Depressão no período periparto: rastreio em mulheres primíparas de alto risco - análise de fatores hormonais, clínicos e epidemiológicos

Abstract

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.