BACKGROUND: Both mood and anxiety disorders are more prevalent in women than men with the onset typically occurring during adolescence or early childbearing years. These disorders are particularly prevalent during pregnancy and the postpartum period. While depression during the perinatal period has received significant attention recently, anxiety has not received the same amount of attention. METHODS: The current study was a secondary analysis of a prospective cohort study that followed 91 women with mood disorders through pregnancy and the postpartum period. Our objective was to determine if a correlation existed between anxiety and suicidality. We hypothesized that pregnant women with a history of a mood disorder and comorbid anxiety are more likely to be suicidal than those without comorbid anxiety. The presence of anxiety was determined using the anxiety subscale of the Edinburgh Postnatal Depression Scale, EPDS; a cut off score of six or greater was used to indicate significant anxiety. Suicidality was determined using three separate measures: question ten on the EPDS, question eighteen on the Inventory of Depressive Symptomatology, and question ten on the Montgomery-Asberg Depression Rating Scale. ANALYSIS: Chi square tests were used to compare the demographics of the anxious and non-anxious women based on both diagnosis of anxiety disorders and symptoms of anxiety. Z proportion tests were then used to compare the proportion women with anxiety versus those without anxiety who were suicidal. Lastly, binary logistic regression was used to determine if patients with anxiety were more likely to be suicidal. RESULTS: Among the women in this study, 62 (68.1%) had a diagnosis of major depressive disorder and 29 (31.9%) had a diagnosis of bipolar disorder based on DSM-IV-TR diagnostic criteria. In addition, 45 (49.5%) had a lifetime history of an anxiety disorder. The prevalence of significant anxiety symptoms, as determined by the anxiety subscale on the EPDS, ranged from 9.1-37.5% depending on the time point. Suicidality prevalence also varied depending on both the time point and the scale used: 0-17.5% using the MADRS, 6.7-24.7% using the EPDS, and 2.4-14.7% using the IDS. Using a binary logistic regression, we determined that anxiety was a risk factor for suicidality at time T3 (OR 2.106; 95% CI 1.274-3.481) and M1 (OR 2.057; 95% CI 1.179-3.586) on the MADRS and at T3 (OR1.758; 95% CI 1.219-2.535) on the EPDS.

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Submitted by Haroudo Xavier Filho (haroudo.xavierfo@ufpe.br) on 2016-03-01T19:18:54Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Mestrado.pdf: 2528294 bytes, checksum: 69ec2d4350eed1f6344f027d79b47ebb (MD5) / Made available in DSpace on 2016-03-01T19:18:54Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Mestrado.pdf: 2528294 bytes, checksum: 69ec2d4350eed1f6344f027d79b47ebb (MD5) Previous issue date: 2015-05-25 / Os períodos de gestação e puerpério nem sempre são marcados por alegrias e realizações. É exatamente nesta fase que muitas mulheres experimentam alterações importantes do humor e/ou ansiedade, sendo o pós-parto o período de maior vulnerabilidade para o aparecimento de transtornos psiquiátricos. Apesar de ser hoje uma das condições clínicas mais estudadas da psiquiatria e de ser bastante conhecida na prática clínica, a depressão pós-parto ainda não apresenta consensos conceituais e metodológicos importantes para um maior grau de confiabilidade no diagnóstico e na comparação de dados de pesquisas. Assim, esta pesquisa busca minimizar a carência de uniformização e consenso a respeito deste tema tão relevante. Este estudo corresponde a uma revisão sistemática descritiva, no qual foram utilizados três bancos de dados: PubMed/MEDLINE, Scientific Electronic Library Online (SciELO) e Literatura Latino-americana e do Caribe em ciências da saúde (LILACS) e foram incluídos os artigos originais em língua inglesa, nos últimos 5 anos até 30 de junho de 2014, em humanos do sexo feminino. Foram excluídos os artigos não originais, os artigos de revisão e os relatos ou séries de casos. Após a exclusão dos artigos não pertinentes, restaram 356 que foram avaliados por dois revisores e apenas 154 artigos preencheram os critérios de inclusão. O resultado evidencia uma grande heterogeneidade nos instrumentos de pesquisa, com 38 instrumentos de triagem, diagnóstico e avaliação distintos. A verificação do instrumento principal dos estudos, registra uma predominância do Edimburg Depression Postpatum Scale (EPDS) em cerca de 65% dos artigos, apresentando pontos de corte com uma variação total de 7 a 20 e predominância entre 12 e 13. Quanto ao tempo, verifica-se que a maior parte das aferições dos instrumentos foram realizadas no primeiro trimestre do puerpério (45%), contudo foram grandes os percentuais de registros fora deste período, 43% acima de 3 meses do puerpério e 12% durante a gestação. Em relação aos períodos com maior prevalência de casos após o nascimento, constata-se que 65% encontra-se nos primeiros 3 meses após o parto e 35% após os 3 meses. Desta forma, apesar de se averiguar uma heterogeneidade significativa entre os estudos, há uma predominância do EPDS como método de triagem mais utilizado. Já em relação ao tempo, os resultados indicam que ele está muito além do que atualmente é preconizado nos manuais diagnósticos, com episódios depressivos desde a gestação até o período de um ano após o parto, relacionando-se ao nascimento do filho. Os resultados deste estudo ajudam a diminuir as discordâncias metodológicas e conceituais sobre as depressões relacionadas ao parto e podem embasar políticas em saúde para melhorar as estratégias na busca de um diagnóstico mais preciso e precoce e, desta forma, ajudar na prevenção e assistência às mães acometidas por essa enfermidade. / Periods of pregnancy and postpartum are not always marked by joys and achievements. It is precisely at this stage that many women experience major changes of mood and / or anxiety, and the postpartum period has the greatest vulnerability to the onset of psychiatric disorders. Although it is now one of the most studied clinical conditions of psychiatry and being well known in clinical practice, the postpartum depression still does not present conceptual and methodological consensus important for a greater degree of reliability in the diagnosis and the data comparison of survey. Therefore, this research seeks to minimize the lack of standardization and consensus on this issue as relevant. This study represents a descriptive systematic review, in which was used three databases: PubMed / MEDLINE, Scientific Electronic Library Online (SciELO) and Latin American and Caribbean Literature in Health Sciences (LILACS) and original articles were included in English in the last five years until June 30, 2014, in human females. Non-original articles, review articles and reports or case series were excluded. After exclusion of irrelevant articles, remaining 356 that were evaluated by two reviewers and only 154 articles met the inclusion criteria. The result shows a great heterogeneity in research tools, with 38 screening tools, diagnostic and distinct evaluation. Verification of the main instrument of the studies, reports a prevalence of Edimburg Depression Postpatum Scale (EPDS) in about 65% of the articles, with cutoff points with a total variation 7-20 and prevalence between 12 and 13. As for the time, it appears that most of the instruments measurements were carried out in the first quarter of the puerperium (45%), however, were large percentage of the records outside of this period, 43% over 3 months postpartum and 12% during pregnancy. For periods with higher prevalence of cases after birth, it appears that 65% is the first 3 months after delivery and 35% after 3 months. Thus, although to ascertain significant heterogeneity between studies, there is a predominance of the EPDS as the most used screening method. In relation to time, the results indicate that it is far beyond what is currently recommended in the diagnostic manual, with depressive episodes from pregnancy to one year after delivery, relating to the birth of the child. The results of this study help to decrease the methodological and conceptual disagreements over the depressions related to childbirth and can to base health policies to improve the strategies in the search for a more accurate diagnosis and early and thus help prevent and assistance to affected mothers by this disease.

Background: Perinatal depression affects 1 in 7 childbearing individuals and remains underdiagnosed and undertreated. Individuals with a psychiatric history are at increased risk of perinatal depression, and little is known about how experiences with the mental health care pathway may differ between these individuals and those without a psychiatric history. Methods: This was a secondary analysis of data from the PRISM (PRogram in Support of Moms) study, a cluster randomized controlled trial of two interventions for perinatal depression. Care access and barriers to care were evaluated in perinatal individuals who screened positive for depression using the EPDS (N=280). Results: Individuals with no psychiatric history prior to pregnancy (N=113), compared to those with such history (N=267), were less likely to be screened for perinatal depression, and less likely to be offered a therapy referral, though equally likely to attend when referred. In adjusted models, those without a psychiatric history had 0.59 times the odds of attending therapy (95% CI 0.28-1.25), 0.23 times the odds of utilizing medication (95% CI 0.11-0.47), and overall, 0.22 times the odds of receiving any depression care (95% CI 0.11-0.43). Participants reported on average 3 barriers as preventing them from receiving care “a lot” or “quite a lot”. The proportion of individuals endorsing each barrier was similar between groups, excepting “concerns about treatments available” and “thinking the problem would get better by itself”, which were more prevalent in those without a prior psychiatric history. Conclusions: There exist meaningful differences in the way perinatal individuals access care for depression based on psychiatric history. An understanding of these differences is crucial in addressing gaps between mental health care need and care receipt.

SAMMANFATTNING  Bakgrund  Depression är vanligt bland unga kvinnor i fertil ålder vilket innebär att barnafödande infaller under en del av livet då många kvinnor är psykisk sårbara. Cirka 10 till 20 procent av alla gravida kvinnor drabbas av depression av varierande grad under den antenatala perioden. Depression ökar risken för tillväxthämning hos fostret, prematur förlossning och postpartum-depression samt försvårar anknytningen mellan mor och barn. Den rådande uppfattningen är att kvinnor som medicinerat med antidepressiva läkemedel innan graviditet bör fortsätta medicinera samt att insättning bör göras när behov finns. Många kvinnor vill dock inte använda antidepressiva läkemedel under graviditet av rädsla för negativ påverkan på fostret och för dessa kvinnor behövs alternativ. I barnmorskans arbete ingår att stödja och vårda kvinnor under graviditet varför kunskap om behandlingsalternativ är vikt för yrkesgruppen.  Syfte Syftet med detta examensarbete var att undersöka vilka icke-farmakologiska behandlingar som finns för depression under graviditet samt dess för- och nackdelar. Metod  En systematisk litteraturstudie har gjorts där 28 artiklar inkluderades av totalt 659 granskade titlar, 110 granskade abstracts och 44 artiklar granskade i sin helhet. De inkluderade artiklarna analyserades med kvalitativ innehållsanalys och kvalitetsgranskades i enlighet med Willman, Stoltz och Bahtsevani, (2016). Resultat  Analysen av studiernas resultat visade attmånga former av ickefarmakologisk behandling kan ha mildrande eller botande effekt vid depression under graviditet. Det framkommer att behandling med yoga, behandling med mind-body terapi, behandling given till par, behandling given digitalt, behandling given i grupp samt behandling med psykoterapi eller samtalsstöd har positiv effekt om än i olika grad.Resultatet ger stöd för att komplement till basprogrammet vid sedvanlig mödrahälsovård är eftersträvansvärt och hjälper kvinnor med antenatal depression och att den positiva effekten ofta kvarstår efter förlossningen. Slutsats  Detta examensarbete visade att många icke-farmakologiska behandlingsmetoder kan hjälpa kvinnor med antenatal depression. Tilltron till behandlingsmetoderna var oftast hög och få negativa effekter framkom. Kvinnor kan utifrån detta informeras om att forskning visat att utöver antidepressiv medicinering finns icke-farmakologiska behandlingsmetoder med god effekt på depression under graviditet. Vidare forskning får visa om behandlingsformerna skulle kunna erbjudas inom ramen för mödrahälsovårdens basprogram, samt om det är möjligt att genom dessa alternativa terapier minska graviditetskomplikationer orsakade av depression. NYCKELORD  Antenatal depression, behandling, depression, graviditet, moderskap, perinatal terapi / ABSTRACT  Background  Depression is common among young women of childbearing age, which means that childbirth occurs during a part of life when many women are mentally vulnerable. About 10 to 20 percent of all pregnant women suffer from depression of varying degree during the antenatal period. Depression increases the risk of growth retardation in the fetus, premature birth and postpartum depression and complicates the bonding between mother and child. The current perception is that women who are taking antidepressants before pregnancy should continue to medicate and that insertation should be made when needed. However, many women do not want to use antidepressant drugs during pregnancy out of fear of adverse affects on the fetus, and for these women more options are needed. Midwifery includes supporting and nursing women during pregnancy, why knowledge about treatment options is important to the occupational group. Purpose  The purpose of this thesis was to investigate the non-pharmacological treatments available in pregnancy depression and their advantages and disadvantages. Method  A systematic review has been made where 28 articles were included in a total of 659 reviewed titles, 110 reviewed abstracts and 44 articles reviewed in full text. The included articles were analyzed with qualitative content analysis and quality assayed according to Willman, Stoltz and Bahtsevani, (2016). Results  The analysis of the results showed that many forms of non-pharmacological treatments may have mitigating or curing effects in the event of depression during pregnancy. It appears that treatment with yoga, treatment with mind-body therapy, treatment given to couples, treatment given digitally, treatment given in a group and treatment with psychotherapy or counseling  has a positive effect, albeit to a different extent. The result provides support for complementing the basic program of customized maternity care, which is desirable and helps women with antenatal depression and that the positive effect often persists after childbirth. Conclusion  This degree project showed that many non-pharmacological treatment methods can help women with antenatal depression. Access to treatment methods was usually high and few negative effects were observed. Women can from this be informed that research has shown that in addition to antidepressant medication there are non-pharmacological treatment methods that have a good effect on depression during pregnancy. Further research can show whether treatment options could be offered within the framework of maternal health care programs, and whether it is possible to reduce pregnancy complications caused by depression through these alternative therapies. KEYWORDS Antenatal depression, depression, maternity, perinatal depression, pregnancy, therapy, treatment

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The purpose of this dissertation was to examine patterns of antenatal stressful life events (SLEs) experienced by women in the United States (U.S.) and their association with postpartum depression (PPD). It further explored the role of women's state-level socio-economic status (SES) on PPD; the racial/ethnic dispartites in SLE-PPD relationship; and the role of provider communication on perinatal depression. Data from 2009–11 Pregnancy Risk Assessment Monitoring System (PRAMS) and SES indicators published by the Institute of Women’s Policy Research (IWPR) were used. Latent class analysis (LCA) was performed to identify unobserved class membership based on antenatal SLEs. Multilevel generalized linear mixed models examined whether state-level SES moderated the antenatal SLE-PPD relationship. Of 116,595 respondents to the PRAMS 2009-11, the sample size for our analyses ranged from 78% to 99%. The majority (64%) of participants were in low-stress class. The illness/death related-stress class (13%) had a high prevalence of severe illness (77%) and death (63%) of a family member or someone very close to them, while those in the multiple-stress (22%) class endorsed most other SLEs. Eleven percent had PPD; women who experienced all types of stressors, had the highest odds (adjusted odds ratio [aOR]: 5.43; 95% confidence interval [CI]: 5.36, 5.51) of PPD. The odds of PPD decreased with increasing state-level social/economic autonomy index (aOR: 0.75; 95% CI: 0.64, 0.88), with significant cross-level interaction between stressors and state-level SES. Among non-Hispanic blacks and non-Hispanic whites, husband/partner not wanting the pregnancy (aOR: 1.47; 95% CI: 1.14, 1.90) and drug/drinking problems of someone close (aOR: 1.37; 95% CI: 1.21, 1.55) were respectively associated with PPD. Provider communication was protective. That 1 out of every 5 and 1 out of every 8 women were in the high- and emotional-stress classes suggests that SLEs are common among pregnant women. Our results suggest that screening for antenatal SLEs might help identify women at risk for PPD. The finding that the odds of PPD decrease with increasing social/economic autonomy, could have policy implications and motivate efforts to improve these indices. This study also indicates the benefits of antenatal health care provider communication on perinatal depression.