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)

El abordaje perinatal interdisciplinar desde Atención Primaria de Salud (APS): el desarrollo de una atención bio-psico-social integrada / The interdisciplinary perinatal approach from Primary Health Care (PHC): the development of an integrated bio-psycho-social care

El Equipo de Atención Primaria (EAP) Roquetes-Canteres de Barcelona se plantea, en el marcode investigación impulsada por Bruc Salut (equipo psicoterapéutico), una intervención bio-psico-social integrada. Eneste artículo se describe la investigación desde su inicio y los diferentes programas que se están llevando a cabo desde2014 con un recorrido por todos los programas desarrollados. Se explica detenidamente cómo se han creado, llevadoa cabo, evaluado y su funcionamiento actual, gracias al trabajo coordinado del equipo interdisciplinar para atenderlos aspectos emocionales de la parentalidad, el establecimiento del vínculo y el buen desarrollo del bebé, así como lasensibilización y contención de los profesionales del equipo. Finalmente, se define la figura del profesional sanitariode enlace del EAP, que se ha creado para coordinar y guiar el equipo y fomentar la mirada bio-psico-social entre losprofesionales, vital para evitar una visión fragmentada de las familias.(AU)

The Primary Health Care Team (EAP) Roquetes-Canteres in Barcelona is considering, within theresearch framework promoted by Bruc Salut (a psychotherapeutic team), an integrated bio-psycho-social intervention.This article describes the research since its beginning and the different programmes that are being carried out since2014 with a tour of all the developed programmes. It explains thoroughly how they have been created, carried out,evaluated and their current operation, thanks to the coordinated work of the interdisciplinary team to address theemotional aspects of parenthood, the establishment of the bond and the good development of the baby, as well asthe awareness and self-restraint of the team professionals. Finally, the figure of the EAP liaison health professional isdefined, which has been created to coordinate and guide the team and to promote the bio-psycho-social view amongthe professionals, vital to avoid a fragmented view of the families.(AU)

L’Equip d’Atenció Primària (EAP) Roquetes-Canteres de Barcelona es planteja,en el marc de la investigació impulsada per Bruc Salut (equip psicoterapèutic), una intervenció biopsicosocialintegrada. En aquest article es descriuen la investigació des de l’inici i els diferents programes que s’estan duenta terme des de 2014 amb un recorregut per tots els programes desenvolupats. S’explica detingudament coms’han creat, dut a terme, avaluat i el funcionament actual, gràcies al treball coordinat de l’equip interdisciplinariper atendre els aspectes emocionals de la parentalitat, l’establiment del vincle, el bon desenvolupament del nadói també la sensibilització i contenció dels professionals de l’equip. Finalment, es defineix la figura del professionalsanitari d’enllaç de l’EAP, que s’ha creat per coordinar i guiar l’equip i fomentar la mirada biopsicosocial entreels professionals, vital per evitar una visió fragmentada de les famílies.(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