masterThesis
Depressão no período periparto: rastreio em mulheres primíparas de alto risco - análise de fatores hormonais, clínicos e epidemiológicos
Fecha
2020-07-13Registro en:
NASCIMENTO FILHO, José Medeiros do. Depressão no período periparto: rastreio em mulheres primíparas de alto risco - análise de fatores hormonais, clínicos e epidemiológicos. 2020. 81f. Dissertação (Mestrado em Neurociências) - Instituto do Cérebro, Universidade Federal do Rio Grande do Norte, Natal, 2020.
Autor
Nascimento Filho, José Medeiros do
Resumen
Major depressive disorder (MDD) is currently a public health problem, affecting more than 300
million people worldwide. This disorder is extremely important in the puerperal period, when
women may develop depressive symptoms linked to variations in sexual hormones and in the
hypothalamic-pituitary-adrenal axis, both changes associated with gestational status and peripartum, with negative consequences for the mother, the newborn, or both. Several studies have
shown that steroid and peptides hormones have modulatory effects on neural circuits associated
with parental care, a behavior that is also influenced by genetic, socio-environmental and
economic factors. Thus, the occurrence of depression in the postpartum period should be
investigated more broadly in order to address these aspects. The objectives of this study were
(1) to describe the characteristics of a sample of primiparous pregnant women in terms of
socioeconomic aspects and prenatal epidemiology, and (2) to model the risk of depression in
this sample. The experimental design consisted of a cross-sectional and quantitative study in
which 116 women over 18 years old, with live birth fetuses, were interviewed within 48 hours
after delivery. Socio-epidemiological questionnaire that also included prenatal quality
questions, and two screening scales for depression - Pacient Health Questionnaire 9 (PHQ9,
cut-off point 10) and Edinburgh Puerperal Depression Scale (EPDS, cut-off point 10) were
used. The day after the questionnaires were applied, blood was collected to measure morning
cortisol. The statistical analysis showed that the average age of the participants was 24.37 years
(61.26%; n = 71) and that most of them had a family income of up to 1 minimum wage (75%;
n = 84), and stable union (72.41%; n = 84), declaring that they receive too much or too much
support from their partner. The general average of the number of prenatal consultations was
8.65 (+ 3,19) with consultations beginning at around 9.34 (+ 4,42 weeks ). Eighty women
(68.96%) stated that they had not been asked about their mood during the prenatal period. Only
13.80% (n = 16) women reported previous psychiatric problems. Of this total, 23.28% (n = 27)
were positive on the EPDS and 52.59% (n = 61) were positive on the PHQ9. It was possible to
collect samples for analysis of cortisol from 107 women. Of the total number of parturient
women, 46 women with an income of up to 1 minimum wage were selected and divided into
two groups: 21 participants who had a positive screening in EPDS and another 25 participants
with both negative screenings (EPDS and PHQ9). Considering those 46 participants from both
groups, the modeling of the risk of depression in the peripartum was performed using a logistic
regression model (Model I). The risk factors found were younger age, lower levels of cortisol, presence of a previous psychiatric history, and support from the father. Another model, using
the 116 participants (Model II), sought to identify the positive screening prediction. In this
analysis, the positive predictive factors were family income of up to one minimum wage,
residing in the state capital and previous psychiatric history. Based on the results obtained,
adjustments to the high-risk prenatal program of the studied maternity will be proposed, and
suggested recommendations for screening for depression in the immediate postpartum period,
using the PHQ2 questionnaire, in order to allow an intervention in women potentially
depressed.