Suicide Risk and Mood Disorders in Women in the Postpartum Period: a Longitudinal Study.

Suicide associated with severe psychiatric illnesses is considered the leading cause of maternal deaths. We aimed to assess the suicide risk in women who experienced depressive or mixed episodes of mood change during the postpartum period and to determine which disorder is more related to suicide risk in the same period. We conducted a longitudinal study with 706 women whose children were born from April 2007 to May 2008 in a southern city in Brazil, and received prenatal care by the Brazilian National System of Public Health. The first assessment occurred during the prenatal period and the second within 30 to 60 days postpartum. The incidence of suicide risk was 10.9%. The odds of postpartum suicide risk were 6.50 (95% CI: 2.73; 15.48) higher in mothers with postpartum depression and 41.50 (95% CI: 12.11; 142.16) higher in those with mixed episodes than those who did not suffer from any mood disorder. Women with chronic episodes (who had depressive or mixed episodes during pregnancy and postpartum) were at increased odds of 4.94 (95% CI: 1.46; 16.69) of a postpartum suicide risk. The postpartum seems to be a critical period in the women's mental health. The impact of mental disorders in this period, especially mixed episodes, can increase the odds of a suicide risk onset. A good psychiatric evaluation and support during the prenatal and postpartum care may prevent the subsequent risk of suicide.

Thimerosal-containing vaccines and deficit in child development: Population-based study in southern Brazil.

BACKGROUND: The discussion on the safety of thimerosal-containing vaccines (TCVs) and their impact on child development it́s very relevant. METHODS: This is a cohort study with mother-child dyads who received prenatal care in the Unified Health System. The domains of motor, cognitive and language development were evaluated in children between 24 and 36 months of age. Data on vaccination were obtained through the child's immunization record. A linear regression analysis was carried out considering possible confounders. RESULTS: In bivariate analyses, motor and language development were associated with TCVs (p < 0.05). However, in the multivariate analysis, this association was not maintained (p > 0.05). These results indicate that the use of TCVs is not associated with child development. The importance of this study is summarized in transmitting relevant information regarding public health, based on reliable data.

Prevalence of mental health problems in preschoolers and the impact of maternal depression.

A large number of children of depressed mothers have one or more mental disorders. This study aimed to evaluate the impact of maternal depression on the mental health of 4-5-year-old children of adolescent mothers, according to the hypotheses generated from the model of accumulation. Between October 2009 and March 2011, all pregnant adolescents who received prenatal care from the public health system in Pelotas (southern Brazil) were invited to participate in the study and have been prospectively followed. Of these individuals, 413 participants were evaluated in the postpartum period and when the child was 2-3 years old and 4-5 years old (current stage). The Strengths and Difficulties Questionnaire was used to assess mental health problems in children, and the Mini International Neuropsychiatric Interview (MINI)-Plus version was used to assess maternal depression. We applied a structured modeling approach to examine the relations between three different hypothesized life course models (accumulation, critical period, and mobility) and maternal depression. After selecting the most appropriate model, we used a logistic regression analysis to assess the effect of depression on mental health problems in 4-5-year-old children of adolescent mothers. We used the Chi square test to estimate the prevalence of mental health problems in 4-5-year-old children. The longer the time of exposure to maternal depression, the greater the probability that the child would present behavioral problems. Investments in strategies to prevent mental disorders beginning in the gestational period are important.

Childhood trauma and depressive symptoms in pregnant adolescents in Southern Brazil.

OBJECTIVES: This study aimed to investigate the association between child maltreatment and depressive symptomatology during gestation in adolescents. METHODS: This was a cross-sectional study with pregnant adolescents aged 12 to 19 years. Data were collected with the Beck Depression Inventory, Childhood Trauma Questionnaire, and Mini International Neuropsychiatric Interview. RESULTS: Compared to adolescents who did not experience each type of neglect or abuse, experiencing them was associated with a higher proportion of depressive symptoms: emotional neglect PR = 1.4 (95% CI 1.1; 1.8); physical neglect PR = 1.7 (95% CI 1.3; 1.7); emotional abuse PR = 1.8 (95% CI 1.4; 2.2); and physical abuse PR = 1.3 (95% CI 1.1; 1.7). CONCLUSIONS: This study demonstrates the association between childhood experiences and mental health in adolescence, especially in vulnerable samples, such as pregnant adolescents. This finding reveals the importance of studying early trauma in life and enabling preventive help, especially in adolescents. High-quality evidence of perinatal mental health problems should be generated to make pregnancy safer for women in low- and middle-income countries.

The perception of parental bonding in pregnant adolescents and its association with generalized anxiety disorder.

BACKGROUND: The parental bonding is influenced by two dimensions: care and control or protection over the child of both parents. The lack of care during childhood may make the individual more susceptible to the onset of psychiatric disorders when adult. These psychiatric disorders when present during pregnancy may have a negative impact on the health of pregnant women and children. The aim of this study was to assess the association between generalized anxiety disorder (GAD) in pregnant adolescents and the perception of parental bonding. METHODS: This is a cross-sectional study with 871 pregnant women under the age of 19, receiving prenatal care in 47 Basic Health Units in the one city, Brazil. The generalized anxiety disorder was measured using the Mini International Neuropsychiatric Interview (MINI) and the perception of parental bonding in childhood using the Parental Bonding Instrument (PBI). RESULTS: The prevalence of GAD was 8.5%. Among all the parental bonding dimensions, only a perceived lack of maternal care under 16 years was associated with GAD. CONCLUSIONS: The results showed that only the perception of maternal bonding was associated with later GAD. It suggests that an adequate maternal bond is an essential component of psychological health.

Brain-derived neurotrophic factor levels in women with postpartum affective disorder and suicidality.

Our aim was to investigate serum brain-derived neurotrophic factor (BDNF) levels in postpartum women, according to the presence of postpartum affective disorder (PPAD) and suicidality. A cross-sectional study was carried out with women between 45 and 90 days after delivery. PPAD (depression, manic and mixed episode) and suicide risk were assessed using the Mini International Neuropsychiatric Interview. BDNF was assessed using a commercial ELISA kit. Linear regression was used for multivariate analyses. A hundred ninety women participated in the study, 15.3 % had PPAD, 7.4 % showed PPAD with suicide risk. BDNF levels were lower in subjects with three or more Stressful Life Events (P = 0.01). The serum BDNF levels of women with PPAD presenting suicide risk were significantly lower than those of women without suicide risk (1.50 ± 1.38 and 2.33 ± 1.28 ng/ml, P = 0.02). Clinicians should enquire postpartum women about their history of stressful life events, PPAD, and suicidality. This study shows the potential role of BDNF in the neurobiology of the association of PPAD and suicidality.

Suicidal behavior in pregnant teenagers in southern Brazil: social, obstetric and psychiatric correlates.

BACKGROUND: Suicidal behavior and its correlates remain relatively understudied in pregnant teenagers. METHODS: A cross-sectional study with a consecutive sample of pregnant teenagers recipient of prenatal medical assistance by the national public health system in the urban area of Pelotas, southern Brazil. Sample size was estimated in 871 participants. Suicidal behavior and psychiatric disorders were assessed with the Mini International Neuropsychiatric Interview; the Abuse Assessment Screen was used to identify physical or sexual abuse; social support was assessed with the Medical Outcomes Survey Social Support Scale; a self-report questionnaire was used to collect socio-demographic, obstetric and other psychosocial data. RESULTS: Forty three (4.94%) teenagers refused to participate, resulting in 828 participants. Prevalence of suicidal behavior was 13.3%; lifetime suicide attempts were referred by 7.4%, with 1.3% reporting attempting suicide within the last month. After adjustment, we found significant associations of suicidal behavior with the 18-19 years old subgroup, low education, prior abortion, previous major depression, and physical abuse within the last 12 months. Pregnant teenagers with high social support showed prevalence ratios (PR) 67% lower (PR: 0.33; 95%CI: 0.19-0.56) than those with low social support. Furthermore, a wide range of psychiatric disorders, most notably major depressive disorder (PR: 2.75; 95%CI: 1.34-5.63) and panic disorder (PR: 6.36; 95%CI: 1.61-25.10), remained associated with suicidal behavior after adjustment. LIMITATIONS: The cross-sectional design precludes causal inferences. CONCLUSIONS: We found that suicidal behavior is a relatively common feature in pregnant teenagers, frequently associated with psychiatric disorders.