Search

Highlights • Brief CBT in pregnancy was effective in preventing PPD. • CBT improved interpersonal relationships and understanding of social status (OQ-45). • Education, among the risk factors for PPD, was decisive in the effectiveness of CBT., 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.

The aim of the study is to verify the association between GAD, the severity of depressive symptoms and stressors in pregnant women between the first and second trimester. Cross-sectional study, part of a cohort that followed 980 women during the gestational period of a city in southern Brazil. We performed bivariate analysis using the t-test and chi-square. The variables that presented p ≤ 0.20 were taken for multivariate analysis, through logistic regression, in order to control possible confounding factors. The Mini International Neuropsychiatric Interview Plus was used to evaluate GAD, the severity of depressive symptoms was investigated through the Beck Inventory of Depression II, and stress events according to the Social Readjustment Assessment Scale of Holmes e Rahe. The sample consisted of 980 women. Women with mild depression symptoms had 9.8 (IC95% 4.6;21.0) times more GAD, those with moderate symptoms had 27.5 (IC95% 12.5;60.0) times more GAD, and those with severe symptoms had 52.9 (IC95% 19.1;146.5) times more GAD when compared to pregnant women with no symptoms or minimal symptoms. Regarding the stressful events, the pregnant women who presented GAD had an increase of 1.0 (IC95% 1.0;1.1) point in the mean of occurrence of stressor events when compared to those without GAD. These findings highlight the need for prevention strategies and interventions to promote maternal mental health, which benefit the development of infants in the long term.

This study aimed to investigate the association between child maltreatment and depressive symptomatology during gestation in adolescents. This was a cross-sectional study with pregnant adolescents aged 12 to 19 years. Data were collected with the Beck Depression Inventory, Childhood Trauma Questionnaire, and Mini International Neuropsychiatric Interview. Compared to adolescents who did not experience each type of neglect or abuse, experiencing them was associated with a higher proportion of depressive symptoms: emotional neglect PR = 1.4 (95% CI 1.1; 1.8); physical neglect PR = 1.7 (95% CI 1.3; 1.7); emotional abuse PR = 1.8 (95% CI 1.4; 2.2); and physical abuse PR = 1.3 (95% CI 1.1; 1.7). This study demonstrates the association between childhood experiences and mental health in adolescence, especially in vulnerable samples, such as pregnant adolescents. This finding reveals the importance of studying early trauma in life and enabling preventive help, especially in adolescents. High-quality evidence of perinatal mental health problems should be generated to make pregnancy safer for women in low- and middle-income countries.

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 Conclusion: The family accommodation is present in family members of Obsessive-Compulsive Disorder patients, regardless of the type of obsessive/compulsive symptom perceived.

Suicide associated with severe psychiatric illnesses is considered the leading cause of maternal deaths. We aimed to assess the suicide risk in women who experienced depressive or mixed episodes of mood change during the postpartum period and to determine which disorder is more related to suicide risk in the same period. We conducted a longitudinal study with 706 women whose children were born from April 2007 to May 2008 in a southern city in Brazil, and received prenatal care by the Brazilian National System of Public Health. The first assessment occurred during the prenatal period and the second within 30 to 60 days postpartum. The incidence of suicide risk was 10.9%. The odds of postpartum suicide risk were 6.50 (95% CI: 2.73; 15.48) higher in mothers with postpartum depression and 41.50 (95% CI: 12.11; 142.16) higher in those with mixed episodes than those who did not suffer from any mood disorder. Women with chronic episodes (who had depressive or mixed episodes during pregnancy and postpartum) were at increased odds of 4.94 (95% CI: 1.46; 16.69) of a postpartum suicide risk. The postpartum seems to be a critical period in the women’s mental health. The impact of mental disorders in this period, especially mixed episodes, can increase the odds of a suicide risk onset. A good psychiatric evaluation and support during the prenatal and postpartum care may prevent the subsequent risk of suicide.

Objective To verify the association between mood and anxiety disorders, and suicide risk during pregnancy and their relationship with premature birth in a population of pregnant adolescents attending prenatal care in the public health system of Pelotas, a southern city in Brazil. Methods This was a cohort study with all pregnant adolescents attending antenatal public services in the urban area of Pelotas between October 2009 and May 2011. The first assessment occurred between the 20th and 22 nd week of pregnancy and the second occurred one month after delivery. We used the Mini International Neuropsychiatric Interview (MINI) to assess mood and anxiety disorders and suicide risk. Results A total of 645 pregnant women aged between 12 and 19 years old were interviewed. An anxiety disorder was present in 9.1% of the pregnant adolescent, and 28.5% had a mood disorder. The prevalence of suicide risk was 12.6%, and 15.3% of the babies were born premature. A multivariate analysis adjusted for maternal education, number of previous pregnancies and previous preterm birth indicated that adolescents who had suicide risk during pregnancy were approximately twice as likely to give birth prematurely when compared to those who were not diagnosed with suicide risk (PR 1.79; CI 1.06–3.03). Conclusion Our findings suggest that pregnant adolescents who were at risk of suicide during pregnancy were more likely to have premature babies. It is important to pay attention to the mental health of this specific population to prevent obstetric complications and consequently improve the health of the children.

Background:The parental bonding is influenced by two dimensions: care and control or protection over the child of both parents. The lack of care during childhood may make the individual more susceptible to the onset of psychiatric disorders when adult. These psychiatric disorders when present during pregnancy may have a negative impact on the health of pregnant women and children. The aim of this study was to assess the association between generalized anxiety disorder (GAD) in pregnant adolescents and the perception of parental bonding.Methods:This is a cross-sectional study with 871 pregnant women under the age of 19, receiving prenatal care in 47 Basic Health Units in the one city, Brazil. The generalized anxiety disorder was measured using the Mini International Neuropsychiatric Interview (MINI) and the perception of parental bonding in childhood using the Parental Bonding Instrument (PBI).Results:The prevalence of GAD was 8.5%. Among all the parental bonding dimensions, only a perceived lack of maternal care under 16 years was associated with GAD.Conclusions:The results showed that only the perception of maternal bonding was associated with later GAD. It suggests that an adequate maternal bond is an essential component of psychological health.

Objective: To evaluate the association between abuse of and dependence on different psychoactive substances and the presence of anxiety disorders in a sample of young adults from a city in southern Brazil. Methods: Between 2007 and 2009, we carried out a cross-sectional, population-based study of individuals aged 18-24 years who lived in Pelotas, a city in southern Brazil. We evaluated anxiety disorders using the Mini International Neuropsychiatric Interview 5.0 (MINI), and use of psychoactive substances with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST 2.0/0MS). We used Fisher’s exact test for univariate analysis, and Poisson regression models with robust variance for multivariable analysis. Results: The sample consisted of 1,560 young adults. The overall prevalence of abuse/dependence was 26.9% for alcohol, 24.9% for tobacco, and 7.3% for illicit substances. Individuals with agoraphobia had a 32% higher prevalence of tobacco abuse/dependence (prevalence ratio [PR] = 1.32 [95%CI 1.01-1.74]). Individuals with posttraumatic stress disorder (PTSD) or generalized anxiety disorder (GAD) had a 2.41-fold (95%CI 1.22-4.77) and 1.76-fold (95%CI 1.00-3.11) higher prevalence of illicit substance abuse/dependence, respectively. Conclusion: In this population-based sample, we found associations between GAD, PTSD, and increased prevalence of illicit substance abuse/dependence. In addition, individuals with agoraphobia seem to have increased tobacco abuse/dependence.

AIM: The aim of this study was to evaluate the prevalence of depressive symptoms and factors associated in the elderly of the city of Pelotas, southern Brazil. METHODS: In this cross-sectional study, the variables of interest were investigated with instruments about the socio-economic profile, aspects of physical and professional activities, eating and sleeping habits. RESULTS: 312 elderly people were interviewed, with a prevalence of depressive symptoms of 30.5%. A higher prevalence of depressive symptoms were found in women, individuals older than 81 years, from the low class, living alone, physically inactive, and retired. In the adjusted analysis, the non-practice of physical activity, low sleep quality, and daily sleeping medication were statistically associated with the outcome. In contradiction to the literature, our results refute the well-established gender roles that preconize that males are more affected by physical impairment, while the females are more affected by psychological and psychiatric disorders. CONCLUSIONS: In conclusion, it is important to identify the prevalence of depressive symptoms in a population commonly affected by other diseases. In addition, characteristics associated with depression were detected, which can help prevent or improve depression in this age group. OBJETIVO: El objetivo de esto estudio fue para evaluar la prevalencia de síntomas depresivos y factores asociados en ancianos de la ciudad de Pelotas, sur de Brasil. MÉTODOS: En este estudio transversal, las variables de interés fueron investigadas con instrumentos sobre perfil socioeconómico, aspectos de las actividades físicas y profesionales, hábitos alimentarios y de sueño.RESULTADOS: Fueron entrevistados 312 ancianos, con prevalencia de síntomas depresivos del 30,5%. Una mayor prevalencia de síntomas depresivos fue encontrada en mujeres, de más de 81 años, de clase baja, viviendo solos, físicamente inactivos y jubilados. En el análisis ajustado, la nula práctica de actividad física, la baja calidad del sueño y la medicación diaria para dormir fueron estadísticamente asociadas al desenlace. En contradicción con la literatura, nuestros resultados refutan papeles de género bien establecidos que preconizan que los hombres son más afectados por el compromiso físico, mientras que las mujeres son más afectadas por disturbios psicológicos y psiquiátricos. CONCLUSIONES: En conclusión, es importante identificar la prevalencia de síntomas depresivos en una población comúnmente afectada por otras enfermedades. Además, las características asociadas a la depresión se han detectado, lo que puede ayudar a prevenir o mejorar la depresión en este grupo de edad. AIM: The aim of this study was to evaluate the prevalence of depressive symptoms and factors associated in the elderly of the city of Pelotas, southern Brazil. METHODS: In this cross-sectional study, the variables of interest were investigated with instruments about the socio-economic profile, aspects of physical and professional activities, eating and sleeping habits. RESULTS: 312 elderly people were interviewed, with a prevalence of depressive symptoms of 30.5%. A higher prevalence of depressive symptoms were found in women, individuals older than 81 years, from the low class, living alone, physically inactive, and retired. In the adjusted analysis, the non-practice of physical activity, low sleep quality, and daily sleeping medication were statistically associated with the outcome. In contradiction to the literature, our results refute the well-established gender roles that preconize that males are more affected by physical impairment, while the females are more affected by psychological and psychiatric disorders. CONCLUSIONS: In conclusion, it is important to identify the prevalence of depressive symptoms in a population commonly affected by other diseases. In addition, characteristics associated with depression were detected, which can help prevent or improve depression in this age group. ***Prevalencia de síntomas depresivos y factores asociados en ancianos de la ciudad de Pelotas-RS***OBJETIVO: O objetivo deste estudo foi avaliar a prevalência de sintomas depressivos e fatores associados em idosos da cidade de Pelotas, sul do Brasil. MÉTODOS: Neste estudo transversal, as variáveis de interesse foram investigadas com instrumentos sobre perfil socioeconômico, aspectos das atividades físicas e profissionais, hábitos alimentares e de sono. RESULTADOS: Foram entrevistados 312 idosos, com prevalência de sintomas depressivos de 30,5%. Uma maior prevalência de sintomas depressivos foi encontrada em mulheres, com mais de 81 anos, de baixa classe, vivendo sozinhos, fisicamente inativos e aposentados. Na análise ajustada, a não prática de atividade física, a baixa qualidade do sono e a medicação diária para dormir foram estatisticamente associadas ao desfecho. Em contradição com a literatura, nossos resultados refutam papéis de gênero bem estabelecidos que preconizam que os homens são mais afetados pelo comprometimento físico, enquanto as mulheres são mais afetadas por distúrbios psicológicos e psiquiátricos. CONCLUSÕES: Em conclusão, é importante identificar a prevalência de sintomas depressivos em uma população comumente afetada por outras doenças. Além disso, características associadas à depressão foram detectadas, o que pode ajudar a prevenir ou melhorar a depressão nessa faixa etária. Descritores: Depressão; Saúde do idoso; Qualidade de vida.

The discussion on the safety of thimerosal-containing vaccines (TCVs) and their impact on child development it́s very relevant.This is a cohort study with mother-child dyads who received prenatal care in the Unified Health System. The domains of motor, cognitive and language development were evaluated in children between 24 and 36 months of age. Data on vaccination were obtained through the child's immunization record. A linear regression analysis was carried out considering possible confounders.In bivariate analyses, motor and language development were associated with TCVs (p 0.05). However, in the multivariate analysis, this association was not maintained (p 0.05). These results indicate that the use of TCVs is not associated with child development. The importance of this study is summarized in transmitting relevant information regarding public health, based on reliable data.

Background The parental bond is characterized by the perception of care and protection received by parental figures throughout human development. During the gestational period, the intensity in which the woman manifests behaviors and feelings for the fetus was denominated maternal-fetal attachment (MFA). In this perspective, the literature indicates that there is association between MFA and the pregnant woman's perception about the bond established with her parents. Aims This study aimed to evaluate the association between MFA and perceived parental bonds of pregnant women in the city of Pelotas/RS (Brazil). Study design This is a cohort study with 839 women during their gestational period. All women answered to the Parental Bonding Instrument to investigate the perceived parental bonds, and the MFA was assessed through the Maternal-Fetal Attachment Scale. Results The main results showed that perceived paternal overprotection was associated with a higher MFA after adjustment (B 2.00 CI95% 0.30; 3.70). Additionally, the pregnant women who were in the first trimester of pregnancy (p, Highlights • Literature suggests an association between maternal-fetal attachment (MFA) and the parental bonding of the pregnant women. • We provide evidence that the overprotection perceived by the women with her paternal figures influences the MFA. • The supportive behaviors provided by the baby's father influence pregnant women's MFA. • Living with a partner also has a positive impact on MFA.

Objective: To describe the incidence of suicidal attempts and the prevalence of suicidal ideation in pregnancy; verifying the factors associated with suicidal ideation in pregnant women. Methods: This analysis is a section from a population-based cohort study with pregnant women between the first and second gestational trimester, identified at their homes in the urban area from a southern Brazilian. The Mini International Neuropsychiatric Interview version Plus (MINI PLUS) was used to assess suicidal ideation and behavior. Variables with a p

A large number of children of depressed mothers have one or more mental disorders. This study aimed to evaluate the impact of maternal depression on the mental health of 4–5-year-old children of adolescent mothers, according to the hypotheses generated from the model of accumulation. Between October 2009 and March 2011, all pregnant adolescents who received prenatal care from the public health system in Pelotas (southern Brazil) were invited to participate in the study and have been prospectively followed. Of these individuals, 413 participants were evaluated in the postpartum period and when the child was 2–3 years old and 4–5 years old (current stage). The Strengths and Difficulties Questionnaire was used to assess mental health problems in children, and the Mini International Neuropsychiatric Interview (MINI)-Plus version was used to assess maternal depression. We applied a structured modeling approach to examine the relations between three different hypothesized life course models (accumulation, critical period, and mobility) and maternal depression. After selecting the most appropriate model, we used a logistic regression analysis to assess the effect of depression on mental health problems in 4–5-year-old children of adolescent mothers. We used the Chi square test to estimate the prevalence of mental health problems in 4–5-year-old children. The longer the time of exposure to maternal depression, the greater the probability that the child would present behavioral problems. Investments in strategies to prevent mental disorders beginning in the gestational period are important.

Objective: To examine the association between Anxiety Disorders (AD) and cognitive performance in young mothers at 30 months postpartum. Methods: This is a cross-sectional study nested to a follow-up study was conducted with 539 young mothers in the city of Pelotas, in southern Brazil. The ADs were evaluated with the Mini International Neuropsychiatric Interview (MINI PLUS), cognitive performance was screened with the Montreal Cognitive Assessment (MoCA). We used multiple linear regression analysis to explore the association between ADs and cognitive performance. Results: The total MoCA score was associated with the following variables: marital status β= -0.86 (95%CI -1.60;-0.13), education β= 1.22 (95%CI 0.90;1.53), occupation β= 1.03 (95%CI 0.28;1.79), Generalized Anxiety Disorder (GAD) β= -2.28 (95%CI -4.07;-0.50) and at least one AD 30 months postpartum β= -0.10 (95%CI -0.20;-0.00). Together, these variables were responsible for 16% of the variance in the total MoCA score, GAD being the variable with the strongest negative association. Conclusions: The results showed that sociodemographic variables, a GAD diagnosis and the presence of at least one AD were significantly associated with low cognitive performance in young mothers at 30 months postpartum.

OBJECTIVES: To describe the prevalence of Major Depressive Disorder (MDD) during pregnancy in teenage mothers and to assess its association with socio-demographic characteristics, obstetric history and psychosocial variables. METHODS: A cross-sectional study was conducted with a sample of pregnant teenagers enrolled in the national public health system in the urban area of Pelotas, southern Brazil. MDD was assessed with the Mini International Neuropsychiatric Interview, the Abuse Assessment Screen was used to identify physical abuse within the last 12 months and during pregnancy, and social support was assessed with the Medical Outcomes Survey Social Support Scale. RESULTS: Forty-three (4.94%) potential subjects refused to participate, resulting in 828 total participants. The prevalence of MDD was 17.8%, 9.2% reported they had been subjected to violence within the last 12 months, while 5.8% had suffered violence during pregnancy, and the mean (SD) overall social support score was 87.40 (11.75). After adjustment, we found the highest incidence of MDD in adolescents with less than 8 years of education, followed by those with previous episodes of MDD and those with lower overall social support. CONCLUSIONS: MDD is a relatively common condition in pregnant teenagers and appears to be more prevalent in young mothers who are both socioeconomically and psychosocially underprivileged.

Background Suicidal behavior and its correlates remain relatively understudied in pregnant teenagers. Methods A cross-sectional study with a consecutive sample of pregnant teenagers recipient of prenatal medical assistance by the national public health system in the urban area of Pelotas, southern Brazil. Sample size was estimated in 871 participants. Suicidal behavior and psychiatric disorders were assessed with the Mini International Neuropsychiatric Interview; the Abuse Assessment Screen was used to identify physical or sexual abuse; social support was assessed with the Medical Outcomes Survey Social Support Scale; a self-report questionnaire was used to collect socio-demographic, obstetric and other psychosocial data. Results Forty three (4.94%) teenagers refused to participate, resulting in 828 participants. Prevalence of suicidal behavior was 13.3%; lifetime suicide attempts were referred by 7.4%, with 1.3% reporting attempting suicide within the last month. After adjustment, we found significant associations of suicidal behavior with the 18–19 years old subgroup, low education, prior abortion, previous major depression, and physical abuse within the last 12 months. Pregnant teenagers with high social support showed prevalence ratios (PR) 67% lower (PR: 0.33; 95%CI: 0.19–0.56) than those with low social support. Furthermore, a wide range of psychiatric disorders, most notably major depressive disorder (PR: 2.75; 95%CI: 1.34–5.63) and panic disorder (PR: 6.36; 95%CI: 1.61–25.10), remained associated with suicidal behavior after adjustment. Limitations The cross-sectional design precludes causal inferences. Conclusions We found that suicidal behavior is a relatively common feature in pregnant teenagers, frequently associated with psychiatric disorders.

To assess the associations of the perceived quality of parental bonding with suicidality in a sample of pregnant adolescents. A cross-sectional study with a sample size of 828 pregnant teenagers receiving prenatal medical assistance in the national public health system in the urban area of Pelotas, southern Brazil. Suicidality and psychiatric disorders were assessed using the Mini International Neuropsychiatric Interview (MINI), and the Parental Bonding Instrument (PBI) was employed to measure the perceived quality of parental bonding. A self-report questionnaire was used to collect sociodemographic, obstetric and other psychosocial data. Forty-three (4.94 %) teenagers from a consecutive sample of 871 refused to participate, resulting in 828 participants. Prevalence of suicidality was 13.3 %, lifetime suicide attempts were 7.4 % with 1.3 % reporting attempting suicide within the last month. Significant associations of suicidality with the 18–19-year-old subgroup, low education, prior abortion, physical abuse within the last 12 months were present, and most psychiatric disorders were associated with a higher suicidality prevalence. Additionally, after adjustment in the multivariate analysis, the style of parental bonding was independently associated with suicidality in the pregnant adolescent, with a PR of 2.53 (95 % CI 1.14–5.59) for the maternal ‘affectionless control’ and a PR of 2.91 (95 % CI 1.10–7.70) for the paternal ‘neglectful parenting.’ We found that maternal ‘affectionless control’ and paternal ‘neglectful parenting’ were independent predictors of suicidality in this sample of pregnant teenagers.