Impact of Facebook on Social Support and Emotional Wellbeing in Perinatal Women during Three Waves of the COVID-19 Pandemic in Mexico: A Descriptive Qualitative Study.

The COVID-19 pandemic affected the mental health of pregnant and postpartum women in unique, unprecedented ways. Given the impossibility of delivering face-to-face care, digital platforms emerged as a first-line solution to provide emotional support. This qualitative study sought to examine the role that a closed Facebook group (CFG) played in providing social support for Mexican perinatal women and to explore the concerns they shared during the COVID-19 pandemic. A thematic analysis of all the posts in the CFG yielded nine main categories: (1) COVID-19 infections in participants and their families; (2) fear of infection; (3) infection prevention; (4) health services; (5) vaccines; (6) concerns about non-COVID-19-related health care; (7) effects of social isolation; (8) probable mental health cases; and (9) work outside the home. Participants faced stressful situations and demands that caused intense fear and worry. In addition to household tasks and perinatal care, they were responsible for adopting COVID-19 preventive measures and caring for infected family members. The main coping mechanism was their religious faith. The CFG was found to be a useful forum for supporting perinatal women, where they could share concerns, resolve doubts, and obtain information in a warm, compassionate, and empathetic atmosphere. Health providers would be advised to seek new social media to improve the quality of their services.

Challenges of Perinatal Depression Care in Mexico City Health Centers.

Background: Perinatal depression is a common mental disorder regarded as a severe public health problem. Studies have shown that incorporating mental health care into primary health services that provide pregnancy care makes it easier for women to seek help for depressive symptoms. In this context, the following question is of interest: How prepared are primary health services in Mexico City that provide pregnancy and postpartum care to treat perinatal depression? This article seeks to explore the perceptions and knowledge of perinatal depression in health professionals and analyze the barriers to its care at primary care centers in Mexico City. Methods: An exploratory study with a qualitative approach was conducted. Doctors, nurses, social workers who provide maternal and childcare, mental health personnel, and the directors of four centers were interviewed. Interviews were audio-recorded and transcribed for thematic analysis. Results: Most primary care personnel are unaware of the Official Standard that recommends providing maternal mental health care during the perinatal period. There is no initiative for its incorporation into routine care. A significant barrier to its implementation is health professionals' biased, stereotyped perception of perinatal depression, motherhood, and the role of women. Other barriers include the workload of health professionals, the division of care between professionals, and the lack of communication between the latter. Women with psychological symptoms are not referred to mental health staff in a timely manner. Social workers are in closer contact with women and are more willing to address their emotional distress. Conclusion: Maternal mental health care, contingent on pregnancy, childbirth, and puerperium care at primary care centers is currently not possible due to the lack of knowledge, barriers, and directors' dependence on hospital management decisions.

Satisfaction and Acceptability Ratings of a Web-Based Self-help Intervention for Depression: Retrospective Cross-sectional Study From a Resource-Limited Country.

BACKGROUND: Web-based interventions are at an early stage in non-English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version. OBJECTIVE: The aim of this study is to explore participants' satisfaction and acceptability for the second version of HDep. METHODS: A retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]). RESULTS: In all groups, users experienced high levels of depressive symptoms (189/191, 98.9%; Center for Epidemiological Studies Scale-Depression >16). Moderate levels of satisfaction (HPUs: mean 21.9, SD 6.7; PUs: mean 21.1, SD 5.8; range: 8-32) and acceptability (HPUs: mean 13.8, SD 3.9; PUs: mean 13.9, SD 3.2; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (odds ratio [OR] 3.4, 95% CI 1.1-10.0), whereas among PUs, older respondents (OR 1.04, 95% CI 1.01-1.08), those with paid work (OR 3.1, 95% CI 2.4-7.6), those who had not been in therapy (OR 2.42, 95% CI 1.09-5.98), and those who had not attempted suicide (OR 3.4, 95% CI 1.1-11.1) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work (OR 2.5, 95% CI 1.1-5.5), those who had not been in therapy (OR 3.1, 95% CI 1.3-7.3), those without disability (OR 2.9, 95% CI 1.3-6.6), and those who had not attempted suicide (OR 2.6, 95% CI 1.0-6.6) showed higher acceptability. CONCLUSIONS: HDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative-quantitative study from a low- to middle-income, non-English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence.

Intimate partner violence and perinatal depression and anxiety: Social support as moderator among Mexican women.

AIMS: To assess the frequency of perinatal Intimate Partner Violence (IPV), the association between IPV and depressive and anxiety symptoms, and the role of social support (SS) in the relation between IPV and depressive and anxiety symptoms, controlling for sociodemographic factors. METHOD: Women were assessed during pregnancy and at six months postpartum (n = 210). The instruments used were: Stressful Life Events Scale; the Patient Health Questionnaire-9; the Anxiety Subscale of the Symptom Checklist-90 and the Social Support Subscale of the Postpartum Depression Predictors Inventory-Revised. RESULTS: The prevalence of IPV was 10.7% in pregnancy and 11% during postpartum. IPV increases the risk of suffering depression in pregnancy (OR = 3.5) and at six months postpartum (OR = 18.3), as well as anxiety (OR = 5.9 and OR = 6.2, respectively). Women with lower educational attainment (OR = 3.8) and income (OR = 3.0) had a higher risk of being victims of IPV during pregnancy. Likewise, lack of SS has a great impact on IPV both during pregnancy (OR = 14.12) and the postpartum period (OR = 5.49). This association decreases the impact and significance of the relationship between perinatal depression and anxiety and IPV. CONCLUSIONS: High levels of SS may partially offset the effect of IPV on postpartum depressive s and perinatal anxiety symptoms. it is necessary for IPV victims to have multiple protective factors. Lack of access to education, poverty and women's submissive role in relation to men lead to greater vulnerability, constituting a distinct social disadvantage for women.

A Cross-Cultural Analysis of the Prevalence and Risk Factors for Prenatal Depression in Spain and Mexico.

The prevalence and risk factors associated with prenatal depression among Spanish-speaking women in Spain and Mexico are examined and compared through a cross-cultural study. The study utilizes secondary data from 563 participants who received prenatal care in Madrid (N = 283) and in Mexico City (N = 280), assessed with the PHQ-9 and the PDPI-R. Spanish women reported a lower prevalence of depressive symptoms (10.0%) than Mexican women (20.3%). Regression analyses showed that previous prenatal anxiety and lack of family emotional support were common risk factors to the two countries. Within each country, significant risk factors included: (a) previous depression history (ß = 0.224; p < 0.001) in Spain; and (b) unplanned pregnancy (ß = - 0.116; p < 0.027), lack of emotional support from others (ß = 0.129; p < 0.032), marital dissatisfaction (ß = 0.186; p < 0.009), and life stress due to financial problems (ß = 0.117; p < 0.026), and life stress due to marital problems (ß = 0.114; p < 0.040) in Mexico. Health professionals can tailor interventions to their particular risk factors to reduce the adverse effects on mothers and infants.

Perinatal Anxiety Symptoms: Rates and Risk Factors in Mexican Women.

Anxiety during pregnancy and after childbirth can have negative consequences for a woman and her baby. Despite growing interest in the perinatal mental health of Mexican women living in the U.S., perinatal anxiety symptom (PAS) rates and risk factors have yet to be established for women in Mexico. We sought to determine PAS rates and identify risk factors, including the traditional female role (TFR) in a sample of Mexican women. This secondary data analysis is based on 234 Mexican women who participated in a longitudinal study on perinatal depression in Mexico. Anxiety symptoms were assessed in pregnancy and at six weeks postpartum. Rates were determined through frequencies, and multiple logistics regressions were conducted to identify risk factors in the sample. The PAS rate was 21% in pregnancy and 18% postpartum. Stressful life events and depressive symptoms were associated with a higher probability of PAS. Adherence to TFR increased the probability of prenatal anxiety; lower educational attainment and low social support during pregnancy increased the probability of postpartum anxiety. The PAS rates were within the range reported in the literature. The TFR was only associated with anxiety in gestation, highlighting the role of this culturally relevant risk factor. Culturally responsive early interventions are therefore required.

Infant temperament and perinatal depressive and anxiety symptoms in Mexican women.

AIM: This study explores the association between infant temperament at six months postpartum and pre- and postpartum depressive and anxiety symptoms. The association between infant temperament and stressful life events is also evaluated. METHOD: A total of 210 Mexican women were assessed during pregnancy (gestational age 32.39 ±â€¯4.01) and at six months postpartum. The instruments used were: Patient Health Questionnaire (PHQ-9), the Anxiety Subscale of the Hopkins Symptoms Checklist (SCL-90R), a short form of Stressful Life Events and The Infant Characteristics Questionnaire, when infants were six months old. RESULTS: Although a mother's emotional state during pregnancy (depressive and anxiety symptoms and stressful life events) was not associated with difficult infant temperament, it was associated with depressive and anxious symptomatology during the postpartum period. Mothers with prenatal depressive symptoms who remained depressed and mothers who only had depression symptoms during the postpartum period reported having more difficult infants. Likewise, mothers with prenatal anxiety symptoms who maintained anxiety symptoms postpartum and mothers with anxiety symptoms during the postpartum period alone reported having more difficult infants. Comorbidity was found between depressive and anxious postnatal symptomatology in its association with difficult infant temperament. CONCLUSION: In this study, postpartum depressive and anxiety symptoms played an important role in shaping difficult infant temperament. Comorbidity between the two conditions warrants clinical attention and additional research, since it is related to maternal perception of difficult infant temperament. Psychological interventions are required, since these women may require assistance with emotional adaptation in the transition to motherhood.

Sensitivity and specificity of the three Whooley and Arroll questions for detecting perinatal depression in Mexican women.

OBJECTIVE: To evaluate the sensitivity and specificity of the Two Whooley questions and the Arroll question, using the SCID, The Structured Clinical Interview (SCID-I) as the gold standard for detecting perinatal depression. MATERIALS AND METHODS: We interviewed 210 women during pregnancy and 6 months postpartum. RESULTS: The criterion with the greatest sensitivity was responding positively to either Whooley question (pregnancy= 94.7 %; postpartum=100.0%), while the most specific criterion was responding positively to the two Whooley questions plus the Arroll question (Pregnancy=90.0% Postpartum = 85.7%). CONCLUSIONS: The Whooley and Arroll questions have adequate psychometric properties to detect possible cases of depression during the perinatal period. They can be applied during prenatal check-ups and postpartum consultations. Timely detection of women at risk of perinatal depression can contribute to their treatment for reducing their adverse consequences in mothers and infants.

OBJETIVO: Evaluar la sensibilidad y la especificidad de la Escala de las dos preguntas de Whooley y la pregunta de Arroll para detectar riesgo de depresión perinatal, usando la SCID como estándar de oro. MATERIAL Y MÉTODOS: Se entrevistó a 210 mujeres durante el embarazo y 6 meses después del parto. RESULTADOS: El criterio con mayor sensibilidad fue responder positivamente a cualquiera de las Preguntas de Whooley (embarazo = 94.7%; posparto = 100.0%) y, el más específico, responder positivamente a las preguntas de Whoo- ley más la de Arroll (embarazo = 90.0% , Posparto = 85.7%). CONCLUSIONES: Las preguntas de Whooley y Arroll tienen propiedades psicométricas adecuadas para detectar posibles casos de depresión durante el periodo perinatal. Pueden aplicarse durante las citas de control prenatal y consultas en el postparto. Detectar de manera oportuna a mujeres en riesgo de depresión perinatal puede ayudar a su atención para reducir sus consecuencias adversas en madres e infantes.

Sensitivity and specificity of the three Whooley and Arroll questions for detecting perinatal depression in Mexican women / Sensibilidad y especificidad de las tres preguntas de Whooley y Arroll para detectar depresión perinatal en mujeres mexicanas

Abstract: Objective: To evaluate the sensitivity and specificity of the Two Whooley questions and the Arroll question, using the SCID, The Structured Clinical Interview (SCID-I) as the gold standard for detecting perinatal depression. Materials and methods: We interviewed 210 women during pregnancy and 6 months postpartum. Results: The criterion with the greatest sensitivity was responding positively to either Whooley question (pregnancy= 94.7 %; postpartum=100.0%), while the most specific criterion was responding positively to the two Whooley questions plus the Arroll question (Pregnancy=90.0% Postpartum = 85.7%). Conclusion: The Whooley and Arroll questions have adequate psychometric properties to detect possible cases of depression during the perinatal period. They can be applied during prenatal check-ups and postpartum consultations. Timely detection of women at risk of perinatal depression can contribute to their treatment for reducing their adverse consequences in mothers and infants.

Resumen: Objetivo: Evaluar la sensibilidad y la especificidad de la Escala de las dos preguntas de Whooley y la pregunta de Arroll para detectar riesgo de depresión perinatal, usando la SCID como estándar de oro. Material y métodos: Se entrevistó a 210 mujeres durante el embarazo y 6 meses después del parto. Resultados: El criterio con mayor sensibilidad fue responder positivamente a cualquiera de las Preguntas de Whooley (embarazo = 94.7%; posparto = 100.0%) y, el más específico, responder positivamente a las preguntas de Whooley más la de Arroll (embarazo = 90.0% , Posparto = 85.7%). Conclusiones: Las preguntas de Whooley y Arroll tienen propiedades psicométricas adecuadas para detectar posibles casos de depresión durante el periodo perinatal. Pueden aplicarse durante las citas de control prenatal y consultas en el postparto. Detectar de manera oportuna a mujeres en riesgo de depresión perinatal puede ayudar a su atención para reducir sus consecuencias adversas en madres e infantes.

Web-Based Intervention to Reduce Substance Abuse and Depression: A Three Arm Randomized Trial in Mexico.

BACKGROUND: Web-based cognitive-behavioral interventions to reduce substance use can be a useful low-cost treatment for a large number of people, and an attractive option in countries where a greater availability of treatment is needed. OBJECTIVE: To evaluate the feasibility and initial effectiveness of a web-based cognitive-behavioral intervention for the reduction of substance use and depression compared with treatment as usual, with and without a printed self-help manual. METHOD: Individuals seeking outpatient treatment for substance use were randomly assigned to one of the following: (1) the web-based Help Program for Drug Abuse and Depression (n = 23); (2) an in-person session with an addiction therapist and use of the Alcohol, Smoking, and Substance Involvement Screening Test Self-Help Strategies guide, followed by treatment as usual (n = 25), or (3) treatment ordinarily offered in the participating treatment centers (n = 26). The study took place in 2013-2014 (trial registration: ISRCTN25429892), and participants completed baseline, posttreatment, and 1-month follow-up evaluation interviews. RESULTS: Treatment retention and data availability were comparable in all three conditions. A reduction was observed from baseline to follow-up in average days of use [F(1,28) = 29.70, p < 0.001], severity of use [F(2,28) = 143.66, p < 0.001], and depressive symptomatology [F = (4)16.40, p < 0.001], independent of the type of treatment provided. CONCLUSIONS: The findings suggest that the web-based intervention to reduce substance abuse is feasible, although it is not more effective than other intervention modalities; its effectiveness must be evaluated in a larger sample. Attrition was a main limitation; future studies must improve retention and assess cost-effectiveness.

Correlation between intake of omega-3 fatty acids and depressive and anxiety symptoms during pregnancy / Correlación entre la ingesta de ácidos grasos omega-3 y los síntomas de depresión y ansiedad en el embarazo

Abstract: Introduction: Anxiety and depression during pregnancy are disabling disorders associated to complications during the pregnancy, delivery, and postpartum period, with a significant prevalence, between 9 and 20%, hence its importance. Nutritional factors, such as omega-3 fatty acids (ω-3FA) deficiency, have been related with both disorders during pregnancy, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Objective: To evaluate the association between dietary intake of EPA and DHA, and anxiety symptoms (AS) and depressive symptoms (DS) in Mexican pregnant women. Method: The sample consisted of 151 women in the second trimester of pregnancy. Instruments included a Food Frequency Questionnaire, the Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale. Results: A daily intake of DHA and EPA of 70 mg/d and 30 mg/d, respectively, was found. The prevalence of AS was 44.4%, and 17.9% for DS. We also found the correlation negatively moderate between dietary intake of DHA and EPA and AS (p = .003, p = .017) and DS (p = .001, p = .020) in the group of women who had a severely insufficient intake of ω-3FA. Discussion and conclusion: The statistical significance shows a negative correlation between variables and the dietary intake of ω-3FA explains in a very small percentage the variability of AS and DS, according to their coefficient of determination. These results suggest the need for an investigation of this relationship through interventional studies.

Resumen: Introducción: La prevalencia de ansiedad y depresión en el embarazo oscilaentre 9 y 20%. Poseen una gran importancia al ser trastornos incapacitantes asociados a complicaciones durante el embarazo, parto y postparto. Factores nutricionales, como la deficiencia de ácidos grasos omega-3 (AGω-3), se han relacionado con ambos trastornos durante el embarazo, especialmente el ácido docosahexaenoico (DHA) y el ácido eicosapentaenoico (EPA). Objetivo: Evaluar la asociación entre la ingesta dietética de EPA y DHA y los síntomas de ansiedad (SA) y depresión (DS) en mujeres embarazadas mexicanas. Método: Se entrevistó a 151 gestantes fueron entrevistadas en el segundo trimestre de embarazo. Los instrumentos de medición utilizados fueron: un Cuestionario de Frecuencia de Consumo de Alimentos, el Inventario de Ansiedad-Rasgo y la Escala de Depresión Postnatal de Edimburgo. Resultados: Se encontró una correlación negativa moderada entre la ingesta de DHA y EPA y los SA (p = .003, p = .017) y SD (p = .001, p = .020) en el grupo de mujeres con ingesta gravemente insuficiente. Se encontró una ingesta dietética diaria de DHA y EPA de 70 mg y 30 mg, respectivamente. La prevalencia de SA fue 44.4% y de SD, 17.9%. Discusión y conclusión: Aunque la significancia estadística mostró una correlación negativa entre variables, de acuerdo con el coeficiente de determinación, la ingesta dietética de AGω-3 explica en un escaso porcentaje la variabilidad de los SA y SD. Estos resultados sugieren la necesidad de investigar dicha relación por medio de estudios de intervención.

Psychometric properties of the Postpartum Depression Predictors Inventory-Revised for pregnant women in Mexico.

This study assessed the reliability and concurrent validity of the prenatal section of the Postpartum Depression Predictors Inventory-Revised for 250 pregnant women receiving prenatal care in Mexico. The Postpartum Depression Predictors Inventory-Revised has shown adequate psychometric properties for English-speaking perinatal women, but no similar data have been reported for Spanish-speaking samples. The results show that the Postpartum Depression Predictors Inventory-Revised is highly reliable and exhibits adequate concurrent validity compared to the Edinburgh Postnatal Depression Scale. These findings suggest that the Postpartum Depression Predictors Inventory-Revised can be a reliable instrument in prenatal care services for detecting risk factors for perinatal depression in Mexican women and potentially in other Spanish-speaking populations.

Psychometric Properties of the Resilience Inventory for Pregnant Mexican Women / Propiedades Psicometricas del inventario de Resiliencia para Mujeres embarazadas Mexicanas

La resilencia ha estado relacionada a la salud mental durante el período perinatal. Sin embargo, hasta donde sabemos, no hay intrumentos para medir la resilencia que hayan sido validados en esta población. El propósito de este estudio fué examinar las propiedades psicométricas del Inventario de Resilencia en mujeres embarazadas mexicanas. Se evaluó una muestra de 280 mujeres usando el Inventario de Resilencia, el Cuestionario de Salud del Paciente y un cuestionario de situaciones de estrés. El coeficiente de confiabilidad del Inventario de Resilencia fué de 0.88 para la escala completa. El análisis factorial exploratorio resultó en una estructura de resilencia de tres factores (capacidad personal, religiosidad y actitud positiva) para mujeres embarazadas. La validez consistente fué respaldada por correlaciones negativas con síntomas prenatales depresivos y situaciones de estrés. El Inventario de Resilencia podría ser potencialmente una medida fiable válida. Es necesario continuar explorando el rol de la resilencia en el período perinatal e identificar los factores que la determinan.

Resilience has been related to mental health during the perinatal period. However, to our knowledge, there are no instruments for measuring resilience that have been validated in this population. The purpose of this study was to examine the psychometric properties of the Resilience Inventory in Mexican pregnant women. A sample of 280 women was evaluated using the Resilience Inventory, Patient Health Questionnaire and a stressful life events questionnaire. The reliability coefficient of the Resilience Inventory was 0.88 for the complete scale. Exploratory factor analysis resulted in a three-factor structure of resilience (personal competence, religiosity and positive attitude) for pregnant women. Concurrent validity was supported by negative correlations with prenatal depressive symptoms and stressful life events. The Resilience Inventory could potentially be a valid reliable measure. It is necessary to continue exploring the role of resilience in the perinatal period and identify the factors that shape it.

Association between depressive symptoms and psychosocial factors and perception of maternal self-efficacy in teenage mothers / Asociación entre sintomatología depresiva y factores psicosociales y percepción de eficacia materna en madres adolescentes

Abstract Introduction Teenage pregnancy is a national health priority. Having to deal with pregnancy during adolescence can cause the mother, at an already vulnerable age, to doubt her maternal capacity to cope with a challenge of this magnitude. The teenage mother's assessment of her maternal self-efficacy is associated with her performance, in other words, the way she relates and responds to the needs of her infant, which has major implications for the latter's development. Objective To study the association between personal (depressive symptoms, self-esteem) and environmental characteristics (social support, partner satisfaction) and those of the infant (problems with infant care, the infants's temperament) and the perception of maternal self-efficacy (PME) in adolescent mothers. Method Cross-sectional study. The following instruments were applied: Center for Epidemiologic Studies Depression Scale (CES-D), Post-partum Depression Predictors Inventory-Revised (PDPI-R), and Maternal Efficacy Questionnaire to 120 mothers under 20 during the first six months postpartum. Bivariate lineal regression and hierarchical linear regression analyses were used for the data analysis. Results When adjusting for other variables, symptoms of depression and difficult infant temperament were associated with lower PME. Social support was only associated with increased PME in the bivariate analysis. Discussion and conclusion These findings contribute to the limited literature on the subject and provide elements for designing strategies to improve adolescent mothers' PME to encourage behaviors that are more relevant and sensitive to infants' physical and emotional needs.

Resumen Introducción El embarazo adolescente es una prioridad nacional para la salud. Enfrentar un embarazo durante la adolescencia puede hacer que la madre, a una edad de por sí vulnerable, dude de su capacidad materna ante un reto de esta magnitud. La valoración que hace de su eficacia materna se asocia con su desempeño, esto es, con la manera de relacionarse y responder a las necesidades de su infante, misma que tiene consecuencias determinantes en el desarrollo de éste. Objetivo Estudiar la asociación entre características personales (síntomas depresivos, autoestima), ambientales (apoyo social, satisfacción con la pareja) y del infante (problemas con el cuidado del infante, temperamento infantil) con la percepción de eficacia materna (PEM) en madres adolescentes. Método Estudio transversal. Se aplicaron: Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D), Inventario de Predictores de Depresión Posparto Revisado (PDPI-R) y Cuestionario de Eficacia Materna a 120 madres menores de 20 años durante el primer semestre posparto. Para los análisis de datos se usaron regresiones lineales bivariadas y análisis de regresión lineal jerárquica. Resultados Al ajustar por otras variables, los síntomas de depresión y el temperamento infantil difícil se asociaron con más baja PEM. El apoyo social se asoció con mayor PEM sólo en los análisis bivariados. Discusión y conclusión Estos hallazgos contribuyen a la escasa literatura sobre el tema y proveen elementos para el diseño de estrategias que mejoren la PEM en madres adolescentes para favorecer conductas más pertinentes y sensibles ante las necesidades físicas y emocionales de los infantes.

Prenatal Predictors of Maternal Attachment and Their Association with Postpartum Depressive Symptoms in Mexican Women at Risk of Depression.

Objectives Although maternal attachment is an important predictor of infant developmental outcomes, little is known about its pre- and postnatal predictors. The purpose of this secondary data analysis is to assess several risk factors for maternal attachment at 6 months postpartum in a sample of Mexican women at risk of depression. The predictors included were prenatal depressive symptoms, pregnancy intendedness, partner relationship, social support, maternal history of childhood sexual abuse, and postpartum depressive symptoms. Methods A total of 156 pregnant women seeking antenatal care at three health centers were selected because they displayed depressive symptoms (CES-D ≥ 16) or had previously suffered depression. Women were interviewed during pregnancy and at 6 months postpartum. A step-wise multivariate logistic regression was conducted to evaluate the pre- and postpartum risk factors for postpartum depression related to low maternal attachment. Results Pre- and postpartum depressive symptoms increased the risk of low maternal attachment by factors of 3.00 and 3.97, respectively, compared with women who did not present these symptoms; low level of adjustment with the partner increased the risk by a factor of 3.11, low social support by a factor of 2.90, and CSA by a factor of 2.77. Conclusions for practice Prevention programs during pregnancy to reduce depressive symptoms should strengthen strategies to promote maternal attachment by improving partner relations and increasing social support. However, evidence shows that such programs alone are insufficient, so direct interventions should also be implemented. Women with a history of childhood sexual abuse should be given additional attention during prenatal care.

Web-Based Intervention to Reduce Substance Abuse and Depressive Symptoms in Mexico: Development and Usability Test.

BACKGROUND: The development of Web-based interventions for substance abuse in Latin America is a new field of interest with great potential for expansion to other Spanish-speaking countries. OBJECTIVE: This paper describes a project aimed to develop and evaluate the usability of the Web-based Help Program for Drug Abuse and Depression (Programa de Ayuda para Abuso de Drogas y Depresión, PAADD, in Spanish) and also to construct a systematic frame of reference for the development of future Web-based programs. METHODS: The PAADD aims to reduce substance use and depressive symptoms with cognitive behavioral techniques translated into Web applications, aided by the participation of a counselor to provide support and guidance. This Web-based intervention includes 4 steps: (1) My Starting Point, (2) Where Do I Want to Be? (3) Strategies for Change, and (4) Maintaining Change. The development of the program was an interactive multistage process. The first stage defined the core structure and contents, which were validated in stage 2 by a group of 8 experts in addiction treatment. Programming of the applications took place in stage 3, taking into account 3 types of end users: administrators, counselors, and substance users. Stage 4 consisted of functionality testing. In stage 5, a total of 9 health professionals and 20 drug users currently in treatment voluntarily interacted with the program in a usability test, providing feedback about adjustments needed to improve users' experience. RESULTS: The main finding of stage 2 was the consensus of the health professionals about the cognitive behavioral strategies and techniques included in PAADD being appropriate for changing substance use behaviors. In stage 5, the health professionals found the functionalities easy to learn; their suggestions were related to the page layout, inclusion of confirmation messages at the end of activities, avoiding "read more" links, and providing feedback about every activity. On the other hand, the users said the information presented within the modules was easy to follow and suggested more dynamic features with concrete instructions and feedback. CONCLUSIONS: The resulting Web-based program may have advantages over traditional face-to-face therapies owing to its low cost, wide accessibility, anonymity, and independence of time and distance factors. The detailed description of the process of designing a Web-based program is an important contribution to others interested in this field. The potential benefits must be verified in specific studies. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 25429892; http://www.controlled-trials.com/ISRCTN25429892 (Archived by WebCite at http://www.webcitation.org/6ko1Fsvym).

Childhood abuse increases the risk of depressive and anxiety symptoms and history of suicidal behavior in Mexican pregnant women

Objective:To explore the relationship between individual and co-occurring childhood sexual, physical, and verbal abuse, prenatal depressive (PDS) and anxiety symptoms (PAS), and history of suicidal behavior (HSB) among Mexican pregnant women at risk of depression.Methods:A sample of 357 women screened for PDS was interviewed using the Childhood Experience of Care and Abuse Questionnaire (CECA-Q), the Beck Depression Inventory (BDI-II), the anxiety subscale of the Hopkins Symptoms Checklist (SCL-90), and specific questions on verbal abuse and HSB.Results:Logistic regression analyses showed that women who had experienced childhood sexual abuse (CSA) were 2.60 times more likely to develop PDS, 2.58 times more likely to develop PAS, and 3.71 times more likely to have HSB. Childhood physical abuse (CPA) increased the risk of PAS (odds ratio [OR] = 2.51) and HSB (OR = 2.62), while childhood verbal abuse (CVA) increased PDS (OR = 1.92). Experiencing multiple abuses increased the risk of PDS (OR = 3.01), PAS (OR = 3.73), and HSB (OR = 13.73).Conclusions:Childhood sexual, physical, and verbal abuse, especially when they co-occur, have an impact on PDS and PAS and lifetime HSB. These findings suggest that pregnant women at risk for depression should also be screened for trauma as a risk factor for perinatal psychopathology.

Childhood abuse increases the risk of depressive and anxiety symptoms and history of suicidal behavior in Mexican pregnant women.

OBJECTIVE: To explore the relationship between individual and co-occurring childhood sexual, physical, and verbal abuse, prenatal depressive (PDS) and anxiety symptoms (PAS), and history of suicidal behavior (HSB) among Mexican pregnant women at risk of depression. METHODS: A sample of 357 women screened for PDS was interviewed using the Childhood Experience of Care and Abuse Questionnaire (CECA-Q), the Beck Depression Inventory (BDI-II), the anxiety subscale of the Hopkins Symptoms Checklist (SCL-90), and specific questions on verbal abuse and HSB. RESULTS: Logistic regression analyses showed that women who had experienced childhood sexual abuse (CSA) were 2.60 times more likely to develop PDS, 2.58 times more likely to develop PAS, and 3.71 times more likely to have HSB. Childhood physical abuse (CPA) increased the risk of PAS (odds ratio [OR] = 2.51) and HSB (OR = 2.62), while childhood verbal abuse (CVA) increased PDS (OR = 1.92). Experiencing multiple abuses increased the risk of PDS (OR = 3.01), PAS (OR = 3.73), and HSB (OR = 13.73). CONCLUSIONS: Childhood sexual, physical, and verbal abuse, especially when they co-occur, have an impact on PDS and PAS and lifetime HSB. These findings suggest that pregnant women at risk for depression should also be screened for trauma as a risk factor for perinatal psychopathology.

Acceptability and barriers to treatment for perinatal depression: An exploratory study in Mexican women / Aceptación y barreras al tratamiento para depresión perinatal: Estudio exploratorio en mexicanas

Background Depression is frequently experienced during the perinatal period. In Mexico, it has received very little attention from researchers and health service providers. It is well known that untreated depression is one of the leading causes of disability in women. Objective This study seeks to explore: 1. the recognition of perinatal depression among pregnant and postpartum women; 2. the acceptance of various modalities of treatment for depression, and 3. the perception of the barriers to receive treatment. Material and methods For this descriptive, exploratory study, 41 women in the third trimester of pregnancy and 30 women between the fourth and sixth postpartum weeks were interviewed. The study was conducted at a health center and a general hospital. The interview included demographic and obstetric data; depressive symptomatology (PHQ-2); open questions on the recognition of perinatal depression and scales relating to the acceptance of treatment modalities and barriers to access health services. Results Almost all the women had heard of the term postpartum depression, while one quarter did not know the causes of this disorder, which was attributed to an inability to face new challenges, emotional and hormonal changes, and lack of social support. The majority considered that it is not easy to speak about their unhappiness or discomfort, and that people would not understand if pre- or post-partum women felt sad or depressed in this period. Individual psychotherapy was the treatment with the highest level of acceptance, while medication, during pregnancy or breastfeeding, was the least accepted. The main barriers to treatment were: lack of time; institutional procedures; being unable to afford care and not having anyone to look after the children. Conclusions These results constitute a preliminary approach to the care needs for depression during the perinatal period. Women's awareness that help is required may not suffice to encourage them to seek assistance due to instrumental barriers and attitudes to treatment. In order to ensure effective care, it is necessary for the official norms regulating the health care for women and babies in this period to include treatment for mental disorders.

Antecedentes La depresión es un estado frecuente en el periodo perinatal. En México ha recibido muy poca atención por parte de investigadores y prestadores de servicios. Se sabe que la depresión no tratada es una de las causas más importantes de discapacidad en las mujeres. Objetivo Explorar: 1. el reconocimiento de la depresión perinatal en embarazadas y puérperas, 2. la aceptación de diferentes modalidades de atención para la depresión y 3. la percepción de las barreras para asistir a tratamiento. Material y métodos En este estudio descriptivo y exploratorio se entrevistó a 41 mujeres en el tercer trimestre del embarazo y a 30 entre la cuarta y sexta semanas del posparto. El estudio se llevó a cabo en un centro de salud y en un hospital general. La entrevista incluyó: datos demográficos y obstétricos; sintomatología depresiva (PHQ-2); preguntas abiertas sobre el reconocimiento de la depresión perinatal y escalas relativas a la aceptación de diversas modalidades de tratamiento y barreras para acudir a servicios de salud. Resultados Casi todas habían escuchado el término depresión posparto; una cuarta parte desconocía las causas de este trastorno, el cual fue atribuido a no saber enfrentar los nuevos retos, cambios emocionales, cambios hormonales y falta de apoyo social. La mayoría consideró que no es fácil hablar de tristeza o malestar en este periodo y que la gente tampoco lo entendería. La psicoterapia individual fue el tratamiento con mayor aceptación; los medicamentos, durante el embarazo o lactancia, los menos aceptados. Las principales barreras al tratamiento fueron: la falta de tiempo, los trámites institucionales, la imposibilidad de pagarlo y la carencia de cuidado para los hijos. Conclusiones Estos resultados constituyen una primera aproximación a los requisitos de atención de la depresión en el periodo perinatal. El reconocimiento de la necesidad de ayuda por parte de las mujeres puede no ser motivo suficiente para que acudan a buscarla debido a las barreras instrumentales y las actitudes hacia el tratamiento. Para poder brindar una atención efectiva es necesario que las normas oficiales, que regulan el cuidado de la salud de mujeres e infantes en este periodo, incluyan una atención a los trastornos mentales.