Depressive Symptoms in Pregnancy: The Influence of Social, Psychological and Obstetric Aspects

Abstract

Purpose To assess the prevalence of depressive symptoms and their association with social, psychological, behavioral and obstetric characteristics in pregnant women.

Methods This is a cross-sectional study. The sample consisted of 375 pregnant women who attended prenatal clinics in two public maternity hospitals located in the city of Goiania, Brazil. To testify the depressive symptoms, we used the Hospital Anxiety and Depression Scale (HADS). A descriptive statistical analysis was performed using programs such as CDC EPI-INFO™, version 7.1.5, and Statistical Package for Social Sciences (IBM SPSS), version 21.0.

Results the patients had probable depressive symptoms (15.47%) and possible depressive symptoms (25.33%). The bivariate analysis showed a significant association among “depressive symptoms” and the following variables: “single or divorced” (prevalence ratio, PR = 2.08; 95% confidence interval, CI = 1.26 to 3.44); “physical activity during pregnancy” (PR = 3.96; 95%CI = 1.28 to 12.31); exposure to “psychological/emotional” violence (PR = 4.74; 95%CI = 2.94 to 7.64); “prior mental problem” (PR = 2.66; 95%CI =1.49 to 4.73) and “obstetric complications during pregnancy” (PR = 2.53; 95%CI = 1.55 to 4.13). The multivariate analysis confirmed the association of these depressive symptoms with the variables “suffered psychological/emotional violence” (odds ratio, OR = 5.821; 95%CI = 2.939 to 11.528); “physical activity during pregnancy” (OR = 3.885; 95%CI = 1.060 to 14.231); “obstetric complications during pregnancy” (OR = 2.442; 95%CI = 1.233 to 4.834) and “single or divorced” (OR = 2.943; 95%CI = 1.326 to 6.533).

Conclusions the prevalence of depressive symptoms among pregnant women is of 15.47%, and emotional violence is the main factor associated with gestational depression.

Resumo

Objetivo verificar a prevalência de sintomas depressivos e suas associações com características sociais, psicológicas, comportamentais e obstétricas em mulheres grávidas.

Métodos trata-se de estudo transversal. A amostra constou de 375 grávidas atendidas no ambulatório de pré-natal de duas maternidades públicas localizadas na cidade de Goiânia. Para a comprovação dos sintomas depressivos, empregou-se a Hospital Anxiety and Depression Scale (HADS). Foi realizada análise estatística descritiva com auxílio dos programas CDC EPI-INFO™, versão 7.1.5, e Statistical Package for Social Sciences (IBM SPSS), versão 21.0.

Resultados apresentaram prováveis sintomas depressivos e possíveis sintomas depressivos 15,47% e 25,33% das entrevistadas, respectivamente. A análise bivariada demonstrou associação significante entre “sintomas depressivos” e as seguintes variáveis: “solteira ou separada” (razão de prevalência, RP =2,08; intervalo de confiança, IC95% = 1,26–3,44); “atividade física na gestação” (RP = 3,96; IC95% = 1,28–12,31); submissão a “violência psicológica/emocional” (RP = 4,74; IC95% = 2,94–7,64); “problema mental prévio” (RP = 2,66; IC95% = 1,49–4,73) e “complicações obstétricas na gestação atual” (RP = 2,53; IC95% = 1,55–4,13). A análise multivariada confirmou associação desses sintomas depressivos com as variáveis “sofreu violência psicológica/emocional” (odds ratio, OR = 5,821; IC95% = 2,939–11,528); “atividade física na gestação” (OR = 3,885; IC95% =1,060–14,231); “complicações obstétricas na gestação atual” (OR = 2,442; IC95% = 1,233–4,834); e “solteira ou separada” (OR = 2,943; IC95% = 1,326–6,533).

Conclusões a prevalência de sintomas depressivos entre as grávidas é de 15,47%, e a violência emocional é o principal fator associado à depressão gestacional.

Keywords

prenatal depression - pregnancy - prevalence - cross-sectional studies - public health

Palavras-chave

depressão pré-natal - gravidez - prevalência - estudos transversais - saúde pública

• Referências

• 1 Shakeel N, Eberhard-Gran M, Sletner L , et al. A prospective cohort study of depression in pregnancy, prevalence and risk factors in a multi-ethnic population. BMC Pregnancy Childbirth 2015; 15: 5
• 2 Wisner KL, Sit DK, McShea MC , et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013; 70 (5) 490-498
• 3 Pereira PK, Lovisi GM. Prevalência da depressão gestacional e fatores associados. Rev Psiquiatr Clín. 2008; 35 (4) 144-153
• 4 Faisal-Cury A, Menezes PR. Antenatal depression strongly predicts postnatal depression in primary health care. Rev Bras Psiquiatr 2012; 34 (4) 446-450
• 5 Thiengo DL, Santos JFC, Fonseca DL, Abelha L, Lovisi GM. Depressão durante a gestação: um estudo sobre a associação entre fatores de risco e de apoio social entre gestantes. Cad Saúde Coletiva. 2012; 20 (4) 416-426
• 6 Van Hyssteen L. Need for wider recognition of antenatal depression. Ther Today. 2008; 19: 28
• 7 Yedid Sion M, Harlev A, Weintraub AY, Sergienko R, Sheiner E. Is antenatal depression associated with adverse obstetric and perinatal outcomes?. J Matern Fetal Neonatal Med 2016; 29 (6) 863-867
• 8 Yusuff AS, Tang L, Binns CW, Lee AH. Antenatal depressive symptoms and breastfeeding: a prospective cohort study. Breastfeed Med 2015; 10 (6) 300-304
• 9 Campbell JC, Szumlinski KK, Kippin TE. Contribution of early environmental stress to alcoholism vulnerability. Alcohol 2009; 43 (7) 547-554
• 10 Vythilingum B, Roos A, Faure SC, Geerts L, Stein DJ. Risk factors for substance use in pregnant women in South Africa. S Afr Med J 2012; 102 (11 Pt 1) 851-854
• 11 World Health Organization [Internet]. Depression is a common illness and people suffering from depression need support and treatment: WHO marks 20th Anniversary of World Mental Health Day: note for the media 9. Geneva: WHO; 2012 [cited 2016 Apr 20]. Available from: http://www.who.int/mediacentre/news/notes/2012/mental_health_day_20121009/en/
• 12 Escribà-Agüir V, Royo-Marqués M, Artazcoz L, Romito P, Ruiz-Pérez I. Longitudinal study of depression and health status in pregnant women: incidence, course and predictive factors. Eur Arch Psychiatry Clin Neurosci 2013; 263 (2) 143-151
• 13 Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T. The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PLoS ONE 2015; 10 (2) e0116820
• 14 Lau Y, Wang Y, Kwong DH, Wang Y. Are different coping styles mitigating perceived stress associated with depressive symptoms among pregnant women?. Perspect Psychiatr Care 2016; 52 (2) 102-112
• 15 Battle CL, Abrantes AM, Schofield CA, Kraines MA. Physical activity as an intervention for antenatal depression: rationale for developing tailored exercise programs for pregnant women with depression. J Midwifery Womens Health 2015; 60 (5) 479-482
• 16 Ussher M, Lewis S, Aveyard P , et al. Physical activity for smoking cessation in pregnancy: randomised controlled trial. BMJ 2015; 350: h2145
• 17 Viellas EF, Gama SG, Carvalho ML, Pinto LW. Factors associated with physical aggression in pregnant women and adverse outcomes for the newborn. J Pediatr (Rio J) 2013; 89 (1) 83-90
• 18 Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Delineando a pesquisa clínica: uma abordagem epidemiológica. 3a ed. Porto Alegre. Art Med 2008;
• 19 de Empresas de Pesquisa AB. (ABEP) [Internet]. Critério de Classificação Econômica Brasil. 2015 [citado 2015 Out 14]. Disponível em: http://www.abep.org/criterio-brasil
• 20 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (6) 361-370
• 21 Botega NJ, Pondé MP, Medeiros P, Lima MG, Guerreiro CAM. Validação da escala hospitalar de ansiedade e depressão (HAD) em pacientes epiléticos ambulatoriais. J Bras Psiquiatr 1998; 47 (6) 285-289
• 22 Bowling A, Ebrahim S. Handbook of health research methods: investigation, measurement and analysis. Maidenhead: Open University Press; 2005
• 23 Urbina S. Fundamentos da testagem psicológica. Porto Alegre: Artmed; 2007. Capítulo 4: Fundamentos em fidedignidade; 121-212
• 24 Nunnally JC. Psychometric theory. 2nd ed. New York: McGraw-Hill; 1967
• 25 Coutinho LM, Scazufca M, Menezes PR. Methods for estimating prevalence ratios in cross-sectional studies. Rev Saude Publica 2008; 42 (6) 992-998
• 26 Browner WS. Publishing and presenting clinical research. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2012
• 27 Silva RA, Jansen K, Souza LDM , et al. Depression during pregnancy in the Brazilian public health care system. Rev Bras Psiquiatr 2010; 32 (2) 139-144
• 28 Cankorur VS, Abas M, Berksun O, Stewart R. Social support and the incidence and persistence of depression between antenatal and postnatal examinations in Turkey: a cohort study. BMJ Open 2015; 5 (4) e006456
• 29 Reis LA, Brito FR, Moreira VS, Aguiar ACSA. Atuação do enfermeiro do Programa de Saúde da Família frente ao indivíduo portador de transtorno mental. Ciênc Desenv. 2013; 6 (2) 175-187
• 30 Choi SK, Park YG, Park IY, Ko HS, Shin JC. Impact of antenatal depression on perinatal outcomes and postpartum depression in Korean women. J Res Med Sci 2014; 19 (9) 807-812
• 31 Fisher J, Tran T, La BT, Kriitmaa K, Rosenthal D, Tran T. Common perinatal mental disorders in northern Viet Nam: community prevalence and health care use. Bull World Health Organ 2010; 88 (10) 737-745
• 32 Waqas A, Raza N, Lodhi HW, Muhammad Z, Jamal M, Rehman A. Psychosocial factors of antenatal anxiety and depression in Pakistan: is social support a mediator?. PLoS ONE 2015; 10 (1) e0116510
• 33 Kohlhoff J, Hickinbotham R, Knox C, Roach V, Barnett Am B. Antenatal psychosocial assessment and depression screening in a private hospital. Aust N Z J Obstet Gynaecol 2016; 56 (2) 173-178
• 34 Chaudron LH. Complex challenges in treating depression during pregnancy. Am J Psychiatry 2013; 170 (1) 12-20
• 35 Gjestland K, Bø K, Owe KM, Eberhard-Gran M. Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression. Br J Sports Med 2013; 47 (8) 515-520
• 36 Rees SJ, Tol W, Mohammad M , et al. A high-risk group of pregnant women with elevated levels of conflict-related trauma, intimate partner violence, symptoms of depression and other forms of mental distress in post-conflict Timor-Leste. Transl Psychiatry 2016; 6: e725
• 37 Nery IS, Santos AG, Vasconcelos TB. Repercussões da violência intrafamiliar contra mulheres grávidas [Internet]. In: Anais do 17o Encontro Nacional da Rede Feminista Norte e Nordeste de Estudos e Pesquisa sobre a Mulher e Relações de Gênero. 2012 [citado 2015 Fev 12]. Disponível em: http://www.ufpb.br/evento/lti/ocs/index.php/17redor/17redor/paper/view/310/140
• 38 Giesbrecht GF, Letourneau N, Campbell T, Kaplan BJ. APrON Study Team. Affective experience in ecologically relevant contexts is dynamic and not progressively attenuated during pregnancy. Arch Women Ment Health 2012; 15 (6) 481-485
• 39 Brasil. Ministério da Saúde [Internet]. Portaria n. 1.020, de 29 de maio de 2013. Institui as diretrizes e normas organização da Atenção à Saúde na Gestação de Alto Risco. Casa de Gestantes, Bebê e Puérpera (CGBP) em conformidade com a Rede Cegonha. Brasília (DF): Ministério da Saúde; 2013 [citado 2015 Abr 20]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt1020_29_05_2013.html
• 40 Schwartz L, Bowen A, Muhajarine N. The effects of episodic versus continuous and major versus mild depression and anxiety symptoms on pregnancy and labour complications. Arch Depress Anxiety. 2015; 1 (1) 10-18