Bibliometric analysis of peer-reviewed literature on perinatal depression in Mexico / Análisis bibliométrico de la literatura revisada por pares sobre depresión perinatal en México

Abstract Background Perinatal depression (PND) is a clinical disease developed in any stage during the pregnancy and postpartum period with serious health and economic implications. Objective The aim of this work was to analyze via bibliometrics indicators Mexico's production on PND to provide a view of the academic landscape and a comprehensive reference for subsequent research in the country. Method The Scopus and Web of Science (WoS) databases were used to perform a search for peer reviewed papers related to PND in México. The search was made following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The extracted data were processed with VOS Viewer to examine link strength and clusters associations of diverse bibliometrics variables. Results A total of 132 records were retrieved and we included 70 studies in the bibliometric analysis after application of the exclusion criteria. The authors with more papers were Navarrete L., and Asunción Lara M. The institutions with more papers were the National Institute of Perinatology, Ramón de la Fuente National Institute of Psychiatry, and National Institute of Public Health of Mexico. A diminution of the research considered in PND is observed in the last two years. Four keyword clusters were identified related to PND: symptoms, prevalence, pregnancy. Discussion and conclusion The scarce literature concerning PND in Mexico compared with other countries could be due the limited collaboration between the health institutes. An urgent need to increase research on PND in Mexico is evident to be applicable in the management of resources in the healthcare system.

Resumen Antecedentes La depresión perinatal (PND) es una enfermedad clínica que se desarrolla en cualquier etapa del embarazo y posparto con graves implicaciones sanitarias y económicas. Objetivo El objetivo de este trabajo fue analizar a través de indicadores bibliométricos la producción de México sobre PND, para brindar una visión del panorama académico y un referente integral para investigaciones posteriores en el país. Método Se utilizaron las bases de datos Scopus y Web of Science (WoS) para realizar una búsqueda de artículos revisados por pares relacionados con la PND en México. La búsqueda se realizó siguiendo los elementos de informes preferidos para revisiones sistemáticas y metaanálisis (PRISMA). Los datos extraídos se procesaron con VOS Viewer para examinar la fuerza de los enlaces y las asociaciones de grupos de diversas variables bibliométricas. Resultados Se recuperaron un total de 132 registros y se incluyeron 70 estudios en el análisis bibliométrico después de la aplicación de los criterios de exclusión. Los autores con más artículos fueron Navarrete L. y Asunción Lara M. Las instituciones con más artículos fueron el Instituto Nacional de Perinatología, el Instituto Nacional de Psiquiatría Ramón de la Fuente y el Instituto Nacional de Salud Pública de México. Se observa una disminución de las investigaciones consideradas en el PND en los últimos dos años. Se identificaron cuatro grupos de palabras clave relacionadas con la PND: síntomas, prevalencia y embarazo. Discusión y conclusión La escasa literatura sobre PND en México en comparación con otros países podría deberse a la limitada colaboración entre los institutos de salud. Se evidencia una necesidad urgente de realizar más investigaciones sobre PND en México que sean aplicables y útiles en la gestión de recursos en el sistema de salud.

Tecnologías de la información y la comunicación como apoyo a la salud mental para mujeres en etapa perinatal / Information and communication technology as a support for mental health in perinatal women / Tecnologias de informação e comunicação como apoio à saúde mental de mulheres na fase perinatal

Durante el embarazo la mujer experimenta muchos cambios, no solo físicos, también mentales, por eso la salud mental perinatal es de gran importancia en esta etapa. La mayoría de las mujeres en embarazo que desarrollan alguna enfermedad mental durante la gestación, como depresión o ansiedad, no son diagnosticadas, lo que puede generar efectos adversos para la madre y el bebé. En ese sentido, es de gran importancia el tamizaje, diagnóstico, manejo y seguimiento de este grupo. Gracias a los avances tecnológicos podemos contar con las tecnologías de la Información y la comunicación (TIC) para buscar maneras cómo aproximarse a las mujeres en etapa perinatal para el tamizaje y hacer el seguimiento de su salud mental. Así que este artículo de revisión se enfoca en ver su aceptabilidad, la percepción, las barreras al acceso y nuevos desarrollos enfocados en mejorar la salud mental en las mujeres en etapa perinatal.

During pregnancy, a woman experiences many changes, not only physical, but also mental, which is why perinatal mental health is of great importance at this stage. The majority of pregnant women who develop a mental illness during pregnancy, such as depression or anxiety, are not diagnosed, which can cause adverse effects for the mother and baby. In this sense, the screening, diagnosis, management and follow-up of this group is of great importance. Thanks to technological advances, we can count on the Information and Communication Technologies (ICT) to find ways to approach women in the perinatal stage for screening and monitoring their mental health. So this review article focuses on seeing its acceptability, perception, barriers to access and new developments focused on improving mental health in perinatal women.

Durante el embarazo la mujer experimenta muchos cambios, no solo físicos, también mentales, por eso la salud mental perinatal es de gran importancia en esta etapa. La mayoría de las mujeres en embarazo que desarrollan alguna enfermedad mental durante la gestación, como depresión o ansiedad, no son diagnosticadas, lo que puede generar efectos adversos para la madre y el bebé. En ese sentido, es de gran importancia el tamizaje, diagnóstico, manejo y seguimiento de este grupo. Gracias a los avances tecnológicos podemos contar con las tecnologías de la Información y la comunicación (TIC) para buscar maneras cómo aproximarse a las mujeres en etapa perinatal para el tamizaje y hacer el seguimiento de su salud mental. Así que este artículo de revisión se enfoca en ver su aceptabilidad, la percepción, las barreras al acceso y nuevos desarrollos enfocados en mejorar la salud mental en las mujeres en etapa perinatal.

Design of a regression model to predict the presence of depression during pregnancy based on emotional intelligence, parental care, anxiety and stress / Diseño de un modelo de regresión para predecir la presencia de la depresión durante el embarazo a partir de la inteligencia emocional, el cuidado parental, la ansiedad y el estrés

Background: Emotion regulation involves the modulation of emotional experiences to facilitate goal attainment. Conversely, emotional difficulties are a pattern of emotional experiences and expressions that interfere with goal-directed behavior. Objectives: Design a new model to predict the presence of depression in women during pregnancy. Methods: Non-experimental, cross-sectional, explanatory study of depression in women during pregnancy (logistic regression) considering the variables emotional intelligence, parental care, anxiety and stress. The sample consisted of 273 pregnant women-mothers between 14 and 38 weeks pregnant, aged between 18 and 38 years, for a mean of 25.67 years (SD= 5.8). Results: The regression model is valid and significant in predicting the probability of occurrence of depression, explaining 82.4% of the variance of DV (Presence of depression) by the variables age, clarity and repair of depression dimensions. emotional intelligence, the maternal and paternal overprotection dimensions, and paternal care of the parental style variables; stress, work and single marital status. There is a 95.2% probability of success in the depression result when each of the model variables is incorporated. Conclusions: The best predictors of depression in pregnancy would be, on the one hand, higher levels or values of the variables and indicators age, reparation, maternal overprotection, paternal care, and stress, and on the other hand, low scores in the dimensions and values of clarity variables, and paternal overprotection; added to whether the woman works and is single. This combination of variables would be the individual and contextual conditions that influence said appearance.

Introducción: La depresión perinatal se ha definido como la presencia de episodios depresivos mayores o menores durante el período gestacional y/o durante el primer año posparto. La depresión durante el embarazo afecta alrededor de un 13% de las mujeres embarazadas a nivel mundial y en un 10% en la población chilena con consecuencias significativas para la mujer, su hijo y su familia. Objetivo: Diseñar un nuevo modelo para predecir la presencia de depresión en mujeres durante el embarazo. Método: Estudio no experimental, transversal, de tipo explicativo de la depresión en mujeres durante el embarazo (regresión logística) considerando las variables inteligencia emocional, cuidado parental, ansiedad y estrés. La muestra estuvo conformada por 273 mujeres-madres gestantes entre 14 y 38 semanas de embarazo, con edades entre 18 y 38 años, para una media de 25.67 años (SD= 5.8). Resultados: El modelo de regresión es válido y significativo en la predicción de las probabilidades de ocurrencia de la depresión, explicando el 82,4% de la varianza de la VD (Presencia de la depresión) por las variables edad, las dimensiones claridad y reparación de la inteligencia emocional, las dimensiones sobreprotección materna y paterna, cuidado paterno de las variables estilo parental; estrés, trabajo y estado civil soltera. Hay un 95.2% de probabilidad de acierto en el resultado de la depresión cuando se incorpora cada una de las variables del modelo. Conclusiones: Los mejores predictores de la depresión en el embarazo serían por una parte mayores niveles o valores de las variables e indicadores edad, reparación, sobreprotección materna, cuidado paterno y estrés, y por otra parte puntajes bajos en las dimensiones y valores de variables claridad, y sobreprotección paterna; sumado a si la mujer trabaja y es soltera. Esta combinación de las variables serían las condiciones tanto individuales como contextuales que influyen en dicha aparición.

Diseño de un modelo de regresión para predecir la presencia de la depresión durante el embarazo a partir de la inteligencia emocional, el cuidado parental, la ansiedad y el estrés

Introducción: La depresión perinatal se ha definido como la presencia de episodios depresivos mayores o menores durante el período gestacional y/o durante el primer año posparto. La depresión durante el embarazo afecta alrededor de un 13% de las mujeres embarazadas a nivel mundial y en un 10% en la población chilena con consecuencias significativas para la mujer, su hijo y su familia. Objetivo: Diseñar un nuevo modelo para predecir la presencia de depresión en mujeres durante el embarazo. Método: Estudio no experimental, transversal, de tipo explicativo de la depresión en mujeres durante el embarazo (regresión logística) considerando las variables inteligencia emocional, cuidado parental, ansiedad y estrés. La muestra estuvo conformada por 273 mujeres-madres gestantes entre 14 y 38 semanas de embarazo, con edades entre 18 y 38 años, para una media de 25.67 años (SD= 5.8). Resultados: El modelo de regresión es válido y significativo en la predicción de las probabilidades de ocurrencia de la depresión, explicando el 82,4% de la varianza de la VD (Presencia de la depresión) por las variables edad, las dimensiones claridad y reparación de la inteligencia emocional, las dimensiones sobreprotección materna y paterna, cuidado paterno de las variables estilo parental; estrés, trabajo y estado civil soltera. Hay un 95.2% de probabilidad de acierto en el resultado de la depresión cuando se incorpora cada una de las variables del modelo. Conclusiones: Los mejores predictores de la depresión en el embarazo serían por una parte mayores niveles o valores de las variables e indicadores edad, reparación, sobreprotección materna, cuidado paterno y estrés, y por otra parte puntajes bajos en las dimensiones y valores de variables claridad, y sobreprotección paterna; sumado a si la mujer trabaja y es soltera. Esta combinación de las variables serían las condiciones tanto individuales como contextuales que influyen en dicha aparición.

Background: Emotion regulation involves the modulation of emotional experiences to facilitate goal attainment. Conversely, emotional difficulties are a pattern of emotional experiences and expressions that interfere with goal-directed behavior. Objectives: Design a new model to predict the presence of depression in women during pregnancy. Methods: Non-experimental, cross-sectional, explanatory study of depression in women during pregnancy (logistic regression) considering the variables emotional intelligence, parental care, anxiety and stress. The sample consisted of 273 pregnant women-mothers between 14 and 38 weeks pregnant, aged between 18 and 38 years, for a mean of 25.67 years (SD= 5.8). Results: The regression model is valid and significant in predicting the probability of occurrence of depression, explaining 82.4% of the variance of DV (Presence of depression) by the variables age, clarity and repair of depression dimensions. emotional intelligence, the maternal and paternal overprotection dimensions, and paternal care of the parental style variables; stress, work and single marital status. There is a 95.2% probability of success in the depression result when each of the model variables is incorporated. Conclusions: The best predictors of depression in pregnancy would be, on the one hand, higher levels or values of the variables and indicators age, reparation, maternal overprotection, paternal care, and stress, and on the other hand, low scores in the dimensions and values of clarity variables, and paternal overprotection; added to whether the woman works and is single. This combination of variables would be the individual and contextual conditions that influence said appearance.

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.

Antecedente de depresión, síntomas de estrés postraumático, apoyo social percibido: prediciendo la depresión posparto / History of depression, post-traumatic stress symptoms, perceived social support: predicting postpartum depression

Objetivo: Describir y analizar si el apoyo social percibido modera la relación entre antecedente de depresión (AD) o síntomas de trastorno de estrés postraumático (TEPT) y desarrollo de síntomas de depresión posparto (SDPP), evaluado prospectivamente. Método: Diseño longitudinal de tres tiempos: antes del parto (n = 458), primer mes posparto (n = 406) y tercer mes posparto (n = 426). Se utilizaron la Escala de Depresión Posparto de Edimburgo (EPDS), la Escala de Síntomas de Estrés Postraumático (PCL-C) y la Escala de Apoyo Social Percibido (MOS). Se realizó un análisis de ocho modelos jerárquicos de regresión lineal múltiple, por cada tiempo de evaluación en el estudio. Resultados: Se encontró una asociación significativa entre síntomas de TEPT y puntaje de SDPP en los tres tiempos. El apoyo social percibido es un factor protector significativo para los SDPP en los tiempos 1 y 2, mientras que el AD es un factor de riesgo significativo en los tiempos 2 y 3. Los resultados no apoyan las hipótesis de interacción. Conclusiones: El apoyo social es un factor protector significativo, que puede disminuir los SDPP; sin embargo, disminuye con el tiempo. El apoyo social no logra revertir la asociación de los síntomas de TEPT con el puntaje en SDPP.

Objective: Describe and analyze if the perceived social support moderates the relationship between depression history or post-traumatic stress disorder symptoms and the development of symptoms of postpartum depression, prospectively evaluated. Method: Longitudinal design of three times: before partum (n = 458), one month (n = 458) and 3 months postpartum (n = 458). The version of the Edinburgh Postnatal Depression Scale (EPDS), the version of the PTSD Checklist-Civilian Version (PCL-C), and the version of the Medical Outcomes Study Social Support Survey (MOS) were used. Analysis of eight hierarchical multiple linear regression models. Results: A significant association was found between symptoms of post-traumatic stress and postpartum depression, in the three times measured. The perceived social support variable was found to be a significant protective factor for perinatal depression in times 1 and 2, and history of depression was significant in times 2 and 3. The results do not support the interaction hypothesis. Conclusions: Social support is a significant protective factor, which can reduce the symptoms of postpartum depression, nevertheless the significance decreases over time. However, social support fails to reverse the association of post-traumatic stress disorder symptoms with symptoms of postpartum depression score.

The lifetime costs of perinatal depression and anxiety in Brazil.

BACKGROUND: Each year, an estimated 860,000 Brazilian women experience depression and anxiety perinatally. Despite well-known devastating impacts of these conditions on mothers and children, they remain neglected in low- and middle-income countries. Knowing the costs of untreated perinatal depression and anxiety can inform decision-making. METHODS: Simulation modelling is used to examine lifetime costs of perinatal depression and anxiety for a hypothetical cohort of women and their children, followed until children are aged 40 years. Costs are measured from a societal perspective, including healthcare expenditure, productivity and health-related quality of life losses; 2017 data are taken from country-specific sources. Present values are calculated using a discount rate of 3 %. RESULTS: Lifetime cost of perinatal depression and anxiety in Brazil are USD 4.86 billion or R$ 26.16 billion, including costs linked to poorer quality of life (USD 2.65 billion), productivity loss (USD 2.16 billion) and hospital care (USD 0.05 billion). When the costs associated with maternal suicide are included, total costs increase to USD 4.93 billion. LIMITATIONS: Several costs could not be included in the analysis because of a lack of data. The study is reliant of longitudinal data on associations between perinatal depression and anxiety and impacts on mothers and children. Therefore, no causality can be inferred. CONCLUSION: Our findings illustrate the economic rationale for investment in this area. This is the first study that estimates the costs of perinatal mental health problems in a low- or middle-income country setting.

Postpartum depression in maternal thyroidal changes.

Evidence in the literature has suggested that there may be an association between thyroid antibodies and depression during pregnancy and in the postpartum period. Thus, this study aims to conduct a systematic review on the prevalence of postpartum depression (PPD) in women with thyroid abnormalities during pregnancy or in the postpartum period. For this review, we used four databases (PubMed, Lilacs, Scielo, and Scopus). Fifteen studies were selected; one study used a case-control design, four used a cross-sectional design and ten utilized prospective cohort designs. All studies were restricted to up to 1 year postpartum, and 46.7% focused on a period between immediate postpartum and 6 months postpartum. Estimates of the prevalence of PPD in pregnant women with thyroid disorders ranged between 8.3% and 36.0%. For follow-up studies, the cumulative incidence of self-reported depression from the primary episode in the first postpartum year was 6.3% in a high-city survey. Although some authors consider the status of positive anti-TPO antibodies to be a possible marker of vulnerability to depression , it is not yet possible to conclude whether thyroid function in the pregnancy-puerperal cycle is involved with the development of PPD.

Epidemiological analysis of perinatal depression.

Perinatal depression is a commonly underdiagnosed problem which not only severely affects maternal mental and physical health, but also affects the newborn on a physical, mental and cognitive level with serious repercussions on adult life. Despite efforts to obtain useful information to dimension the problem, most experts in the field agree that this disorder is more frequent than estimated. Thus, the improvement in obtaining information on perinatal mental health will not only allow for a better dimensioning of the problem, but will also allow for better decision making in public mental health to reduce morbidity and mortality and the burden of disease associated with perinatal depression.

La depresión perinatal es un problema habitualmente subdiagnosticado que no sólo afecta de manera importante la salud mental y física materna, sino también al recién nacido en los aspectos físico, mental y cognitivo, con serias repercusiones en la vida adulta. A pesar de los esfuerzos para obtener información útil para dimensionar el problema, la mayoría de los expertos en el tema coinciden en señalar que este trastorno es más frecuente de lo que se estima. La mejora en la obtención de información en salud mental perinatal permitirá dimensionar mejor el problema y una adecuada toma de decisiones en salud mental pública para disminuir la morbimortalidad y la carga de la enfermedad asociada a la depresión perinatal.

Partner relationship quality predicts later postpartum depression independently of the chronicity of depressive symptoms

Objective: Given the lifelong implications of extended postpartum depression (PPD), research is needed to examine the social factors implicated in its development (such as relationship quality) and associated predictors. This study sought to examine the association of partner relationship quality (PRQ) and decline of sexual life (DSL) with maternal PPD at 12-15 months after childbirth. Methods: Prospective study of 294 low-income postpartum women. A structured questionnaire and the Patient Health Questionnaire-9 (PHQ-9) captured responses for the main outcome variable and covariates. Results: The prevalence of the main outcome (PPD at 12-15 months) was 19.1%. Using logistic regression models, low PRQ (risk ratio [RR] = 1.58, 95%CI 1.01-2.49) and DSL (RR = 1.97, 95%CI 1.23-3.15) were associated with PPD at 12-15 months even after controlling for perinatal depression. Conclusions: Late PPD (12 to 15 months after giving birth) is very common among low-income women, and is independently associated with different aspects of the couple's relationship. Improving PRQ may prevent late PPD. Future investigations are warranted.

Anxiety, Depression, and Trauma Among Immigrant Mexican Women up to Two-Years Post-partum.

Anxiety has significant consequences for maternal and infant health, and Mexican immigrant mothers are at significantly high-risk. This study examined whether maternal depressive symptoms and trauma are related to anxiety symptoms in perinatal Mexican immigrants. Data were collected from 103 Mexican women residing in the Midwestern United States who were pregnant or up to two years postpartum. Half were aged 30-34. The majority had two or more children and low socio-economic status. Linear regression analyses predicted current anxiety symptoms from current maternal depression symptoms, trauma history, and socio-demographics. Anxiety symptoms were significantly related to depressive symptoms (B = 0.87, 95% CI 0.73, 1.01) and trauma. Compared to women with no trauma history, women who experienced more than ten traumas had increased anxiety symptoms (B = 7.15, 95% CI 0.34, 13.96). Perinatal Mexican women with higher depression symptoms and trauma have increased anxiety symptoms, increasing the need for more comprehensive screening.

Depresión perinatal: detección, diagnóstico y estrategias de tratamiento / Perinatal depression: a review on diagnosis and treatment strategies

Para las mujeres, experimentar cambios emocionales durante el embarazo y hasta un año posterior al parto puede ser parte del proceso de adaptación a los cambios fisiológicos y emocionales de esta nueva etapa, siendo por lo general manejable por ellas mismas. Diferente es el desarrollo de síntomas depresivos durante este período perinatal que comprende el embarazo y hasta doce meses posterior al parto. La depresión perinatal constituye un trastorno de alta prevalencia que puede tener efectos negativos tanto para la salud de la madre, del hijo y de otros miembros de la familia.

For women it is natural to experience changes in mood and feelings during pregnancy and after twelve months after childbirth, these shifting moods are often manageable by themselves, it differs with depressive symptoms that appear during these period. Perinatal depression constitutes a high prevalence disorder that might have a negative effect not only in the mother, but the child and other familiy members.

Barriers to Seeking and Accepting Treatment for Perinatal Depression: A Qualitative Study in Rio de Janeiro, Brazil.

Few studies have investigated the reasons why pregnant and puerperal women fail to seek or accept treatment for perinatal depression in low- and middle-income countries, where there is a high prevalence of this disorder. To help fill this gap, this study investigated the factors influencing the decision not to seek or to refuse treatment for perinatal depression in a low-income community in Rio de Janeiro, Brazil. Qualitative research was conducted in two primary health care units in Rio de Janeiro, Brazil in 2017-2018. Five focus groups were held with 26 women. Convenience sampling was used, and the sample size was determined by data saturation. A content analysis methodology was used to identify theme categories to objectively describe the group's manifest contents. Ten categories were obtained: stigma and misconception, self-image as a mother, socioeconomic stigma, lack of knowledge, lack of a health service approach to mental health, difficulty recognising depression symptoms, fear of children being removed, negative reaction to patient referral, denial of the problem and previous experience with the care unit. Perinatal depression is permeated with stigma and prejudice, and there is a belief that women with depression are unable to be good mothers. It is important to conduct programmes disseminating information about perinatal depression and implementing an approach that includes routine consultations so that women can access perinatal mental health services.

Depresión en el embarazo / Depression in Pregnancy

RESUMEN Introducción: La depresión es la morbilidad psiquiátrica más común en el embarazo, y llega a afectar a más del 13% de las gestantes. Su diagnóstico se basa en los criterios establecidos por el DSM-V y la aplicación de escalas validadas como la Escala de Depresión Posnatal de Edimburgo; sin embargo, entre los profesionales de la salud aún existen errores y falencias en el reconocimiento, el diagnóstico y el tratamiento de la depresión durante el embarazo, lo que propicia las diferentes consecuencias y repercusiones para la gestación misma o el feto. Objetivo: Presentar una revisión de tema acerca de la depresión en el embarazo, sus factores de riesgo, las características clínicas, las complicaciones y el tratamiento. Métodos: Se utilizaron las bases de datos PubMed y LILACS para la búsqueda de manuscritos; de 223 artículos, 55 cumplían los criterios de inclusión. Resultados: En Sudamérica se registra una prevalencia de aproximadamente el 29%. Los factores de riesgo con mayor significación son el abuso sexual, la edad temprana al embarazo y la violencia intrafamiliar. Por ello, el diagnóstico temprano favorece la disminución en las conductas de riesgo, los trastornos del neurodesarrollo fetal y los resultados obstétricos. Conclusiones: La depresión en el embarazo es una afección frecuente; no obstante, se presenta subregistro por la atribución de los síntomas a la gestación misma. Se recomienda el uso de antidepresivos como los inhibidores de la recaptación de serotonina, especialmente la fluoxetina, que no sea ha relacionado con teratogenicidad, además de la implementación de tratamiento no farmacológico como psicoterapia, mindfulness y ejercicio aeróbico. La sensibilización del personal de salud permitirá el diagnóstico y el tratamiento adecuados de esta enfermedad.

ABSTRACT Introduction: Depression is the most common psychiatric morbidity in pregnancy, affecting more than 13% of pregnant women. Its diagnosis is based on the criteria established by the DSM-5 and the application of validated scales such as the Edinburgh Postnatal Depression Scale. However, there are still errors and shortcomings among healthcare professionals in the recognition, diagnosis and treatment of depression during pregnancy, with the resulting consequences and repercussions on the gestation itself or the foetus. Objective: To present a review of depression in pregnancy, its risk factors, clinical characteristics, complications and treatment. Methods: The PubMed and LILACS databases were used to search for manuscripts. Of the 223 articles found, 55 fulfilled the inclusion criteria. Results: The prevalence of depression in pregnancy in South America is approximately 29% and the most significant risk factors are sexual abuse, pregnancy at an early age and intrafamily violence. Therefore, early diagnosis favours a reduction in risk behaviour, foetal neurodevelopmental disorders and obstetric outcomes. Conclusions: Depression in pregnancy is common condition but is underreported as its symptoms are often attributed to the pregnancy itself. The use of selective serotonin reuptake inhibitor antidepressants, particularly fluoxetine, which has not been associated with teratogenicity, is recommended, in addition to the implementation of non-pharmacological treatment such as psychotherapy, mindfulness and aerobic exercise. Educating healthcare professionals will facilitate the correct diagnosis and treatment of this condition.

Depression in Pregnancy. / Depresión en el embarazo.

INTRODUCTION: Depression is the most common psychiatric morbidity in pregnancy, affecting more than 13% of pregnant women. Its diagnosis is based on the criteria established by the DSM-5 and the application of validated scales such as the Edinburgh Postnatal Depression Scale. However, there are still errors and shortcomings among healthcare professionals in the recognition, diagnosis and treatment of depression during pregnancy, with the resulting consequences and repercussions on the gestation itself or the foetus. OBJECTIVE: To present a review of depression in pregnancy, its risk factors, clinical characteristics, complications and treatment. METHODS: The PubMed and LILACS databases were used to search for manuscripts. Of the 223 articles found, 55 fulfilled the inclusion criteria. RESULTS: The prevalence of depression in pregnancy in South America is approximately 29% and the most significant risk factors are sexual abuse, pregnancy at an early age and intrafamily violence. Therefore, early diagnosis favours a reduction in risk behaviour, foetal neurodevelopmental disorders and obstetric outcomes. CONCLUSIONS: Depression in pregnancy is common condition but is underreported as its symptoms are often attributed to the pregnancy itself. The use of selective serotonin reuptake inhibitor antidepressants, particularly fluoxetine, which has not been associated with teratogenicity, is recommended, in addition to the implementation of non-pharmacological treatment such as psychotherapy, mindfulness and aerobic exercise. Educating healthcare professionals will facilitate the correct diagnosis and treatment of this condition.

Mexican-American adolescents' perceptions about causes of perinatal depression, self-help strategies, and how to obtain mental health information.

PROBLEM: Perinatal depression is a public health concern as it is associated with adverse pregnancy outcomes. Previous studies have recommended further examination of perinatal depression among Mexican-American adolescents. Thus, the purpose of this study was to understand pregnant and postpartum Mexican-American adolescents' knowledge and beliefs concerning perinatal depression. METHODS: This qualitative descriptive study examined perceptions about the causes of perinatal depression, self-help strategies, and how to obtain mental health information. Data were analyzed using deductive and inductive qualitative content analysis. A convenience sample, consisiting of 20 pregnant and postpartum adolescents, self-identified as Mexican-Americans, between the ages of 15 and 19 years was interviewed. FINDINGS: The quality of relationships with their family and significant other and difficulties in transitioning to motherhood were described as potential causes for depression. Journaling, exercising, and spending time with friends and family were identified as self-help strategies. Healthcare providers, the internet, and mothers who have experienced depression were stated as helpful sources of mental health information. CONCLUSION: An assessment of their psychosocial environment is indicated to identify risk or protective factors for perinatal depression. Its consideration and inclusion in interventions may optimize mental health among perinatal adolescents.

"We Don't Want to be Judged": Perceptions about Professional Help and Attitudes Towards Help-Seeking among Pregnant and Postpartum Mexican-American Adolescents.

PURPOSE: The purpose of this qualitative study is to understand how depression is recognized, as well as perceptions of professional help and attitudes concerning perinatal depression among pregnant and postpartum (perinatal) Mexican-American adolescents. DESIGN AND METHODS: This qualitative descriptive study used deductive and inductive content analysis to analyze data. Categories and subcategories describing the mental health literacy of perinatal Mexican-American adolescents concerning perinatal depression are presented. A convenience sample of 20 perinatal Mexican-American adolescents between the ages of 15 and 19 years were interviewed. Participants were recruited from parenting classes across urban high-schools in Southwestern United States. RESULTS: Adolescents expressed difficulties in recognizing perinatal depression. Depressive symptoms were identified through self-appraisals or the appraisal of others. Establishing rapport with empathetic health care providers facilitated trust among adolescents. Fear of judgement was the most common response and prevented help-seeking. Lack of trust, normalization of depression, and reluctance with disclosing symptoms were also indicated by participants. CONCLUSIONS: Stigma concerning perinatal depression was identified as a barrier for help-seeking among participants who were already experiencing criticism due to their pregnancy status. The quality of interactions with health providers may hinder or facilitate adolescents from professional help-seeking. PRACTICE IMPLICATIONS: Active engagement and collaboration with Mexican-American adolescents are indicated in identification and treatment of perinatal depression. Integration of mental health services in primary care settings is suggested to facilitate help-seeking for perinatal depression. Mental Health First Aid may be utilized to improve knowledge and decrease stigma concerning perinatal depression among Mexican-American adolescents.

Preparing to launch the 'Thinking Healthy Programme' perinatal depression intervention in Urban Lima, Peru: experiences from the field.

BACKGROUND: An estimated 19-25% of perinatal women in low- and middle-income countries are affected by depression which, untreated, is associated with multiple health problems for mothers and children. Nonetheless, few perinatal women have access to depression care. The Thinking Healthy Programme (THP), promoted by the World Health Organization (WHO), is an evidence-based, non-specialist delivered depression intervention that addresses this care gap. However, the WHO THP manual explains intervention delivery but not the antecedents to implementation. Here, we describe a principled, planned approach leading to the implementation of THP in Lima, Peru by the non-profit organization Socios En Salud with community health workers (CHW) to inform its implementation in other settings. METHODS: The Replicating Effective Programs (REP) framework guided THP implementation, following four phases: (I) pre-conditions; (II) pre-implementation; (III) implementation; and (IV) maintenance and evolution. This paper centers on REP phases I and II, including (1) documented high perinatal depression rates in Peru; (2) designation of perinatal depression as a government priority; (3) THP Implementation Team orientation and training; (4) data collection plan development; (5) public health system coordination; (6) CHW selection and training; and (7) THP launch. RESULTS: Between December 2016 and March 2017, a THP training program was developed and seven CHW were trained to deliver the intervention to 10 perinatal women, the first of whom was enrolled on 17 April 2017. CONCLUSIONS: THP was rapidly implemented by a community-based organization with no prior experience in delivering non-specialist perinatal depression care. The steps followed may inform the implementation of THP in other settings.

Screening and diagnosing postpartum depression: when and how? / Triagem e diagnóstico de depressão pós-parto: quando e como?

Abstract Introduction: Prevalence rates of postpartum depression (PPD) vary widely, depending on the methodological parameters used in studies: differences in study populations, diagnostic methods, and postpartum time frame. There is also no consensus on the ideal time to perform screening, on whether PPD can only be diagnosed in the early postnatal period, or on how soon after a delivery depression may be related to it. Objective: To review which instruments have been used over recent years to screen and diagnose PPD and the prevailing periods of diagnosis. Methods: Only articles published within 5 years and related exclusively to screening and diagnosis were selected. The sample comprised 22 articles. Results: The Edinburgh Posnatal Depression Scale (EPDS) was the most common screening tool, used in 68% of the sample (15 articles), followed by the Beck Depression Inventory (BDI-II) (27%, 6 articles), and the Patient Health Questionnaire-9 (PHQ-9) (18%, 4 articles). Screening time frame was reported in 21/22 articles: 0 to 3 months postpartum in 9 (43%), up to 6 months in 4 (19%), and up to 12 months or more in 8 (38%). In short, 13 articles screened during the first 6 months (59%) while only 8 (36%) screened up to 1 year. Conclusion: The most frequent PPD diagnosis tool was the EPDS, but other scales were also used. The most common period for diagnosis was up to 3 months postpartum. However, some researchers diagnosed PPD 12 months or more postpartum. Greater standardization of parameters for investigation of this disease is needed.

Resumo Introdução: A prevalência de depressão pós-parto (DPP) varia consideravelmente dependendo dos parâmetros metodológicos utilizados: diferentes populações, métodos de diagnóstico e o tempo pós-parto considerado. Também não há consenso sobre o momento ideal para a triagem, se a DPP pode ser diagnosticada apenas no período puerperal, e por quanto tempo após o parto a depressão pode ser relacionada a ele. Objetivo: Revisar os instrumentos mais usados recentemente para rastreamento e diagnóstico de DPP e os períodos predominantes de diagnóstico. Métodos: Foram selecionados apenas artigos relacionados exclusivamente ao rastreio e diagnóstico publicados num período de 5 anos. A amostra incluiu 22 artigos. Resultados: A Escala de Depressão Pós-Parto de Edimburgo (EPDS) foi a ferramenta mais frequente, utilizada em 68% da amostra (15 artigos), seguida pelo Inventário de Depressão de Beck (27%, 6 artigos) e o Patient Health Questionnaire-9 (PHQ-9) (18%, 4 artigos). O tempo de rastreio foi definido em 21/22 artigos: 0-3 meses pós-parto em 9 (43%), < 6 meses em 4 (19%), e ≤ 12 meses em 8 (38%). Treze artigos selecionaram as mulheres durante os primeiros 6 meses (59%), enquanto apenas 8 (36%) o fizeram até 1 ano. Conclusão: A EPDS foi o instrumento mais utilizado para o diagnóstico de DPP, mas outras escalas também foram aplicadas. O período mais comum para o diagnóstico foi de < 3 meses pós-parto. No entanto, alguns pesquisadores consideraram o diagnóstico de PPD em ≤ 12 meses após o parto. Há necessidade de maior padronização de parâmetros em relação à investigação desta doença.

Unplanned pregnancy and risk of maternal depression: secondary data analysis from a prospective pregnancy cohort.

PURPOSE: to evaluate the relationship between unplanned pregnancy (UP), a common problem in high and low income countries and maternal depression (MD). METHODS: Secondary analysis of data from a prospective cohort study with pregnant women recruited from 10 primary care clinics of the public sector in São Paulo, Brazil. Participants were questioned about pregnancy intention at 20-30 weeks of gestation. The Self Report Questionnaire score >7 was used to evaluated the presence of depression during pregnancy and 11 months after childbirth. Four groups of MD were defined: never; antenatal only; postnatal only; persistent (both antenatal/postnatal). Multinomial logistic regression was used to assess the relationship between UP and MD, controlling for confounding. RESULTS: Data were analysed for 701 at the postpartum period. Five hundred and sixty-two (67.8%) women did not plan the pregnancy. Women with UP had 2.5 more risk of being depressed during both assessments (during pregnancy and postpartum) when compared to women with a planned pregnancy (RR: 2.5; 95% CI: 1.47:4.30). In the adjusted models, women with UP were significantly more likely to have persistent depression (RR: 2.3; 95% CI: 1.2:4.3). CONCLUSION: UP is an independent risk factor for persistent depression, but not for postpartum depression.