparece em escritos psicanalíticos.(AU)

This article studies the concept of other as similar and object. It is based on texts that question the alterity in psychoanalysis and refers to the themes of otherness complex, loss, grief, negative, repetition, and evaluates the concept of other, using articles of diverse authors. Based on Freudian psychoanalysis, it studies the Thing and the denial and discriminates a structuring object in the origin of psychism. It approaches technical texts of psychoanalysis to delimitate the theme of repetition. The recordation and repetition are also linked to the object and studied from the perspective of modern philosophy. Themes of the platonic dialogues are resumed to define the place of the erotic and the friendship. In the end of the article, we propose the greek classic term Oikos, with equal value to the Freudian Thing, as this one appears in psychoanalytic writings.(AU)

Este artículo estudia el concepto Otro como semejante y como objeto. A partir de textos que interpelan la alteridad en psicoanálisis y que se refieren a temas del complejo semejante, de la satisfacción, de la pérdida, del duelo, de la negación, de la repetición, se evalúa el concepto de Otro articulando textos de diferentes autores. Basado en el psicoanálisis freudiano, se aborda Ding y la negación, discriminando con estos términos un objeto estructurante en el origen de lo psíquico. Se abordan textos técnicos del psicoanálisis para delimitar el tema de la repetición; el recuerdo y la repetición son vinculadas al objeto y estudiadas desde la perspectiva de la filosofía moderna; y se retoman temas de los diálogos platónicos para definir el lugar de lo erótico y la amistad. Al culminar este artículo se propone leer el término griego clásico Oikos con un valor equivalente al de la Cosa freudiana como aparece en los escritos psicoanalíticos.(AU)

O inventário de envolvimento paterno revisado: inclusão de pais com filhos pré-escolares / The inventory of father involvement revised: inclusion of fathers with preschool children / El inventario de envolvimiento paterno revisado: inclusión de padres de preescolares

Apesar da importância do envolvimento paterno, sua avaliação persiste desafiadora. No Brasil, o Inventário de Envolvimento Paterno (IFI-BR) vem se mostrando adequado para uso com pais de crianças de 5 a 10 anos. Entretanto, do ponto de vista do desenvolvimento infantil e de intervenções preventivas, seria importante avaliar o envolvimento paterno quando as crianças são mais novas. Assim, este trabalho teve como objetivos: identificar limitações do IFI-BR, quando usado com pais de crianças entre 2 e 10 anos, e avaliar itens para o IFI-BR-revisado. No Estudo 1, 434 pais com filhos no Ensino Infantil ou Fundamental 1 responderam a um questionário sociodemográfico e ao IFI-BR. Com base em análises de dados omissos, estrutura interna e precisão, modificações foram sugeridas, visando à manutenção da estrutura interna original do instrumento. No Estudo 2, 572 pais com filhos na mesma faixa etária responderam a um questionário sociodemográfico e à versão modificada do IFI-BR. Foram comparadas as frequências de dados omissos e estimativas de precisão para os itens originais e modificados, selecionando aqueles que melhor representavam essa amostra de pais para compor a versão revisada do IFI-BR. Esses resultados indicaram evidências adequadas de validade, com base no conteúdo da versão revisada do IFI-BR, quando utilizada para avaliar a qualidade do envolvimento paterno de pais brasileiros com filhos do Ensino Infantil ao Fundamental 1. Após verificadas evidências de validade adicionais, essa versão revisada do IFI-BR poderá ser utilizada, por exemplo, em estudos longitudinais e na avaliação de intervenções precoces com pais.(AU)

Despite the importance assigned to father involvement, evaluating this construct remains a challenge. In Brazil, the Inventário de Envolvimento Paterno (IFI-BR) has showed satisfactory evidence of validity for fathers of children between 5 and 10 years old. From the perspective of child development and preventive interventions, however, evaluating father involvement with younger children is essential. Hence, this study sought to: identify limitations of the IFI-BR for fathers of children between 2 and 10 years old, and evaluate items for a revised IFI-BR. In Study 1, 434 fathers of children in early childhood and primary school settings answered a sociodemographic questionnaire and the IFI-BR. Based on analyses of missing data, internal structure, and reliability, modifications were suggested to maintain the original internal structure. In Study 2, 572 fathers of children in the same age range answered a sociodemographic questionnaire and the modified IFI-BR. After comparison between values for missing data and reliability of the original and modified items, the items that best represented the broader sample of fathers were selected to compose the revised IFI-BR. Results indicated adequate evidence of content validity for the revised IFI-BR when used to assess the involvement of Brazilian fathers with children in early childhood education and primary school settings. After additional evidence has been verified, this revised IFI-BR can be used, for example, in longitudinal studies and to evaluate early interventions with fathers.(AU)

La participación paterna es importante, pero su evaluación sigue siendo desafiadora. En Brasil, el Inventário de Envolvimento Paterno (IFI-BR) demuestra ser adecuado para aplicar a padres de niños de 5 a 10 años de edad. No obstante, desde la perspectiva del desarrollo infantil y de las intervenciones preventivas, sería importante evaluar la participación de los padres de niños más jóvenes. Este estudio tuvo como objetivos: identificar limitaciones del IFI-BR cuando se aplica a padres de niños entre los 2 y 10 años y evaluar ítems para el IFI-BR-revisado. En Estudio 1, 434 padres con hijos en el jardín de infantes o escuela primaria respondieron un cuestionario sociodemográfico y el IFI-BR. Con base en el análisis de datos faltantes, estructura interna y exactitud, se sugirieron modificaciones para mantener la estructura interna original del instrumento. En Estudio 2, 572 padres respondieron un cuestionario sociodemográfico y la versión modificada del IFI-BR. Se compararon las frecuencias de datos faltantes y estimaciones de exactitud para los ítems originales y modificados, seleccionando aquellos que representaban mejor a esta muestra de padres para la versión revisada del IFI-BR. Estos resultados indicaron evidencia adecuada de validez, basada en el contenido de la versión revisada del IFI-BR, cuando se utilizó para evaluar la calidad de la participación de padres brasileños con niños en el jardín de infantes y en la escuela primaria. Después de verificada la evidencia adicional de validez, la versión revisada del IFI-BR se puede utilizar, por ejemplo, en estudios longitudinales y en la evaluación de intervenciones precoz con los padres.(AU)

A experiência da tentativa de suicídio e o significado da vida / The suicide attempt experience and the meaning of life

Introdução: A compreensão da experiência da tentativa e do significado da vida para pessoas que tentaram suicídio propicia maior conhecimento sobre o processo de ressignificação, conexões e comprometimento com a vida, que podem ser úteis em diferentes abordagens terapêuticas. Objetivo: Compreender o significado da vida e a experiência de uma tentativa de suicídio na perspectiva de adultos que tentaram suicídio. Métodos: Estudo qualitativo com oito adultos brasileiros assistidos em serviço de saúde mental. Os dados foram coletados em 2018 por entrevistas semidirigidas sobre a experiência da tentativa de suicídio e encontros grupais que utilizaram recursos artísticos para facilitar a expressão. O Interacionismo Simbólico foi o referencial teórico utilizado. Os dados foram submetidos à análise temática. Resultados: Três temas representaram a experiência da tentativa de suicídio: "Ambiente intrapsíquico: representação e comunicação com o self" que revelou a generalização de fracassos e expectativas negativas na construção de significados atribuídos ao self, à vida e às relações; "Relações interpessoais" que expressou a necessidade de vínculo, pertença, reconhecimento, acolhimento e sentirem necessários para outras pessoas; e "Representações da tentativa de suicídio: a fuga e o encontro com a dor" a tentativa de suicídio era motivada pelo desejo de aliviar a dor, mas resultava no encontro com a dor, o que instigava a busca por novos métodos, a evitação do suicídio por medo ou a reconstrução de significados. O significado da vida foi representado pelos temas: "Buscas no campo afetivo, relacional e espiritual" (manifestações de afeto, zelo, compreensão e acolhimento e pareciam aumentar o elo e o comprometimento com a vida, bem como a abertura para ressignificá-la); "A vida e a constância da impermanência" (vida como alternância entre fraqueza e força, crise e bem-estar, problemas e superações); e "Descobertas e relação com o próprio self" (um self anteriormente autodestrutivo poderia ser ressignificado como capaz de superar, resistir e desenvolver resiliência). Conclusões: O estudo fornece importantes insights a serem abordados na prática clínica, no delineamento de protocolos, políticas institucionais, bem como na formação de profissionais

Introduction: Understanding the experience of trying and the meaning of life for people who attempted suicide provides greater knowledge about the process of reframing, connections and commitment to life, which can be useful in different therapeutic approaches. Objective: To understand the meaning of life and the experience of a suicide attempt from the perspective of adults who attempted suicide. Methods: Qualitative study with eight Brazilian adults assisted in a mental health service. Data were collected in 2018 by semi-directed interviews about the experience of the suicide attempt and group meetings that used artistic resources to facilitate expression. Symbolic Interactionism was the theoretical framework used. The data were submitted to thematic analysis. Results: Three themes represented the experience of the suicide attempt: "Intrapsychic environment: representation and communication with the self", which revealed the generalization of failures and negative expectations in the construction of meanings attributed to the self, life and relationships; "Interpersonal relationships" that expressed the need for bonding, belonging, recognition, acceptance and feeling necessary for other people; and "Representations of the suicide attempt: the escape and the encounter with the pain" the suicide attempt was motivated by the desire to relieve the pain, but resulted in the encounter with the pain, which instigated the search for new methods, the avoidance of pain. suicide out of fear or the reconstruction of meanings. The meaning of life was represented by the themes: "Searches in the affective, relational and spiritual field" (manifestations of affection, zeal, understanding and welcoming and seemed to increase the link and commitment to life, as well as the openness to re-signify it) ; "Life and the constancy of impermanence" (life as an alternation between weakness and strength, crisis and well-being, problems and overcoming); and "Discoveries and the relationship with the self" (a previously self-destructive self could be re-signified as capable of overcoming, resisting and developing resilience). Conclusions: The study provides important insights to be addressed in clinical practice, in the design of protocols, institutional policies, as well as in the training of professionals.