Validation of the anxiety subscale of the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS-A).

Introduction: There is a need to implement routine perinatal mental health screening in Spain. Therefore, it is necessary to systematise the detection of depressive and anxious symptoms in pregnancy and postpartum using the same instrument. The Edinburgh Postnatal Stress Depression Scale (EPDS) is frequently used as a rapid, effective and cross-culturally validated screening tool for perinatal depression. In several countries, an Anxiety subscale, the EPDS-A, was identified within the EPDS. Although the factorial structure of the EPDS has been investigated in Spanish population, the EPDS-A has not yet been validated. This study aimed to validate the EPDS-A as a measure of perinatal anxiety in Spanish population. Methods: 161 women were evaluated with the EPDS and the State-Trait Anxiety Inventory (STAI) during pregnancy and postpartum. Confirmatory factor analysis (CFA) was used to confirm the trifactorial structure of the EPDS, comprising the dimensions of Depression, Anhedonia and Anxiety. Likewise, the invariance of the trifactorial model between pregnancy and postpartum was tested. Finally, the correlations between the EPDS-A and the STAI subscales (State Anxiety and Trait Anxiety) were calculated. Results: The Exploratory factor analysis (EFA) driven three-factor structure of the EPDS, consisting of an Anhedonia factor (Items 1, 2, and 10), an Anxiety factor (Items 3, 4, 5, and 6) and a Depression factor (Items 7, 8, and 9), was the best measurement model for the current data compared to the alternative model tested [χ2 = 34.592, df = 32, p = 0.34; χ2/df = 1.08; RMSEA = 0.023, 90% Confidence Interval [CI] [0.000, 0.064], CFI = 0.996, GFI = 0.960]. The model's invariance between pregnant and postpartum women was confirmed. The existence of an Anxiety subscale within the EPDS was also confirmed. The scores obtained with the EPDS-A correlated moderately with scores on both subscales of the STAI during pregnancy and after delivery. Using the STAI as a criterion and prioritising the instrument's sensitivity, a cut-off point of 4 points was established for the EPDS-A. Conclusion: Our results confirm the trifactorial structure of the EPDS in Spanish population. The Anxiety subscale was validated for routine perinatal mental health screening.

Una psicoterapia centrada en la parentalidad para tratar la psicopatología perinatal, sostener el vínculo madre-bebé y prevenir los trastornos en el niño / A psychotherapy focused on parenting to treat perinatal psychopathology, to support the mother-baby bond and to prevent disorders in the child

El embarazo y el año que sigue al parto son los períodos de la vida más propiciospara la emergencia de trastornos psicológicos en la mujer. Las consecuencias pueden convertirse en dramáticas paraella, para el vínculo con su hijo y para el desarrollo somático, social y psíquico de este último. Este artículo muestrapor qué es importante cuidar la dimensión psíquica de la parentalidad para un tratamiento eficaz de estos trastornos,a fin de que los efectos terapéuticos beneficien a la vez a la mujer, al vínculo madre-bebé y al niño. Se propone unmodelo de psicoterapia breve centrada en la parentalidad que permite intervenir desde el embarazo y luego incluir elniño en el posparto.(AU)

The pregnancy and first year following childbirth are the most conduciveperiods of life for the emergence of psychological disorders in women. The consequences can be dramatic forthem, for the bond with their child and for the child’s somatic, social and psychological development. This articleshows why it is important to take care of the psychic dimension of parenthood for an effective treatment ofthese disorders, so that the therapeutic effects benefit at the same time the woman, the mother-baby bondand the child. A model of brief psychotherapy focused on parentality is proposed, which allows to intervenefrom pregnancy and then to include the child in the postpartum period.(AU)

L’embaràs i l’any que segueix al part són els períodes de la vida més propicisper a l’emergència de trastorns psicològics en la dona. Les conseqüències poden esdevenir dramàtiques per aella, per al vincle amb el seu fill i per al desenvolupament somàtic, social i psíquic d’aquest. Aquest article mostraper què és important tenir cura de la dimensió psíquica de la parentalitat per a un tractament eficaç d’aqueststrastorns, per tal que els efectes terapèutics beneficiïn al mateix temps la dona, el vincle mare-nadó i el nen. Esproposa un model de psicoteràpia breu centrada en la parentalitat que permet intervenir des de l’embaràs idesprés incloure el nen al postpart.(AU)

The exploration of maternal representations during a parenthood-centred psychotherapy from pregnancy to one year postpartum.

Maternal representations play a key role in intrapsychic conflicts relating to accession to parenthood and in the formation of the mother-baby bond. Around the birth of the child, the shadows of past objects are cast on the baby and the parent's self-image. Mother-baby psychoanalytic psychotherapy helps us to understand internal conflicts that tend to interfere with the mother's representations of her child or of herself as a mother, as well as aiming to reduce the risk of difficulties for the child. Through a clinical case, this article explores the development of maternal representations in a course of parenthood-centred psychotherapy that begins during pregnancy and ends 11 months after the baby's birth. The psychic change carried out by the mother frees the mother-baby bond from the projections of the past. Excerpts from clinical sessions illustrate mother-baby interactions during the session, the projection of the mother's internal objects on to the baby, and the elaboration and reintrojection of the mother's internal conflicts. Changes in the mother's representations were measured both qualitatively and quantitatively using the 'R' interview, which allows various dimensions of these representations to be measured on a Likert scale.

Detection of depressive-anxiety symptomatology and associated risk factors among pregnant women in a low-income neighborhood.

AIM: To determine the prevalence of anxiety-depressive symptomatology and associated risk factors in a population of pregnant women in the low-income neighborhood of Roquetes (Barcelona, Spain). DESIGN: Quasi-experimental, cross-sectional study. LOCATION: The study was carried out at the Primary Care Center, Roquetes Canteres, Barcelona. PARTICIPANTS: Between 2015 and 2017, all pregnant women who visited the Sexual and Reproductive Care Team in Primary Care (ASSIR) or their Family Physician (FP) were invited to take part in a study if they met the following criteria: (a) over 18 years old (b) able to understand in any of the 4 study languages. Of a total of 239 gestating women, 19 declined to participate, 14 moved away from the area and 16 underwent voluntary termination of pregnancy, leaving a sample of 190 subjects. MATERIAL AND METHODS: The Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptomatology, the State-Trait Anxiety Inventory (STAI) was used to assess anxiety, and a sociodemographic data questionnaire was administered. Once all descriptive demographic data from the whole sample was analyzed, baseline clinical and demographic characteristics were compared using the independent t-test for continuous variables and the chi-squared analysis for categorical variables. RESULTS: The t-test showed that 48% of pregnant women presented an at-risk degree of anxiety-depressive symptomatology, double that found in the general population. Applying a chi-squared test to the at-risk and non-risk groups revealed associated prenatal risk factors including: having a history of violence; living in a rented room, mistreatment in infancy and mental health issues. The ROC curves analysis obtained a cutoff point score of 4 Accumulated Associated Factors (AAF) (AUC 0.765, p < .001, 57% sensitivity and 79% specificity). CONCLUSIONS: Our study shows that rates of anxiety-depressive symptomatology in a population with considerable socio-economic deprivation can more than double. AAF in the population at risk of anxiety and depression were detected, highlighting the need to allocate resources to identification and prevention during pregnancy. This requires the involvement of a multidisciplinary, professional team with a biopsychosocial perspective.

La salud mental perinatal en tiempos de pandemia por COVID-19 / Perinatal mental health during COVID-19 pandemic / La salut mental perinatal en temps de pandèmia per COVID-19

El propósito de este artículo es compartir la experiencia de la atención grupal online e interdisciplinar a embarazadas y a madres con bebés (0-6 meses de vida) con la finalidad de aumentar la contención ante las consecuencias de la pandemia actual. Constatamos la importancia de la atención primaria en red durante el período perinatal, debido a la gran cantidad de profesionales que intervienen. Así mismo, observamos que las embarazadas y madres precisan de un enfoque holístico (atendiendo las necesidades físicas y emocionales), a través de la propuesta del arrullo multisensorial, que incorpora las diferentes visiones de los profesionales en los síntomas, preocupaciones y malestares. Observamos que estos dos aspectos (la red y la atención interdisciplinar holística) permiten reducir la fragmentación asistencial y favorecer la contención emocional de las familias y los profesionales

The purpose of this article is to share the experience of online and interdisciplinary group care for pregnant women and mothers with babies (0-6 months of age) in order to increase containment when facing the consequences of the current pandemic. We highlight the importance of networked primary care during the perinatal period due to the high number of professionals involved. Similarly, we realize that pregnant women and mothers require a holistic approach (attending to physical and emotional needs) through a suggested multisensory lullaby that includes various perspectives of professionals regarding symptoms, concerns and distress. We observe that these two aspects (the network and interdisciplinary holistic care) allow to reduce healthcare fragmentation and to promote emotional containment for families and professionals

El propòsit d'aquest article és compartir l'experiència de l'atenció grupal en línia I interdisciplinària a embarassades I a mares amb bebès (0-6 mesos de vida) amb la finalitat d'augmentar la contenció davant les conseqüències de la pandèmia actual. Constatem la importància de l'atenció primària en xarxa durant el període perinatal, a causa de la gran quantitat de professionals que intervenen. Així mateix, observem que les embarassades I mares necessiten un enfocament holístic (atenent les necessitats físiques I emocionals), a través de la proposta de l'embolcall multisensorial, que incorpora les diferents visions dels professionals en els símptomes, preocupacions I malestars. Observem que aquests dos aspectes (la xarxa I l'atenció interdisciplinària holística) permeten reduir la fragmentació assistencial I afavorir la contenció emocional de les famílies I els professionals

Representaciones maternas y observación madre-bebé / Maternal representations and mother-baby observation

En este trabajo presentamos nuestra experiencia clínica en contexto de investigación con embarazadas y en la relación madre-bebé en el Centro de Atención Primaria de Roquetes de Barcelona. La investigación iniciada en 2014 lleva por título "Impacto de una intervención sobre parentalidad en atención primaria en mujeres embarazadas con riesgo de ansiedad y depresión: evolución de las representaciones maternas y el vínculo madre-bebé". Se ilustra la intervención y la metodología de investigación a través de casos clínicos

In this paper, we present our clinical experience in the context of a study with pregnant women and in the mother-baby relationship at the Primary Care Center of Roquetes in Barcelona. The research started in 2014 is named "Impact of an intervention on primary care in pregnant women with risk of anxiety and depression: evolution of maternal representations and the mother-baby bond". The intervention and the research methodology are illustrated through clinical cases

Una experiencia grupal en pacientes con trastornos generalizados del desarrollo / A group experience with patients with pervasive developmental disorders / Una experiència grupal en pacients amb trastorns generalitzats del desenvolupament

Los trastornos generalizados del desarrollo presentan dificultades relacionales y de simbolización (Alcácer y Viloca, 2014), que se agravan con los cambios físicos de la pubertad. Nos planteamos un abordaje grupal centrado en la relación a través de una tarea que favorezca el proceso de simbolización. Observamos en los pacientes una mejoría en la capacidad de interesarse por el otro, una menor necesidad de contención con psicofármacos, un aumento de la capacidad de abstracción y una mayor simbolización. La hipótesis consiste en que la observación de imágenes y discusión sobre las mismas en grupo puede ser un elemento facilitador del trabajo del mundo interno y la relación entre los integrantes del grupo

Pervasive Developmental Disorders present relational and symbolic difficulties (Alcácer and Viloca, 2014), which are aggravated by the physical changes of puberty. We propose a relationship-centered group approach employing a task that favors the process of symbolization. We observed improvements in the patients in their capacity to be interested in others, a decreased need for containment with psychoactive drugs, an increase in the capacity for abstract thought and greater symbolization. The hypothesis is that the observation of images and discussion about them in a group might be an element that facilitates the work of the internal world and the relations between the members of the group

Els trastorns generalitzats del desenvolupament presenten dificultats relacionals I de simbolització (Alcácer I Viloca, 2014), que s'agreugen amb els canvis físics de la pubertat. Els plantegem un abordatge grupal centrat en la relació mitjançant una tasca que afavoreixi el procés de simbolització. Observem en els pacients una millora en la capacitat d'interessar-se per l'altre, una menor necessitat de contenció amb psicofàrmacs, un augment de la capacitat d'abstracció I una major simbolització. La hipòtesi consisteix en el fet que l'observació d'imatges I la discussió sobre aquestes en grup pot ser un element facilitador del treball del món intern I la relació entre els integrants del grup

Reflexiones sobre el trauma en el vínculo y su expresión a través del cuerpo adolescente / Reflections on traumatic bonding and its expression through the teen body / Reflexions sobre el trauma en el vincle i la seva expressió mitjançant el cos adolescent

En el presente artículo se reflexiona entorno al vínculo traumático de la primera infancia que se revive en la adolescencia y cómo se observa la manifestación de dicha problemática a través del cuerpo. El aumento de adolescentes que consultan por autoagresiones en el Centro de Salud Mental Infanto-Juvenil (CSMIJ) ha motivado el tratar de entender con más profundidad esta manifestación psicopatológica actual. Se ilustran las reflexiones teóricas con un resumen del tratamiento de psicoterapia focalizada en la transferencia (TFP) semanal de una paciente joven en el CSMIJ de L’Hospitalet de Llobregat

In this article we reflect on the traumatic bonding in early childhood and on how this is revived in adolescence and the ways in which this problem manifests itself through the body in observable ways. An increase in the number of adolescents presenting with self-harm at the Center for Child and Adolescent Mental Health (CSMIJ) spurred this attempt to try to come to a deeper understanding of this contemporary psychopathological manifestation. We illustrate our theoretical reflections with a summary of a weekly Transference-Focused Psychotherapy (TFP) for a young patient at the Mental Health Center For Children And Youth of L’Hospitalet de Llobregat

En el present article es reflexiona entorn el vincle traumàtic de la primera infància que es reviu a l’adolescència i com s’observa la manifestació d’aquesta problemàtica a través del cos. L’augment d’adolescents que consulten per autoagressions en un centre de salut mental infantil i juvenil (CSMIJ) ha motivat tractar d’entendre amb més profunditat aquesta manifestació psicopatològica actual. S’il·lustren les reflexions teòriques amb un resum del tractament amb psicoteràpia focalitzada en la transferència (TFP) setmanal d’una pacient jove en el CSMIJ de l’Hospitalet de Llobregat

Psicosis y diferencias sociales: comparando la prevalencia de las psicosis en dos medios urbanos diferenciados / Psychosis and social differences: comparing psychosis prevalence between two socially differentiated urban settings

Objetivos: Contribuir a la reflexión sobre la etiología y/o los factores de riesgo para las psicosis comparando la prevalencia en población general y población de riesgo de la esquizofrenia y otras psicosis en dos barrios de Barcelona (España). Método: Nuestras aportaciones en este trabajo se apoyan sobre todo en un estudio descriptivo transversal de todos los pacientes con psicopatología detectados en la USM de Sant Martí-La Mina: un territorio geodemográfica y asistencialmente delimitado formado por 5 Áreas Básicas de Salud (103.615 habitantes. Resultados: Sobre un total de 21.536 pacientes con registro de casos abierto desde el año 1982 hasta el año 2000, se halló que 838 cumplían los criterios restrictivos para ser diagnosticados como «esquizofrénicos» (N=476) o «afectados por otras psicosis» (N=362). Sin embargo, las prevalencias de esquizofrenia y otras psicosis en el barrio sujeto a más factores de riesgo psicosociales eran alrededor de 2 veces mayores que las encontradas en el barrio colindante por el mismo equipo y en el mismo período temporal. Conclusión: Es necesario tener en cuenta el gran peso de los factores de sociales y psicosociales para poderse explicar las diferencias de prevalencia de la esquizofrenia y otras psicosis entre diferentes poblaciones (AU)

Objectives: To contribute to the discussion about aetiology and risk factors of psychosis comparing the prevalence in general population and in «age of risk population» for schizophrenias and other psychoses on two neighbourhoods of Barcelona (Spain). Method: We base our reflections in a transversal study about the results of an informatized case register of all the patients' with detected psychopathology in this geodemographic and assistencially differentiated area: 5 Basic Areas of Health (103.615 inhabitants). Results: The total «psychopathological patients» detected were 21.536. From them, 838 completed the restrictive criteria to be diagnosed as «schizophrenics» (476) or «affected by other psychoses» (362). Among the neighborhood charged with psychosocial risk factors and the other 4 adjacent basic areas of health, assisted for the same team, so much clinical as investigator, the incidence and the prevalence of the schizophrenia and other psychoses is twice as much, almost in each group diagnosis. Conclusion: It seems necessary to keep in mind the great weight of the social and psychosocial factors to explain those differences of incidence and prevalence of the schizophrenia and the psychoses in different populations (AU)

Neighborhood differences in psychoses: prevalence of psychotic disorders in two socially-differentiated metropolitan areas of Barcelona.

INTRODUCTION: The prevalence of schizophrenia and other psychoses can vary between close geographic locations and can be biased by the use of epidemiological designs. With data derived from a public mental health centre with close relations to primary care teams we have compared the distribution of psychotic disorders in two neighborhoods in Barcelona with marked psycho-social differences. METHODS: Using a computerized database from Barcelona's National Health Service covering 5 basic health-care areas with a total population of 103,615 inhabitants, we have accessed case records showing any psycho-pathology between the years of 1982 and 2000. RESULTS: From the case records of 21,536 registered patients showing any psycho-pathology, and using strict diagnostic, clinical and assistance criteria, we found that there were 476 patients diagnosed as "schizophrenic" and 362 that were "affected by other psychoses." Despite being evaluated by the same mental health personal, the same research team using identical criteria and over the same period of time (thus precluding operator and selection bias) the prevalence of these disorders was twice as high in La Mina (a district with a marked accumulation of psycho-social risk-factors) as compared to the neighboring district of La Verneda. CONCLUSIONS: When assessing prevalence of psychoses, it is necessary to consider the impact of social and psycho-social factors, even in neighboring communities.

Factores de riesgo para padecer trastornos psicóticos: ¿es posible realizar una detección preventiva? / Psychosis risk factors: is there a chance for preventive identification?

Introducción: Revisión de los factores de riesgo para las psicosis desde la perspectiva de la literatura internacional y desde la perspectiva de la experiencia clínica e investigadora del equipo. Objetivo principal: Se presenta el diseño y las primeras pruebas de un instrumento de exploración y cribaje de señales de alarma y factores de riesgo de trastornos mentales severos, y en especial trastornos psicóticos, aplicable en los primeros años de vida por parte de los servicios de atención primaria de salud y los equipamientos de salud mental vinculados con ellos. Se trata del LISMEN(Listado de ítems de Salud Mental en edades preescolares y escolares). Metodología: 5 muestras diferentes, tanto de edad infantil como de adultos. El trabajo se centra en la muestra A del Proyecto LISMEN: Se trata de un estudio descriptivo retrospectivo de los dossieres de los pacientes que han desarrollado una psicosis (N=838) y se habían visitado previamente, ya durante la infancia, en la misma Unidad de Salud Mental (N=120). Resultados: Se utilizan los resultados de las muestras anteriormente estudiadas para encuadrar el tema y presentar los primeros resultados de la muestra A: Estos señalan una constelación de factores de riesgo que aparecen ya en las historias o dossiers clínicos de la infancia de los pacientes que van a desarrollar una psicosis postpuberal. Conclusiones: Aunque hoy poseemos un amplio acervo de conocimientos sobre factores de riesgo de la esquizofrenia y otras psicosis, eso no implicaque podamos predecir el trastorno en base a los mismos. El LISMEN es un intento en ese sentido (AU)

This paper reviews risk factors associated with psychosis from both a literatureperspective and the clinical and research practice. The development of atool for the diagnosis and screening of alarm signs and risk factors of severemental disorders is described along with preliminary tests. The tool is aimedto be administered by primary health care systems and associated mentalhealth teams during a person’s early years. The tool is called LISMEN–standing for “list of mental health items at pre-school and school ages”.The list was administered to 5 different samples including children andadults. This paper focuses on Project LISMEN sample A. It is an investigationof medical records of patients who had developed a psychosis (N = 838). Anumber of them (N = 120) had already been assisted by the same MentalHealth Unit during their childhood. Samples already assisted were used as abenchmark for sample A preliminary results. A constellation of risk factors hadalready been identified in medical records during the childhood of people whowould develop a psychosis after their adolescence.Even though there is a broad pool of knowledge on risk factors associatedwith schizophrenia and other psychoses, this does not mean that prediction ofthe disorder can be made on this base. Nevertheless, LISMEN is a contributionin this direction (AU)

Seguimiento de pacientes dados de alta de un hospital de día para adolescentes. Estudio descriptivo / Follow up of patients discharged from a day-care hospital for teenagers

Estudio descriptivo del Hospital de Día para Adolescentes de Gavà (Barcelona) a partir de una encuesta ad hoc que se administró al ingreso, al alta y, posteriormente, a los seis meses y al año (AU)

Descriptive study in the adolescent day-hospital of Gavà (Barcelona) is based on an ad hoc questionnaire given at the time of income, discharge, six months after discharge and finally one year after discharge (AU)