Which social, gestational and mental health aspects are associated to maternal-fetal attachment? / Quais aspectos sociais, gestacionais e de saúde mental materna estão associados ao apego materno-fetal?

Abstract Objectives: this study aimed to explore a set of factors associated with lower maternal-fetal attachment (MFA) in pregnant women. Methods: this is a cross-sectional study corresponding to the second wave of a cohort study with a population-based sample of pregnant women in the South of Brazil. The maternal-fetal attachment scale (MFAS) was used to measure MFA. Bivariate analysis was performed using the t-test and ANOVA. The variables that presented p<0.20 were taken for multivariate analysis, through linear regression, in order to control possible confounding factors. Results: a total of 840 pregnant women were included. Pregnant women who had lower MFA means were those who did not live with a partner (B=-3.8 [CI95%=-6.0; -1.7]), those between the first and second trimester of pregnancy (B=-4.3 [CI95%=-5.9; -2.6]), those who did not have support from their mother during pregnancy (B=-2.4 [CI95%=-4.6; -0.2]), and those with depressive symptoms (B=-4.9 [CI95%=-7.4; -2.5]). Conclusions: the results showed that a higher MFA it is associated with an adequate support network during pregnancy, better maternal mental health, and with an advanced pregnancy. Early evaluation of MFA and effort to promote an adequate prenatal bond, focusing on maternal psychological and emotional aspects are strongly suggested.

Resumo Objetivos: explorar um conjunto de fatores associados ao menor apego materno-fetal (AMF) em gestantes. Métodos: trata-se de um estudo transversal, correspondente à segunda fase de um estudo de coorte com uma amostra de base populacional de gestantes no sul do Brasil. Foi utilizada a Escala de Apego Materno-Fetal (EAMF) para medir o AMF. A análise bivariada foi realizada através do teste t e ANOVA. As variáveis que apresentaram p<0,20 foram levadas para análise multivariada, por meio de regressão linear, a fim de controlar possíveis fatores de confusão. Resultados: foram incluídas 840 gestantes. As gestantes que apresentaram menores médias de AMF foram aquelas que não moravam com um companheiro (B=-3,8 [IC95%=-6,0; -1,7]), que estavam entre o primeiro e o segundo trimestre de gestação (B=-4,3 [IC95%=-5,9; -2,6]), que não tiveram o apoio da mãe durante a gestação (B=-2,4 [IC95%=-4,6; -0,2]) e que apresentaram sintomas depressivos (B=-4,9 [IC95%=-7,4; -2,5]). Conclusões: os resultados mostraram que um maior AMF está associado a presença de uma rede de apoio adequada na gravidez, melhor saúde mental materna e a uma gestação avançada. A avaliação precoce do AMF e a promoção de um vínculo pré-natal adequado, com foco nos aspectos psicológicos e emocionais maternos são fortemente sugeridos.

Major depressive episode in mothers during the COVID-19 pandemic: a population-based study in the Southern Brazil.

The COVID-19 pandemic has changed individuals and families, causing adverse psychological effects, especially in young adults, women, and parents. This study aimed to verify the prevalence of current major depressive episode (CMDE) in mothers of preschoolers (up to five years old) and its associated stressors during the COVID-19 pandemic in a municipality in the Southern Brazil. This is a cross-sectional, population-based study with mothers. All mothers were interviewed by telephone call during the COVID-19 pandemic. We used the Mini-International Neuropsychiatric Interview (M.I.N.I. Plus) to assess the presence of CMDE. Statistical analysis was conducted using the chi-square test and a multivariate logistic regression. We evaluated 666 mothers. The prevalence of CMDE was 12.3%. Mothers with financial losses had 2.1 (95%CI: 1.3-3.4) more odds of presenting CMDE than those financially stable. We observed that financial losses were determinant for the higher prevalence of depression in mothers.

Antenatal depression: Efficacy of a pre-post therapy study and repercussions in motor development of children during the first 18 months postpartum. Study: "Pregnancy care, healthy baby".

AIMS: To evaluate the efficacy of brief psychotherapeutic interventions of cognitive behavioral therapy to treat antenatal depression and verify the association between interventions and motor development of infants at 3 and 18 months of age. METHODS: Pre-post-intervention study nested a randomized clinical trial, both of which are extracts from a population-based cohort study of a southern Brazilian city. The major depressive episode was measured through Mini Plus, the severity of depressive symptoms by BDI-II and motor development using Bayley-III and AIMS. The follow-ups occurred during the gestational period (T2) and at 3 (T3) and 18 months (T4) after delivery. RESULTS: Data were analyzed from 336 women in the control group (not intervened) and 108 from the group of depressed women who received intervention for antenatal depression. The effectiveness of the interventions for a major depressive episode was around 80% for both models in the two follow-up stages (3 and 18 months postpartum). In addition, the children whose mothers received intervention presented 3.7 (95% CI 0.7-6.6) points higher in Bayley-III at 3 months old when compared to the children in the control group (p = 0.01). There was no difference between the two psychotherapy models tested, both being equally effective (p > 0.05). CONCLUSIONS: We found that the brief psychotherapeutic interventions of cognitive behavioral therapy for gestational depression were effective in causing remission of the condition both in the short and long term, besides indirectly causing benefits also to the children, with regard to their motor development.

Family perception of the symptoms of Obsessive-Compulsive Disorder patient and the family accommodation.

BACKGROUND: Family members tend to modify their routine by assisting or participating in the patient's rituals. These behaviors have been identified as family accommodation (FA). AIMS: The aim of this study was to describe the relationship between family accommodation of relatives of Obsessive-Compulsive Disorder (OCD) patients and their perceptions about the obsessions and compulsions of the patient. METHOD: This was a cross-sectional study with family members of Obsessive-Compulsive Disorder in a Southern Brazilian city. The family perception of the OCD symptoms and their accommodation were assessed through the Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR). RESULTS: The level of family accommodation was higher in those family members who lived with the patient when compared to those who did not live with them (p = .011). The obsessions associated with higher levels of family accommodation were: contamination (p < .001), hoarding/saving (p = .001), symmetry/exactness (p = .001), religious (p = .019), and diverse (p = .003). Regarding compulsions, the perception of all symptoms was associated with higher levels of family accommodation (p < .05). CONCLUSION: The family accommodation is present in family members of Obsessive-Compulsive Disorder patients, regardless of the type of obsessive/compulsive symptom perceived.

Evidence of validity of the revised Helping Alliance Questionnaire based on the internal structure in a Brazilian clinical sample.

The revised Helping Alliance Questionnaire (HAq-II) is among the most used instruments that measure therapeutic alliance. Despite its use in research, this instrument is not validated for the Brazilian population. The aim of this study was to explore the evidence of validity of the HAq-II based on the internal structure in a sample of Brazilian psychiatric patients. An ambulatory convenience sample of 204 patients with major depressive disorder (MDD) and 81 patients with obsessive-compulsive disorder (OCD) was randomized between two different types of treatment. The HAq-II was completed by patients (patient version) and by 33 therapists who performed the interventions (therapist version) between the second and third sessions. We used confirmatory factor analysis (CFA) to investigate two models: (1) a one-dimensional therapeutic alliance model and (2) a two-dimensional model considering the factors 'positive alliance' and 'negative alliance'. The internal consistency of the HAq-II was measured by Cronbach's alpha. To investigate discriminant validity, we used the t-test for independent samples, ANOVA and Pearson's correlation coefficient. The analysis showed that the best model of the instrument was one-dimensional. Cronbach's alpha for both versions displayed values above 0.89. The Brazilian version of the HAq-II presented properties similar to those found in the original version. However, studies related to the one-dimensional model with other samples are necessary.

Major depressive episode in mothers during the COVID-19 pandemic: a population-based study in the Southern Brazil / Episódio depressivo maior entre mães durante a pandemia da COVID-19: um estudo populacional no Sul do Brasil / Episodio depresivo mayor en madres durante la pandemia de COVID-19: un estudio de base poblacional en el sur de Brasil

The COVID-19 pandemic has changed individuals and families, causing adverse psychological effects, especially in young adults, women, and parents. This study aimed to verify the prevalence of current major depressive episode (CMDE) in mothers of preschoolers (up to five years old) and its associated stressors during the COVID-19 pandemic in a municipality in the Southern Brazil. This is a cross-sectional, population-based study with mothers. All mothers were interviewed by telephone call during the COVID-19 pandemic. We used the Mini-International Neuropsychiatric Interview (M.I.N.I. Plus) to assess the presence of CMDE. Statistical analysis was conducted using the chi-square test and a multivariate logistic regression. We evaluated 666 mothers. The prevalence of CMDE was 12.3%. Mothers with financial losses had 2.1 (95%CI: 1.3-3.4) more odds of presenting CMDE than those financially stable. We observed that financial losses were determinant for the higher prevalence of depression in mothers.

A pandemia da COVID-19 tem levado a mudanças em indivíduos e famílias, com efeitos psicológicos adversos, principalmente em adultos jovens, mulheres e pais e mães. O estudo buscou averiguar a prevalência de episódio depressivo maior atual (EDMA) em mães de pré-escolares (até 5 anos de idade) e estressores associados durante a pandemia da COVID-19 em uma cidade no Sul do Brasil. Este é um estudo transversal aninhado em um estudo de base populacional com mães. Todas as mães foram entrevistadas através de contato telefônico durante a pandemia da COVID-19. Os autores usaram a Mini-International Neuropsychiatric Interview (M.I.N.I. Plus) para avaliar a presença de EDMA. A análise estatística foi realizada, calculando o qui-quadrado e a regressão logística multivariada. Foram avaliadas 666 mães. A prevalência de EDMA foi de 12,3%. Mães com perdas financeiras apresentaram probabilidade 2,1 vezes maior (IC95%: 1,3-3,4) de apresentar EDMA, comparadas com aquelas que mantiveram a situação financeira. Com base nos resultados, os autores observaram que perdas financeiras foram determinantes para a prevalência maior de depressão materna.

La pandemia de COVID-19 ha provocado cambios en los individuos y las familias, causando efectos psicológicos adversos, especialmente en los adultos jóvenes, las mujeres y los padres y madres. El objetivo de este estudio fue verificar la prevalencia del episodio depresivo mayor actual (EDMA) en madres de preescolares (hasta 5 años) y sus estresores asociados durante la pandemia de COVID-19 en una ciudad del sur de Brasil. Se trata de un estudio transversal anidado en un estudio poblacional con madres. Todas las madres fueron entrevistadas mediante contacto telefónico durante la pandemia de COVID-19. Se utilizó la Mini-International Neuropsychiatric Interview (M.I.N.I. Plus) para evaluar la presencia de EDMA. El análisis estadístico se realizó calculando la prueba de chi-cuadrado y una regresión logística multivariante. Se evaluaron 666 madres. La prevalencia de EDMA fue del 12,3%. Las madres con pérdidas económicas tenían un 2,1 (IC95%: 1,3-3,4) más probabilidades de presentar EDMA que las que mantuvieron su situación económica. Teniendo en cuenta los resultados, observamos que las pérdidas económicas fueron determinantes para la mayor prevalencia de depresión materna.

Brief cognitive behavioral therapy in pregnant women at risk of postpartum depression: Pre-post therapy study in a city in southern Brazil.

BACKGROUND: Postpartum depression (PPD) affects a high number of women, often the first manifestation of a mood disorder that will occur later in life, bringing serious consequences for the patient and her offspring. Depression today is the leading cause of disability worldwide. The aim of this study was to evaluate the effectiveness of a preventive cognitive behavioral therapy (CBT) for PPD. METHODS: Pre-post therapy study, as part of a population-based cohort study. Pregnant women without a diagnosis of depression participated, who were divided into two groups: risk of depression (CBT) and a control group (without therapy). The preventive therapy consisted of six sessions of CBT, administered weekly. The Outcome Questionnaire (OQ-45) was used in all sessions. The Mini International Neuropsychiatric Interview and Beck Depression Inventory-II were used on three occasions. The final statistical analyses were performed by Poisson regression. RESULTS: The prevalence of PPD in the risk group was 5.5% and in the control group 2.2%, with no difference between the groups (PR 1.66 95% CI 0.44-6.18). The OQ-45 averages gradually reduced during the therapy sessions, indicating therapeutic progress. Schooling was an associated factor, both with the manifestation of PPD and with the greater effectiveness of the therapy. LIMITATIONS: Rate of 40.5% refusal to preventive treatment and absence of a group with similar characteristics in another therapy model. CONCLUSIONS: Brief cognitive behavioral therapy applied by mental health professionals with basic training was effective in preventing the manifestation of PPD.

[Quality of life with Obsessive-Compulsive Disorder: a study among Primary Care users]. / Qualidade de vida no Transtorno Obsessivo-Compulsivo: um estudo com usuários da Atenção Básica.

Quality of life (QOL) can be affected by the presence of mental disorders, like Obsessive-Compulsive Disorder (OCD). Thus, the evaluation and monitoring of QOL in patients with mental disorders enables the identification of priorities, making it possible to implement actions to improve QOL among health system users. The scope of this article is to measure QOL in OCD patients in primary health care. It involves a cross-sectional study with a convenience sample including all users of three Basic Health Units of Pelotas in the State of Rio Grande do Sul, Brazil. The quality of life was measured with the WHOQOL-Bref and the OCD was assessed using the Mini-International Neuropsychiatric Interview (M.I.N.I.) This study included 1081 individuals. The prevalence of OCD was 3.9%. OCD patients had a lower average in all domains of QOL when compared to individuals without OCD (p < 0.001). The findings of this study emphasize the importance of using QOL as a monitoring tool of the disorder in basic health care.

Qualidade de vida no Transtorno Obsessivo-Compulsivo: um estudo com usuários da Atenção Básica / Quality of life with Obsessive-Compulsive Disorder: a study among Primary Care users

Resumo A qualidade de vida (QV) pode ser afetada pela presença de transtornos mentais, como o Transtorno Obsessivo-Compulsivo (TOC). Assim, a avaliação e o acompanhamento dos índices de QV em pacientes com transtornos mentais permite a identificação de suas prioridades, sendo possível a implementação de ações para a melhora desses índices nos usuários do sistema de saúde. O objetivo deste artigo é avaliar a QV em portadores de TOC usuários da atenção primária à saúde. Estudo transversal com amostragem por conveniência, incluindo todos os usuários de três Unidades Básicas de Saúde de Pelotas, RS. Para avaliar a QV foi utilizada a WHOQOL-Bref, e o TOC foi avaliado através da M.I.N.I. Foram avaliados 1081 indivíduos. A prevalência de TOC foi de 3,9%. Portadores de TOC apresentaram médias inferiores em todos os domínios da QV quando comparados aos indivíduos sem TOC (p < 0,001). Os achados deste estudo enfatizam a importância de utilizar a QV como instrumento de monitoramento da melhora do transtorno no âmbito da atenção básica à saúde.

Abstract Quality of life (QOL) can be affected by the presence of mental disorders, like Obsessive-Compulsive Disorder (OCD). Thus, the evaluation and monitoring of QOL in patients with mental disorders enables the identification of priorities, making it possible to implement actions to improve QOL among health system users. The scope of this article is to measure QOL in OCD patients in primary health care. It involves a cross-sectional study with a convenience sample including all users of three Basic Health Units of Pelotas in the State of Rio Grande do Sul, Brazil. The quality of life was measured with the WHOQOL-Bref and the OCD was assessed using the Mini-International Neuropsychiatric Interview (M.I.N.I.) This study included 1081 individuals. The prevalence of OCD was 3.9%. OCD patients had a lower average in all domains of QOL when compared to individuals without OCD (p < 0.001). The findings of this study emphasize the importance of using QOL as a monitoring tool of the disorder in basic health care.