INTRODUÇÃO: As mães deprimidas apresentam redução do contato afetivo e dificuldade em expressar sentimentos positivos pelo bebê. O objetivo do presente estudo é avaliar a associação entre depressão pós-parto (DPP) e confiança materna baixa (CMB) em mulheres com histórico de depressão na gravidez prévia. METODOLOGIA: Estudo transversal, realizado entre junho de 2013 a maio de 2015, a partir de dados coletados entre 6 e 9 meses após o parto de 344 puérperas que já haviam participado de ensaio de comunidade (PROGRAVIDA). A Confiança Materna foi avaliada por meio do Questionário de Confiança Parental (MCQ) e as informações sócio-demográficas, socioeconômicas e de saúde das participantes foram avaliadas por meio de questionário estruturado. A DPP foi avaliada por meio do \"Patient Health Questionnaire\" (PHQ-9). A razão de prevalência (RP), não ajustada e ajustada, e o IC 95% foram calculados usando regressão de Poisson com variância robusta. Foram usados 3 modelos: no modelo bruto (modelo 1) foi estimada a RP entre DPP e CMB levando em conta a randomização das participantes no ensaio de comunidade. No modelo multivariado foram estimadas as RP entre DPP e CMB ajustadas por variáveis sócio-demográficas (escolaridade, renda familiar mensal em tercis, etnia e estado civil) (modelo 2) e por características maternas (idade materna, número de filhos e gravidez planejada (modelo 3). A análise estatística foi realizada com uso do programa STATA 12 e o nível de significância estatística foi considerado igual ou inferior a 5%. RESULTADOS: Na análise univariada, a prevalência de CMB em mulheres com depressão moderada/grave é 36% maior na comparação com mulheres sem depressão. Mulheres com 3 ou mais filhos apresentaram menor prevalência de CMB na comparação com mulheres com apenas 1 filho (RP: 0,76, IC 95% 0,58:0,99). Na análise multivariada, a associação entre CMB e DPP na forma moderada/grave se manteve após ajustes para possíveis variáveis confundidoras (socioeconômicas e características maternas). A estimativa da associação bruta entre CMB e depressão moderada/grave não se modificou significativamente após ajustes, mostrando que puérperas com depressão moderada/grave apresentaram aumento do risco de CMB de 42% (RP 1,42, IC95% 1,14:1,77). DISCUSSÃO: No presente estudo, as mulheres com sintomas depressivos moderados/graves apresentaram aumento no risco de CMB em comparação com mulheres sem sintomas depressivos. Por outro lado, CMB não se associou com DPP na forma leve. Esses resultados corroboram evidências da literatura que afirmam que a DPP pode perturbar a expressão da confiança e as práticas de cuidado materna. Os resultados reforçam a importância da avaliação do sentimento de confiança materna no primeiro ano de vida da criança, particularmente nas mulheres com formas mais graves de depressão / INTRODUCTION: Depressed mothers show reduced affective contact and difficulty in expressing positive feelings towards the baby. The objective of the present study is to evaluate the association of postpartum depression (PPD) and low maternal confidence (LMC) in women with a history of depression in the past pregnancy. METHODOLOGY: Transversal study, performed from June 2013 to May 2015, through data collected from the sixth to the ninth month after labor, from 344 puerperal women who had participated in a community trial (PROGRAVIDA). Maternal Confidence was assessed through the Maternal Confidence Questionnaire (MCQ) while socio-demographic, socioeconomic and health information on the participants was collected via structured questionnaire. PPD was evaluated through the \"Patient Health Questionnaire\" (PHQ-9). The prevalence ratio (PR), adjusted and non-adjusted, and the 95% CI were calculated using Poisson regression with robust variance. Three models were used: in the gross model (model 1), the PR between PPD and LMC was estimated, taking into account the randomization of participants in the community trial. The multivariate models estimated the PR between PPD and LMC adjusted for socio-demographic variables (education, monthly family income in tertiles, ethnicity and marital status) (model 2) and for maternal characteristics (mother\'s age, number of children and planned pregnancy) (model 3). The statistical analysis was performed with the STATA 12 software and the significance level was considered equal or lower than 5%. RESULTS: In the univariate analysis, the prevalence of LMC in women with moderate/severe depression was 35% higher in comparison to women without depression. Women with three or more children presented a lower prevalence of LMC in comparison to women with only one child (PR: 0.76, CI 95% 0.58:0.99). In the multivariate analysis, the association between LMC and PPD in its moderate/severe form remained after adjustment for possible confounding variables (socioeconomic variables and maternal characteristics). The estimation of the gross association between LMC and moderate/severe depression did not significantly change after the adjustments, evidencing that puerperal women with moderate/severe depression presented an increase of 42% in the risk of LMC (PR 1.42, IC 95% 1.14:1.77). DISCUSSION: In the present study, women with moderate/severe depressive symptoms showed increased risk of LMC in comparison to women without depressive symptoms. On the other hand, LMC was not associated to PDD in its minor form. These results corroborate evidence in the literature which state that PPD can disturb the expression of confidence and maternal care practices. The results reinforce the importance of the evaluation of maternal trust feeling in the first year of the child\'s life, particularly for women with more severe forms of depression

No description available.

We sought to examine the concordance of two suicidal ideation items from the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS), to evaluate the prevalence of suicidal ideation among pregnant women, and to assess the co-occurrence of suicidal ideation with antepartum depressive symptoms. A cross-sectional study was conducted among 1,517 pregnant women attending prenatal care clinics in Lima, Peru. Item 9 of the PHQ-9 assesses suicidal ideation over the last 14 days while item 10 of the EPDS assesses suicidal ideation in the past 7 days. The two suicidal ideation items have a high concordance rate (84.2 %) but a moderate agreement (the Cohen's kappa = 0.42). Based on the PHQ-9 and the EPDS, 15.8 and 8.8 % of participants screened positive for suicidal ideation, respectively. Assessed by the PHQ-9, 51 % of participants with suicidal ideation had probable depression. In prenatal care clinics, screening for suicidal ideation is needed for women with and without depressive symptoms. Future studies are needed to identify additional predictors of antepartum suicidality, determine the appropriate duration of reporting period for suicidal ideation screening, and assess the percentage of individuals with positive responses to the two suicidal ideation items at high risk of planning and attempting suicide. / This research was supported by an award from the National Institutes of Health (NIH), the Eunice Kennedy Shriver Institute of Child Health and Human Development (R01-HD-059835). The NIH had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The authors wish to thank the dedicated staff members of Asociacion Civil Proyectos en Salud (PROESA), Peru and Instituto Especializado Materno Perinatal, Peru for their expert technical assistance with this research. The authors would like to thank Kathy Brenner for her help with revising this manuscript. / Revisión por pares

Background Alterations of mental status are characteristic of psychiatric disorders but may also result from a multitude of organic causes. Generally, physical examination and blood analysis are a part of basic psychiatric differential diagnostics, whereas more sophisticated procedures (for example, brain imaging) are applied only in cases with pathologic diagnostic findings. Our report challenges this approach by describing a case of glioblastoma multiforme presenting as postpartum depression without abnormalities in basic differential diagnostics. Case presentation A 28-year-old white woman who had been in outpatient treatment for postpartum depression was taken to the psychiatric emergency room. The psychopathological assessment, however, showed mild disorientation and severe deficits of long-term memory. Moreover, she complained of stabbing, bilateral headaches, but results of her physical examination and blood analysis were unremarkable. Magnetic resonance imaging of the brain was performed, which showed a contrast-enhanced mass lesion in the left frontal lobe. The patient underwent urgent tumor resection, and histologic results revealed an IDH-mutant glioblastoma multiforme. The patient was discharged with a substantially improved psychopathology and without neurological deficits. Conclusions This report adds to the evidence that postpartum depression may have organic causes in some cases, a fact that needs to be considered in the clinical setting. Atypical neurocognitive findings in a psychiatric interview may alone justify brain imaging, despite normal physical examination and blood analysis results.