O vínculo afetivo mãe-bebê, que se cria desde as primeiras interações, afeta o desenvolvimento emocional da criança. A depressão pós-parto (DPP) é um transtorno de humor que pode prejudicar a qualidade destas interações. Sendo o primeiro ano de vida um período em que o bebê está especialmente suscetível aos estímulos externos e totalmente dependente de cuidados, o objetivo da pesquisa relatada na dissertação de mestrado foi verificar o impacto da DPP no desenvolvimento neuropsicomotor em uma amostra representativa de crianças moradoras de uma região urbana da cidade de São Paulo, Brasil. Este estudo faz parte de um Projeto Temático FAPESP que teve por objetivo investigar os fatores de risco relacionados à DPP e sua influência no desenvolvimento das crianças ao longo de três anos. A Escala de Depressão Pós-parto de Edinburgh (EDPE) foi aplicada aos quatro e oito meses e o desenvolvimento neuropsicomotor dos bebês foi avaliado aos quatro (N=144), oito (N=127) e doze meses de vida (N=94), por itens baseados nos Testes Gesell e Amatruda, M-Chat, Denver e IRDI. Foram consideradas informações sobre a gestação, condições do parto e a avaliação neonatal obtidas nos prontuários do Hospital Universitário. A razão sexual no nascimento foi viesada no sentido de maior nascimento de meninas, o que é compatível com a Teoria de Trivers e Willard de viés da razão sexual por condições adversas. Aplicou-se uma análise de Regressão Logística aos dados de desenvolvimento, considerando-se no modelo a depressão pós-parto, o sexo, a idade e a frequência de creche. Os resultados mostraram que a depressão pós-parto materna foi um fator que prejudicou o desenvolvimento infantil nas avaliações realizadas aos oito e doze meses, mas não aos quatro meses. O sexo do bebê mostrou-se uma variável significativa. Aos oito meses os bebês do sexo masculino mostraram pior desempenho neuropsicomotor quando comparados aos bebês do sexo feminino. A literatura tem apontado nesta direção, evidenciando maior prejuízo dos meninos em função da depressão materna. Ao contrário do esperado, aos 12 meses as crianças que frequentavam creche mostraram pior desempenho quando comparadas às crianças que não frequentavam. A prevalência de DPP na amostra foi alta (26,7%) e os resultados sobre o desenvolvimento, preocupantes, apontando para a necessidade de políticas públicas de prevenção e intervenção precoce. Mesmo em condições adversas, podem surgir soluções criativas de grande impacto, a exemplo do método canguru. Além disso, os resultados desta investigação contribuem para o esforço multidisciplinar, relevante para o enfrentamento da questão da DPP / The mother-infant bond, created from the earliest dyadic interactions, affects the infant emotional development. The postpartum depression (PPD) is a depressive disorder that can impair the quality of these interactions. During the first year of life the infant is particularly susceptible to external stimuli and totally dependent on parental care. The goal of the research reported in the dissertation was to investigate the impact of PPD on psychomotor development in a sample of children living in an urban area of the city of Sao Paulo, Brazil. This study is part of a FAPESP Thematic Project which aimed to investigate the risk factors related to Postpartum Depression (PPD) and its influence on children\'s development over the first three years of life. Mothers mental state was assessed by the Edinburgh Postpartum Depression Scale (EPDS) at four and eight months after delivery and neurodevelopmental milestones were evaluated at four (N = 144), eight (N = 127) and twelve months (N = 94) through items based on Gesell and Amatruda, M-Chat, Denver and IRDI. Information was also collected about pregnancy, birth and neonatal evaluation from University Hospital reports. The sex ratio was biased at birth in favor of girls, consistent with Trivers and Willard Theory that harsh environmental conditions affects sex-ratio. Data were analyzed through logistic regression, considering the influence of postpartum depression, sex, age and day-care support. The results showed that child development was negatively affected by maternal postpartum depression at eight and twelve months, but not at four months. The baby\'s sex was also significant. At eight month male babies had worse psychomotor performance when compared to female, in accordance with literature showing that boys of PPD mothers are at greater risk of poor development. Unlike expected, at 12 months children attending day-care service showed poorer performance when compared to children who stayed at home. The high prevalence of PPD in this population (26,7%) and the results of the developmental evaluation are worrying, pointing to the need for mental health public policies and early intervention. Even in adverse conditions high impact solutions can be created, as Kangaroo care method. Furthermore, the results of this research can contribute to a multidisciplinary effort, relevant to address issues related to depression

Förstagångsmammors välbefinnande är ett diskuterat ämne med mycket tidigare forskning bakom sig. Studiens syfte var att undersöka huruvida det finns ett samband mellan förstagångsmammors fysiska och psykiska välbefinnande och olika faktorer som relationer samt stöd från social omgivning och sjukvård med en kvantitativ analysmetod. Enkäter skickades ut till sociala medier och utefter det sammanställdes resultatet via SPSS. Resultatet av denna studie visar att förstagångsmammor är i behov av stöd från sjukvård och social omgivning. En bra relation till framförallt partner och vänner är viktigt för det mentala måendet. Tidigare psykiska besvär, medicinering för psykiska besvär och diagnostisering av personlighetsstörning påvisar en stor risk att drabbas av förlossningsdepression. En besvärlig förlossningsupplevelse kan också bidra till en förlossningsdepression och deltagarna upplevde att de fått bättre information från sjukvården kring de psykiska bieffekterna av att föda barn än de fysiska bieffekterna, något som sa emot tidigare forskning. / The wellbeing of first-time mothers is a well discussed subject with previous research from all over the world. The aim of this study was to see whether there is a connection between the physical and mental wellbeing of first-time mothers and several factors such as relationships, social support and support from healthcare with a quantitative analysis method. Surveys were sent out on social media and the results were compiled via SPSS. The results of this study indicates that first-time mothers are in need of both support from healthcare and their social surrounding. A good relationship to especially partner and friends are important for their mental health. Previous mental disorders, medication for mental disorders or that the person is diagnosed with a personality disorder could increase the risk of experiencing postpartum depression. A difficult birth experience could also contribute to a postpartum depression and the participants experienced that they received better information about the mental side effects of giving birth rather than the physical side effects, which contradicts previous research.

O vínculo afetivo mãe-bebê, que se cria desde as primeiras interações, afeta o desenvolvimento emocional da criança. A depressão pós-parto (DPP) é um transtorno de humor que pode prejudicar a qualidade destas interações. Sendo o primeiro ano de vida um período em que o bebê está especialmente suscetível aos estímulos externos e totalmente dependente de cuidados, o objetivo da pesquisa relatada na dissertação de mestrado foi verificar o impacto da DPP no desenvolvimento neuropsicomotor em uma amostra representativa de crianças moradoras de uma região urbana da cidade de São Paulo, Brasil. Este estudo faz parte de um Projeto Temático FAPESP que teve por objetivo investigar os fatores de risco relacionados à DPP e sua influência no desenvolvimento das crianças ao longo de três anos. A Escala de Depressão Pós-parto de Edinburgh (EDPE) foi aplicada aos quatro e oito meses e o desenvolvimento neuropsicomotor dos bebês foi avaliado aos quatro (N=144), oito (N=127) e doze meses de vida (N=94), por itens baseados nos Testes Gesell e Amatruda, M-Chat, Denver e IRDI. Foram consideradas informações sobre a gestação, condições do parto e a avaliação neonatal obtidas nos prontuários do Hospital Universitário. A razão sexual no nascimento foi viesada no sentido de maior nascimento de meninas, o que é compatível com a Teoria de Trivers e Willard de viés da razão sexual por condições adversas. Aplicou-se uma análise de Regressão Logística aos dados de desenvolvimento, considerando-se no modelo a depressão pós-parto, o sexo, a idade e a frequência de creche. Os resultados mostraram que a depressão pós-parto materna foi um fator que prejudicou o desenvolvimento infantil nas avaliações realizadas aos oito e doze meses, mas não aos quatro meses. O sexo do bebê mostrou-se uma variável significativa. Aos oito meses os bebês do sexo masculino mostraram pior desempenho neuropsicomotor quando comparados aos bebês do sexo feminino. A literatura tem apontado nesta direção, evidenciando maior prejuízo dos meninos em função da depressão materna. Ao contrário do esperado, aos 12 meses as crianças que frequentavam creche mostraram pior desempenho quando comparadas às crianças que não frequentavam. A prevalência de DPP na amostra foi alta (26,7%) e os resultados sobre o desenvolvimento, preocupantes, apontando para a necessidade de políticas públicas de prevenção e intervenção precoce. Mesmo em condições adversas, podem surgir soluções criativas de grande impacto, a exemplo do método canguru. Além disso, os resultados desta investigação contribuem para o esforço multidisciplinar, relevante para o enfrentamento da questão da DPP / The mother-infant bond, created from the earliest dyadic interactions, affects the infant emotional development. The postpartum depression (PPD) is a depressive disorder that can impair the quality of these interactions. During the first year of life the infant is particularly susceptible to external stimuli and totally dependent on parental care. The goal of the research reported in the dissertation was to investigate the impact of PPD on psychomotor development in a sample of children living in an urban area of the city of Sao Paulo, Brazil. This study is part of a FAPESP Thematic Project which aimed to investigate the risk factors related to Postpartum Depression (PPD) and its influence on children\'s development over the first three years of life. Mothers mental state was assessed by the Edinburgh Postpartum Depression Scale (EPDS) at four and eight months after delivery and neurodevelopmental milestones were evaluated at four (N = 144), eight (N = 127) and twelve months (N = 94) through items based on Gesell and Amatruda, M-Chat, Denver and IRDI. Information was also collected about pregnancy, birth and neonatal evaluation from University Hospital reports. The sex ratio was biased at birth in favor of girls, consistent with Trivers and Willard Theory that harsh environmental conditions affects sex-ratio. Data were analyzed through logistic regression, considering the influence of postpartum depression, sex, age and day-care support. The results showed that child development was negatively affected by maternal postpartum depression at eight and twelve months, but not at four months. The baby\'s sex was also significant. At eight month male babies had worse psychomotor performance when compared to female, in accordance with literature showing that boys of PPD mothers are at greater risk of poor development. Unlike expected, at 12 months children attending day-care service showed poorer performance when compared to children who stayed at home. The high prevalence of PPD in this population (26,7%) and the results of the developmental evaluation are worrying, pointing to the need for mental health public policies and early intervention. Even in adverse conditions high impact solutions can be created, as Kangaroo care method. Furthermore, the results of this research can contribute to a multidisciplinary effort, relevant to address issues related to depression

Childbirth can be associated with short and long-term psychological morbidity including depression, anxiety and trauma symptoms. Some previous studies have used psychological interventions to reduce postpartum distress but have primarily focussed on attempting to relieve symptoms of depression with little recognition of trauma symptoms. Furthermore, the intervention used in these studies has generally been poorly documented. The first aim of the present study was to develop a counselling framework, suitable for use by midwives, to address psychological trauma following childbirth. Multiple methods were used to develop the intervention including focus groups with women and midwives. Both the women and midwives gave unequivocal support for postpartum debriefing. Themes that emerged from the focus groups with women included the need for opportunities to talk about their birth experience, an explanation of events, an exploration of alternative courses of action that may have resulted in a different birth experience, talking about their feelings such as loss, fear, anger and self-blame, discussing social support, and discussing possible future childbearing. There was a high level of agreement between the women's and midwives' views. These themes were synthesized with contemporary literature describing counselling interventions to assist in reconciling a distressing birth experience and a model for understanding women's distressing birth experiences to develop a counselling framework. The counselling intervention was then tested using a randomised controlled study involving 400 women recruited from antenatal clinics of three public hospitals. When interviewed within seventy-two hours of birth, 103 women reported a distressing birth experience and were then randomised into either the treatment or control group. Women in the intervention group had the opportunity to debrief at the initial postpartum interview (< 72 hours postpartum) and at four to six weeks postpartum. The prevalence of posttraumatic stress disorder was quite high; 9.6% of participants meeting the diagnostic criteria for acute PTSD at four to six weeks postpartum. Fewer participants (3.5%) met the diagnostic criteria for chronic PTSD at three months postpartum. As with previous research relating to childbearing women, few demographic factors or antenatal psychological factors were associated with the development of a PTSD symptom profile following childbirth. The development of PTSD symptom profile was strongly associated with obstetric intervention and a perception of poor care in labour. This finding is also consistent with previous research. Emotional distress was reduced for women in the intervention group in relation to the number of PTSD symptoms [t (101) = 2.144, p = .035], depression [c2 (1) = 9.188, p = .002], stress [c2 (1) = 4.478, p = .029] and feelings of self-blame [t (101) = -12.424, p <.001]. Confidence about a future pregnancy was higher for these women [t (101) = -9.096, p <.001]. Although there was not a statistically significant difference in the number of women with a PTSD symptom profile at three months postpartum, fewer women in the intervention group (n=3) than in the control group (n=9) met PTSD criteria. Likewise, there were fewer women in the intervention group (n=1) with anxiety levels above mild than in the control group (n=6). Importantly, this study found that offering women who have had a traumatic birth the opportunity for counselling using the framework documented in this dissertation was not harmful. This finding is in contrast to previous findings of other studies. The intervention was well received by participants. All the women in the intervention group found the counselling sessions helped them come to terms with their birth experience. Maternity service providers need to be cognizant of the prevalence of this debilitating condition and be able to identify women at risk for early intervention and referral to a mental health practitioner if appropriate. This research offers further support for the compelling need to implement changes to the provision of maternity services that reduce rates of obstetric intervention and humanise service delivery as a means of primary prevention of birth-related PTSD.

University of Macau / Faculty of Social Sciences and Humanities / Department of Psychology

Bakgrund: En moder som lider av post partum depression har svårare att knyta an till sitt barn. Barnets kognitiva och känslomässiga utveckling kan då hämmas. Det är viktigt att tidigt upptäcka dessa mödrar för att på så vis kunna erbjuda stöd och förkorta moderns sjukdomstid. Syfte: Syftet var att belysa BVC-sjuksköterskors erfarenheter av att ge stöd till mödrar med post partum depression. Metod: Datamaterialet analyserades med kvalitativ innehållsanalys med induktiv ansats. Data insamlades genom intervjuer med åtta BVC-sjuksköterskor med specialistexamen som distriktssköterska verksamma inom barnhälsovård. Resultat: Ur analysen av datamaterialet framträdde sex kategorier så som; följsam till moderns behov, erbjuda råd och vägledning, bygga upp moderns insikt om post partum depression, initiera samarbete runt modern, känsla av egen otillräcklighet, kommunikationsproblem med 14 underkategorier. Konklusion: För att kunna erbjuda modern ett optimalt stöd behöver en relation byggd på förtroende skapas mellan BVC-sjuksköterskan och modern. Kommunikation är ett viktigt verktyg för att skapa tillit vilket är en förutsättning för relationen. / Background: A mother who is suffering from post partum depression has difficulties with the attachment to her child. As a result of this, the child’s cognitive and emotional development can be harmed. It is important to detect these mothers at an early stage, to offer support in order to shorten the time of suffering. Aim: The aim of this study was to illustrate child health care nurses’ experiences of giving support to mothers with postpartum depression. Method: The data were analyzed using qualitative content analysis technique with inductive approach. Eight interviews with child health care nurses’ who work with childrens’ health care were performed. Results: Six categories emerged from the analysis; Responsive to the needs of the mother, offer advice and guidance, build awareness of postpartum depression, initiate collaboration around the mother, sense of their own inadequacy, communication problem and 14 subcategories. Conclusion: In order to offer the mother optimal support needs a relationship between the child health care nurse and the mother be created, which is built on trust. Communication is an important tool to build trust, which is essential for the relationship.

Project (Ed.S.)--James Madison University, 2009. / Includes bibliographical references.

An ethnographic method was used for data collection and analysis. Three interrelated themes from the data analyses informed study findings: (1) being cut off from family and feeling lonely, (2) what's the point? and (3) not depression, just depressed. Understanding young mothers' depression after the birth of their babies is important to inform future research and gain insights into relevant nursing interventions for this population. More knowledge of the phenomenon will lead to earlier identification and prevention of the long-term sequelae of depression and potentially promote healthier mother-baby interactions.

OBJETIVO: Esta dissertação tem por objetivo apresentar o estudo da associação entre transtornos psiquiátricos pós-parto e fatores demográficos, psicossociais e relacionados à gestação e parto em uma amostra de base populacional de um bairro de Porto Alegre. MÉTODO: O estudo envolveu todas as mães de crianças nascidas em hospital público no bairro Vila Jardim, em Porto Alegre, de novembro de 1998 a dezembro de 1999. As famílias foram estudadas quando os bebês completaram quatro meses de idade. A saúde mental das mães e pais foi avaliada pelo Self Report Questionnaire (SRQ) e por entrevistas semi-estruturadas individuais e do casal. A Escala Avaliação Global do Funcionamento Relacional (GARF) do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV) foi usada para aferir a qualidade do relacionamento do casal, do relacionamento materno com sua família de origem, com a família paterna e com a rede social. Para os outros fatores foram feitas perguntas diretas à mãe e ao pai da criança. RESULTADOS: Segundo a escala SRQ 34,45% das 148 mulheres entrevistadas apresentaram suspeita de transtorno psiquiátrico, sendo que a avaliação clínica feita por dois profissionais de saude mental que avaliavam independentemente utilizando os critérios diagnósticos do DSM-IV indicou um percentual de 54%. Sessenta e dois por cento das mulheres coabitavam com companheiro, sendo que estes também foram entrevistados. Dos 118 pais, 25,4% apresentaram suspeita de transtorno psiquiátrico, segundo a escala SRQ. Nesta população, o fato de coabitar ou não com companheiro não esteve associado com transtorno mental. Nesta pesquisa, na análise de regressão logística estudando a totalidade do grupo de mulheres os fatores que se mostraram relacionados com o desfecho (SRQ igual ou superior a sete ) foram a baixa renda familiar (p=0,017) e a presença de transtorno psiquiátrico materno no passado (p=0,043). Na regressão logística feita exclusivamente com as mulheres que viviam com companheiro, apenas a má qualidade da relação do casal (notas de 1 a 3 pela escala GARF) esteve associada à presença de transtornos psiquiátricos quatro meses após o parto (OR=7,34, p=0,001). CONCLUSÃO: Este estudo reforça a necessidade de verificar a presença de transtornos psiquiátricos da mãe nas consultas de puericultura, introduz dados sobre o pai e, especialmente, sobre a importância de avaliar rotineiramente a relação conjugal. / OBJECTIVE: To study the association between suspicion of psychiatric disorder and demographic, psychosocial factors, as well as those related to pregnancy and delivery, in a population-based sample of women from a circumscribed neighborhood in Porto Alegre. METHOD: This study included the mothers of all the children born in public hospitals in Vila Jardim, a district of Porto Alegre, Brazil, from November 1998 through December 1999. Families were assessed when infants were 4 months of age. Parents’ mental health was assessed using the Self-Report Questionnaire (SRQ) and individual and couple semi-structured interviews. The DSM-IV Global Assessment of Relational Functioning Scale was used to measure quality of couple relationship, of maternal relationship with the mother's family of origin, with paternal family and with social network. As to other factors, direct questions were asked to the child’s parents. RESULTS: According to the SRQ scale, 34.45% of all 148 interviewed women had suspicion of psychiatric disorder. The clinical assessment by two mental health professionals independently using DSM-IV criteria revealed a percentage of 54%. Sixty-two percent of women lived with partners, who were also interviewed. Of the 118 fathers, 25.4% had suspicion of psychiatric disorder, according to the SRQ scale. In this population, the fact of living or not with a partner was not associated with mental disorder. Analysis by logistic regression of the total group of women showed that factors associated with the main outcome (SRQ equal or higher than 7) were low family income (p = 0.017) and presence of previous maternal psychiatric disorder (p = 0.043). Logistic regression including only women living with a partner showed that poor marital relationship was associated with presence of psychiatric disorder, 4 months after delivery (OR = 7.34 p = 0.001). CONCLUSION: This study reinforces the need of investigating presence of maternal psychiatric disorder during childcare, introduces data on the father and especially on the importance of a routine assessment of the marital relationship.

O presente estudo investigou a conjugalidade e a parentalidade durante uma psicoterapia breve pais-bebê, em famílias em que a mãe apresentava depressão pós-parto. Participaram do estudo duas famílias com mães deprimidas, com base no Inventário Beck de Depressão e em uma entrevista diagnóstica. Os pais não apresentavam depressão. Foi utilizado um delineamento de estudo de casos, a fim de se analisar o processo de mudança ao longo de três momentos da psicoterapia: entrevistas iniciais, sessões de psicoterapia e avaliação final. Ao todo foram realizados 14 encontros com a primeira família atendida e 18 com a segunda. Todos os encontros foram filmados e transcritos para fins de análise, que foi baseada em duas categorias: conjugalidade e parentalidade. Os resultados revelaram que a conjugalidade e a parentalidade estavam sendo experienciadas com dificuldades pelas famílias atendidas. No entanto, isso não se traduziu necessariamente em interações disfuncionais entre a mãe e o bebê. Apesar das particularidades de cada família atendida, os resultados da psicoterapia foram bastante positivos, com relatos de mudanças tanto na conjugalidade como na parentalidade, já a partir da quarta sessão de psicoterapia. Nos dois casos também se observou que eventos significativos na história de vida das mães estavam intimamente relacionadas com as dificuldades após o nascimento do bebê, reforçando a importância de se considerar fatores relacionais durante o tratamento de mães deprimidas. As avaliações que se seguiram após a psicoterapia não revelaram depressão nas mães. A participação do pai na psicoterapia se mostrou muito relevante para a melhora de suas esposas, refletindo num aumento da satisfação conjugal. Além disso, ao se intervir durante um momento de crise na família, como a depressão após o nascimento de um filho, é possível evitar que padrões interativos disfuncionais sejam cristalizados. Discute-se o papel dos aspectos relacionais envolvidos na depressão, bem como a adequação da psicoterapia pais-bebê como um dos tratamentos possíveis para a depressão pós-parto. / The present study investigated conjugality and parenthood during a brief parent-infant psychotherapy, in families in which the mother had postpartum depression. Two families with depressed mothers participated in the study. Postpartum depression was assessed according to the Beck Depression Inventory and a diagnostic interview. The fathers didn’t have depression. A case-study design was used, in order to analyze the process of change in three moments of the psychotherapy: the initial interviews, the psychotherapy sessions and the final evaluation. The total number of meetings was 14 with the first family and 18 with the second. All meetings were filmed and transcribed in order to be analyzed, based on two categories: conjugality and parenthood. The results showed that conjugality and parenthood were being experienced with difficulties by the two families. However, did not result necessarily in dysfunctional interactions between the mother and the baby. Despite the particularities of each family, the results of the psychotherapy were very positive, with report of changes in both conjugality and parenthood from the forth session onwards. In both cases it was also observed that significant events in the mothers’ life history were intimately related to difficulties after child birth, reinforcing the importance of relational factors during the treatment of depressed mothers. The evaluations that were made after the psychotherapy did not show depression in the mothers. The fathers´ participation in psychotherapy seemed to be very relevant to theirs wives´ improvement, reflecting an increased marital satisfaction. Moreover, when intervening in a moment of crisis in the family, such as depression after childbirth, it is possible to avoid that dysfunctional interactional patterns be crystallized. The role of relational aspects involved in depression is discussed, as well as the adequacy of parent-infant psychotherapy as one of the possible treatments for postpartum depression.