Syftet med föreliggande studie var att med hjälp av Borg centiMax® skalans (CR100) unika egenskaper utveckla ett screeninginstrument som innehåller uppgifter som anpassats till både mödrar och fäder för att upptäcka postpartum depression (PPD). Totalt deltog 190 testdeltagare varav 50 män och 140 kvinnor. En konfirmatorisk faktoranalys visade signifikanta samband mellan dimensionerna nedsatt stämningsläge, aggressivitet, ambivalens, ångest, copingstrategier och huvudkonstruktet depression. Detta indikerar att nämnda dimensioner är minst lika viktiga att föra in i ett nytt screeninginstrument som frågor som mäter nedsatt stämningsläge, och att screeninginstrumentet mäter huvudkonstruktet depression. Vidare visade studien att både fäder och mödrar uppvisade andra symtom än de som framkommer vid Egentlig depression i DSM – 5. Screeninginstrumentet visade god reliabilitet för hela skalan. Vilket tyder på att CR 100 skalan är ett användbart redskap för denna typ av ändamål

Made available in DSpace on 2016-08-03T16:34:26Z (GMT). No. of bitstreams: 1 Laura Maza Garrido.pdf: 1233443 bytes, checksum: 4b654b800a8c25776a5fa5c3fa872389 (MD5) Previous issue date: 2013-03-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Pregnancy and maternity are periods that cause deep changes in women's life. Due to the intensity of those changes, these periods are considered of high vulnerability for the development of Postpartum Depression (PPD). In regard of that, this study had as its objectives to evaluate the adaptation efficacy of women during the gestation and puerperium periods, to verify the incidence of adaptation crisis and PPD, to verify the association between adaptation efficacy and PPD and to verify the validity of EDAO as an instrument for the identification of Postpartum depression. This is, therefore, a longitudinal study with a qualitative, exploratory and descriptive clinical method, in which were used as instruments the Operationalized Adaptive Diagnosis Scale - EDAO, the Questionary of Social-Economic Classification of the Brazilian Association of Institutes of Market Research - ABIPEME and the Postpartum Depression Scale of Edinburgh - EPDS. Seven pregnant women who were attended by the public health system of Santo André City in São Paulo state participated in this study. Data analysis has shown that 42,86% of these women have developed PPD, and that all of them had adaptation crisis. Within the four women who did not present PPD, none of them demonstrated adaptation crisis and three of them had adaptation improvement / A gestação e a maternidade são períodos que promovem profundas mudanças na vida da mulher. Devido à intensidade dessas mudanças, estes períodos são considerados de grande vulnerabilidade para o desenvolvimento da Depressão Pós-Parto (DPP). Diante disso, esse estudo teve como objetivo avaliar a eficácia adaptativa de mulheres no período gestacional e puerperal, verificar a incidência de crise adaptativa e DPP, verificar a associação da eficácia adaptativa com a DPP e verificar a EDAO como instrumento para identificação da depressão pós-parto. Trata-se de um estudo longitudinal com método clínico qualitativo, exploratório e descritivo, no qual foram utilizados como instrumentos a Escala Diagnóstica Adaptativa Operacionalizada EDAO, Questionário de classificação socioeconômica da Associação Brasileira de Institutos de Pesquisa de Mercado ABIPEME e Escala de depressão pós-parto de Edimburgo EPDS. Participaram desse estudo sete gestantes atendidas no sistema público de saúde da cidade de Santo André / SP. A análise dos dados demonstrou que 42,86% das mulheres desenvolveram DPP, sendo que todas elas tiveram crise adaptativa. Das quatro mulheres que não apresentaram DPP, nenhuma demonstrou crise adaptativa e três delas obtiveram melhora adaptativa. O suporte familiar, principalmente do companheiro, foi considerado um fator externo positivo que atua como promotor de saúde. Os indicadores para desenvolvimento da DPP foram: a crise adaptativa, a ausência do companheiro e o sexo do bebê ser diferente do desejado. A EDAO mostrou-se um instrumento eficaz para discriminar fatores indicativos de DPP, o que favorece as intervenções primárias. O índice elevado de DPP e crise adaptativa diagnosticado nesse estudo revelou a urgência de desenvolver políticas públicas que atendam as mulheres no período gravídico-puerperal, uma vez que sua saúde mental fica vulnerável neste período, o que influenciará diretamente o desenvolvimento dos bebês e das famílias.

O presente estudo investigou as mudanças na leitura materna sobre seus sintomas depressivos e sobre os sintomas psicofuncionais do bebê em um contexto de Psicoterapia Mãe-Bebê em Grupo. Participaram deste estudo uma díade mãe-bebê em que a mãe apresentava depressão pós-parto, de acordo com a Escala de Depressão Pós-Parto de Edimburgo (EPDS) e pela Entrevista MINI e confirmados através da Entrevista sobre a Gestação e Parto e também pela Entrevista sobre a Experiência da Maternidade. Já o bebê tinha sintomas psicofuncionais detectados através do Questionário Symptom Check List (SCL). Essa dupla participou de uma Psicoterapia Mãe-bebê em Grupo no período de maio a agosto de 2015. Foi utilizado o delineamento de estudo de caso único, a fim de analisar as mudanças na leitura materna sobre seus sintomas depressivos e sobre os sintomas psicofuncionais do bebê ao longo das sessões de psicoterapia. Para tanto, foi realizada uma análise qualitativa, relacionando os materiais clínicos provenientes das 11 sessões de psicoterapia com os conhecimentos teóricos existentes na literatura, a partir de uma compreensão psicanalítica. Os sintomas depressivos maternos considerados nessa análise foram tristeza, labilidade emocional e irritabilidade e os sintomas psicofuncionais do bebê foram sono, alimentação e comportamento, em especial os que envolvem separação. Os resultados revelaram mudanças na leitura da mãe acerca dos seus sintomas depressivos e sobre os sintomas psicofuncionais do bebê ao longo das sessões da Psicoterapia Mãe-Bebê em Grupo. Além disso, verificou-se que os sintomas depressivos maternos e os sintomas psicofuncionais do bebê estavam mutuamente associados e que a partir da intervenção utilizada houve uma melhora dos sintomas tanto da mãe quanto do bebê. Palavras-chave: leitura materna, depressão pós-parto, sintomas psicofuncionais do bebê, psicoterapia mãe-bebê em grupo. / The present study investigated the changes in maternal read about their depressive symptoms and on psychofunctional symptoms baby in a context Psychotherapy Brief Mother-Baby Group. The study included a mother-baby dyad in which the mother had postpartum depression, according to Depression Scale Postpartum Edinburgh (EPDS) and Interview MINI and confirmed through the interview about Pregnancy and Childbirth and also the interview on the Maternity Experience. But the baby had psychofunctional symptoms detected by the Symptom Check List Questionnaire (SCL). This double attended a Mother-Baby Group Brief Psychotherapy in the period May-August 2015. We used a single case study design in order to analyze the changes in the mother reading about her depressive symptoms and about the baby psychofunctional symptoms along the psychotherapy sessions. For this, a qualitative analysis was conducted, linking clinical materials from 11 psychotherapy sessions with existing theoretical knowledge in literature, from a psychoanalytic understanding. Maternal depressive symptoms were considered in this analysis sadness, emotional lability and irritability and the baby’s psychofunctional symptoms were sleeping, feeding and behavior, in particular those involving separation). The results revealed changes in the mother's reading about their depressive symptoms and about the baby-s symptoms psychofunctional during the sessions of brief mother-infant psychotherapy group. In addition, it was found that maternal depressive symptoms and the baby psychofunctional symptoms were mutually associated and was a improvement in symptoms of both mother and baby with the intervencion.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objetivo do presente estudo foi investigar a associação entre a depressão pós-parto e a retenção de peso no pós-parto. Trata-se de um estudo longitudinal, com 563 mulheres no baseline acolhidas em unidades de saúde do município do Rio de Janeiro entre 2005 e 2009, acompanhadas até o 6 mês pós-parto, com dados sobre peso e estatura aos 15 dias pós-parto e peso pré-gestacional. O peso retido após o parto foi calculado a partir da diferença entre o peso aferido nas ondas de seguimento (15 dias, 1, 2, 4 e 6 mês) e o peso pré-gestacional. O estado nutricional pré-gestacional foi classificado de acordo com a OMS. A presença de depressão pós-parto foi avaliada a partir da versão em português da Escala de Depressão Pós-parto de Edimburgo (EPDS) aos 15 dias e no 2 mês após o parto, utilizando-se 11/12 da EPDS como ponto de corte. Considerou-se depressão recorrente quando houve presença de depressão nos dois momentos. Inicialmente analisaram-se características da população. Para as análises estatísticas do efeito do estado nutricional pré-gestacional e do efeito da depressão pós-parto sobre a retenção de peso pós-parto empregou-se o proc mixed do pacote estatístico SAS. Dentre os principais achados, destaca-se que 22,7% (IC 95% 19,3-26,4) das mulheres iniciaram a gravidez com sobrepeso e 10,9% (IC 95% 7,0-15,7) apresentaram depressão recorrente. A retenção média de peso foi de 5,6 kg (IC 95% 5,1-6,1) aos 15 dias pós-parto. Na análise das trajetórias no tempo do peso pós-parto por estado nutricional pré-gestacional ajustadas por idade, escolaridade, número de filhos, aleitamento materno e ganho de peso gestacional, observou-se diminuição da retenção de peso pós-parto para os grupos de baixo peso e sobrepeso pré-gestacional e aumento da retenção de peso pós-parto para o grupo de obesidade pré-gestacional. Na análise das trajetórias no tempo do peso pós-parto por depressão pós-parto verifica-se que o efeito entre o tempo e a retenção de peso pós-parto se modifica para mulheres com depressão pós-parto recorrente nas análises bruta e ajustadas por idade, escolaridade, estado nutricional pré-gestacional, número de filhos, ganho de peso gestacional, aleitamento materno e rede social, nas quais observa-se que as mulheres com depressão pós-parto recorrente perdem menos peso. Os resultados permitem identificar que há no pós-parto perda e ganho de peso, apesar de ser esperada perda de peso almejando o retorno ao peso pré-gestacional. Ressalta-se o impacto da depressão pós-parto observado nesta dinâmica de peso, uma vez que mulheres com depressão pós-parto recorrente apresentaram menor perda de peso. Destaca-se a relevância dos resultados deste estudo para o desenvolvimento da promoção da saúde e da segurança alimentar e nutricional, visando um monitoramento do estado nutricional pós-parto e avaliação da saúde mental materna de forma a contribuir para a prevenção da obesidade feminina e comorbidades / The objective of this study was to evaluate the association between postpartum depression and weight retention in the same period. This is part of a cohort study conducted with 563 women in the baseline that were treated in public services from the city of Rio de Janeiro, between 2005 and 2009, followed up to the 6th month after delivery, and data regarding weight and height at 15 days after delivery (baseline) and this pre-pregnancy weight were collected. The retained weight after delivery was calculated as the difference between the weight measured at 15 days, 1, 2, 4 and 6 months after delivery and the pre-pregnancy weight. The womens nutritional status was classified according to WHO. The presence of postpartum depression was evaluated using the portuguese version of the Edinburgh Postpartum Depression Scale (EPDS) at 15 days and 2 months after delivery, and using as cutoff 11/12 points in the Scale. Recurrent depression was considered when there was presence of depression at both times. Firstly, general, characteristics of the population were analyzed. To the statistical analysis of the effect of pre-pregnancy nutritional status and the effect of postpartum depression on postpartum weight retention the package proc mixed from SAS was applied. The results show that 22.7% (95% CI 19.3-26.4) of the women started pregnancy overweight, 10.9% (95% CI 7.0-15.7) presented recurrent depression. The average weight retention was 5.6 kg (95% CI 5.1-6.1) at 15 days postpartum. When the time trajectories of weight after delivery according to pre-pregnancy nutritional status were analyzed adjusted for age, schooling years, number of children, breastfeeding and gestational weight gain, it was observed a reduction of weight retention after delivery to those women who were classified as underweight and overweight before pregnancy and an increased in the same trajectory for the who were obese. When the time trajectories of weight after delivery according to postpartum depression were analyzed it was showed that the effect between time and weight retention changes for women with recurrent postpartum depression in the crude and adjusted analyzes by age, schooling years, pre-pregnancy nutritional status, number of children, gestational weight gain, breastfeeding and social network, in this analysis women with recurrent postpartum depression lose less weight. The results show that during the postpartum period the impact of postpartum depression in this dynamic weight is important, since women with recurrent postpartum depression showed less weight loss. The results of this study present the importance of it to the development of health promotion and food and nutrition security, assessment of maternal mental health in order to contribute to the prevention of female obesity and comorbities

Submitted by Marcela Muzel Poles (marcela.mpoles@gmail.com) on 2018-04-23T14:48:16Z No. of bitstreams: 1 Dissertação Marcela.pdf: 8613909 bytes, checksum: c26ca312611afd363fc9bcbb25e6d85a (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-04-23T19:48:09Z (GMT) No. of bitstreams: 1 poles_mm_me_bot.pdf: 8613909 bytes, checksum: c26ca312611afd363fc9bcbb25e6d85a (MD5) / Made available in DSpace on 2018-04-23T19:48:09Z (GMT). No. of bitstreams: 1 poles_mm_me_bot.pdf: 8613909 bytes, checksum: c26ca312611afd363fc9bcbb25e6d85a (MD5) Previous issue date: 2018-02-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Aproximadamente 10% das gestantes e 13% das puérperas vivenciam algum transtorno mental, inclusive a depressão, condição que dificulta a vivência da maternidade. Os fatores que levam à depressão perinatal ainda não estão completamente elucidados, em especial aspectos sociodemográficos. O objetivo deste estudo foi investigar a ocorrência e fatores de risco para sintomas depressivos maternos no puerpério imediato. Trata-se de estudo epidemiológico e transversal com 1099 puérperas. A presença de sintomas depressivos foi obtida com a escala Edinburgh Postnatal Depression Scale (EPDS), adotando-se ponto de corte ≥10. Fatores associados aos sintomas depressivos foram investigados por regressão logística múltipla. Houve 6,7% de puérperas com sintomas depressivos. Uso de medicação antidepressiva, violência sofrida na gestação e operação cesariana aumentaram as chances de sintomas depressivos no puerpério imediato em duas, quatro e duas vezes, respectivamente. Reconhecer os sintomas depressivos precocemente, ainda com as puérperas nas maternidades, pode contribuir de forma a reduzir as chances de depressão pós-parto futura, bem como encorajar ações preventivas da equipe de saúde com o cuidado materno e neonatal. / About 10% of pregnant women and 13% of the puerperae experience some mental disorder, including depression, a condition that makes the experience of motherhood difficult. The factors that lead to perinatal depression are still not fully elucidated, especially sociodemographic ones. Our objective with this study was to investigate occurrence and risk factors for maternal depressive symptoms in the immediate puerperium. It is an epidemiological and transversal study with 1099 puerperae. We obtained the presence of depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) scale, with a cut-off point of ≥10. Factors associated with depressive symptoms were investigated by multiple logistic regression. There were 6.7% of the puerperae with depressive symptoms. The use of antidepressant medication, gestational violence and cesarean section increased the odds of depressive symptoms in the immediate puerperium in two, four, and two times, respectively. Recognizing depressive symptoms early on, with the puerperae still inside maternity wards, can contribute to reduce the chances of future postpartum depression, as well as encourage preventive actions of the health team with maternal and neonatal care.

Theoretischer Hintergrund: Psychische Störungen in Schwangerschaft und Postpartalzeit sind mit 10-15% häufig und erhalten aufgrund ihrer weitreichenden negativen Konsequenzen für den Schwangerschaftsverlauf, die Geburt, die Mutter-Kind-Bindung und die kindliche Entwicklung eine besondere Bedeutung bei der Behandlung (Alder et al., 2007, Reck, 2012). Obwohl das Wissen um die negativen Auswirkungen mittlerweile gut belegt ist und sich daraus die Notwendigkeit einer spezialisierten und vor allem kurzfristigen Behandlung ergibt, bestehen dennoch verschiedene Grenzen und Problemfelder in der Versorgungslandschaft. Hierzu zählen ein objektiver Mangel an Behandlungsangeboten mit schnellem Zugang, vor allem in ländlichen Gebieten (Köllner, 2012), Unsicherheiten hinsichtlich psychotherapeutischer und/oder psychopharmakologischer Optionen bzw. des Settings (Mitnahme des Neugeborenen in die Therapie; Mutter-Kind-Therapie; Weidner et al., 2012) und eine geringe Inanspruchnahme professioneller Hilfe bei Frauen in Schwangerschaft und Postpartalzeit, was am ehesten mit Stigmatisierungsangst oder Angst vor Nebenwirkungen bzw. Wissen um Versorgungsengpässe sowie Organisationsprobleme begründet werden kann (Freed et al., 2012). Um dem Versorgungsdefizit zu begegnen, wurde in Dresden eine sektorenübergreifende multiprofessionelle Behandlung für betroffene Frauen etabliert. Ein bedeutsamer Teil dieses Behandlungsangebotes leistet die Spezialsprechstunde "Psychisch gesund für Zwei" an der Klinik für Psychotherapie und Psychosomatik des Universitätsklinikums Dresden. In der vorliegenden Dissertationsschrift wurde dieses spezialisierte Sprechstundenangebot evaluiert mit den Zielen, den Status quo darzulegen und Schwachstellen oder Versorgungslücken zu identifizieren, den objektiven Versorgungsbedarf und die Behandlungsinanspruchnahme gegenüberzustellen, Einflussfaktoren speziell für die Inanspruchnahme von Psychotherapie zu analysieren und die Psychopathologie im Verlauf in Abhängigkeit der Therapieinanspruchnahme zu beschreiben. Fragestellungen: Die Fragestellungen lauteten: (1) Wie sind die Frauen charakterisiert, die in die Sprechstunde kommen? (2) Wie wird die Spezialsprechstunde bewertet, wie ist der Zuweisungsmodus, die Wartezeit auf einen Ersttermin, wie viele Termine werden in Anspruch genommen und wie zufrieden sind die Patientinnen mit den Behandlungsempfehlungen sowie der Unterstützung bei der Weitervermittlung? (3) Wie häufig werden welche Behandlungs- und Unterstützungsangebote empfohlen und wie häufig werden diese im Zeitraum von t0 bis sechs Monate nach dem Erstgespräch umgesetzt? (4) Was sind Einflussfaktoren auf die Psychotherapieinanspruchnahme und (5) wie ist der Verlauf des psychischen Befindens in Abhängigkeit der Psychotherapieinanspruchnahme? Methoden: Es handelte sich um eine Versorgungsstichprobe mit zwei Messzeitpunkten. N=147 Frauen (49 schwanger, 98 postpartal; Alter: 29,9 Jahre, SD=5,3, 18-45 Jahre) wurden bei Erstvorstellung in der Spezialsprechstunde (t0) und sechs Monate später (t1) untersucht. Zu t0 wurden Informationen zu soziodemografischen, schwangerschafts- und geburtsspezifischen Merkmalen, zur Psychopathologie mittels SKID-I, BSI, EPDS und GAF-Skala, zu Persönlichkeitsstilen mittels PSSI, zur sozialen Unterstützung mittels F-SozU und zu Aspekten der Sprechstunde (Zuweisungsmodus, Zufriedenheit mit dem Sprechstundenangebot, Beziehungserleben im Erstkontakt) mittels selbstentwickeltem Fragebogen erfasst. Zu t1 wurden die Zufriedenheit mit den Behandlungsempfehlungen und der Weitervermittlung sowie die aktive Unterstützung durch den Therapeuten mittels selbstentwickeltem Fragebogen erhoben. Probandinnen, denen zu t0 eine Psychotherapie empfohlen worden war, wurden zu t1 zur Psychotherapie-Inanspruchnahme befragt. Zu t1 umfasste die Stichprobe 102 Frauen, was einer Teilnehmerquote von 69.4% entspricht. Ergebnisse: Frauen, die die Sprechstunde aufsuchten, verfügten über ein gutes Bildungsniveau, lebten überwiegend in einer festen Partnerschaft bzw. waren verheiratet und zwei Drittel der Probandinnen waren Erstgebärende. Frauen, die sich während der Schwangerschaft vorstellten, gaben häufiger eine ungeplante und ungewollte Schwangerschaft im Vergleich zu Frauen, die sich postpartal vorstellten an. Am häufigsten wurden die Kriterien für Angst- und depressive Störungen, gefolgt von Anpassungsstörungen erfüllt. Fast 75% berichteten psychische Störungen in der Vorgeschichte und zwei Drittel der Frauen gaben Schwangerschafts- und Geburtskomplikationen an. Die Bewertung der Sprechstunde durch die Patientinnen fiel sehr zufriedenstellend aus, bei kurzen Wartezeiten von durchschnittlich zwei Wochen und durchschnittlich 2-3 Therapeutenkontakten. Hauptzuweiser waren Frauenärzte, Hebammen und Psychotherapeuten. Hinsichtlich der erhaltenen Empfehlungen und Unterstützung bei der Suche nach einer geeigneten Weiterbehandlung bestand ebenfalls eine hohe Zufriedenheit. Von 102 Frauen erhielten 88 Frauen (86.3%) eine Psychotherapie-Empfehlung. 78.4% setzten die Empfehlung um. (Tendenziell) signifikante Einflussfaktoren auf die Therapieinanspruchnahme waren: psychische Komorbidität, psychische Störungen in der Vorgeschichte, geringes globales Funktionsniveau, ausgeprägte Zwanghaftigkeit und Ängstlichkeit, zurückhaltend-selbstunsicher-fürsorglicher Persönlichkeitsstil, positives Beziehungserleben im Erstgespräch und eine direkte Therapieanbahnung durch den Sprechstundentherapeuten. Die Psychopathologie verbesserte sich im Verlauf von sechs Monaten sowohl bei Frauen, mit und ohne Psychotherapie-Inanspruchnahme. Auch wenn kein statistisch signifikanter Interaktionseffekt für die Inanspruchnahme von Psychotherapie nachgewiesen werden konnte, wiesen die deskriptiven Daten dennoch auf eine allgemein stärker ausgeprägte psychische Belastung und höhere Krankheitsschwere zu t0 bei den Frauen mit Psychotherapieinanspruchnahme hin. Schlussfolgerungen: Die Spezialsprechstunde wird von Frauen mit peripartalen psychischen Belastungen gut angenommen und gibt innerhalb von wenigen Stunden die Möglichkeit für eine auf das jeweilige Anliegen angepassten Diagnostik, Problemanalyse, Krisenintervention, Kurzzeittherapie, Psychopharmakotherapie bzw. Vermittlung in weiterführende ambulante oder stationäre Psychotherapieangebote. Erstgebärende, Frauen mit Schwangerschafts- und Geburtskomplikationen und Frauen mit psychischen Störungen in der Vorgeschichte sollten über peripartale psychische Beschwerden, deren Behandelbarkeit und über verfügbare Versorgungsstrukturen im Rahmen der Geburtsvorbereitung und Nachsorge aufgeklärt werden. Ein Großteil der Patientinnen konnte in eine für sie geeignete Therapieform vermittelt werden, was für eine gute Netzwerkarbeit spricht. Dabei ließ sich die Psychotherapie-Inanspruchnahme durch konkrete Hilfestellung bei der Therapievermittlung durch den Sprechstundentherapeuten und einem positiven Beziehungserleben im Erstgespräch positiv beeinflussen. Die Ergebnisse zur Psychotherapieinanspruchnahme weisen auf eine Selbstselektion der Patientinnen hin: Frauen mit einer stärker ausgeprägten Psychopathologie konnten für die Inanspruchnahme von Psychotherapie motiviert werden; weniger stark psychisch belastete Frauen erfuhren durch die Kurzintervention innerhalb der Sprechstunde Stabilisierung und Entlastung. Patientinnen mit einem eher selbstsicheren Persönlichkeitsstil, einem guten globalen Funktionsniveau, einer geringen psychischen Komorbidität und ohne psychische Vorbelastung sollten frühzeitig herausgefiltert und für eine Kurzzeitpsychotherapie motiviert werden. Die Sprechstunde übernimmt als "Weichensteller" eine wichtige Funktion im Versorgungsnetz und leistet einen Beitrag zur Prävention von Mutter-Kind-Beziehungsstörungen und potentiell nachfolgenden Verhaltens- und emotionalen Problemen des heranwachsenden Kleinkindes. Die Verfügbarkeit dieses professionellen Hilfsangebotes hilft den potentiellen Zuweisern im Umgang mit ihren eigenen Unsicherheiten bzgl. der Behandlung und fördert somit in gewisser Weise erst das „Hinsehen“ und damit die adäquate Versorgung von Mutter und Kind. / Background: Mental disorders during pregnancy and postpartum period have a high prevalence of 10 to 15%. Their treatment is of particular importance with respect to their far-reaching negative consequences for pregnancy, birth, mother-child-relationship, and child development (Alder et al., 2007, Reck, 2015). Although the knowledge about these negative consequences is well documented which results in the necessity of a specialized urgent care, different limits and problem areas can be identified within the care landscape. Firstly, there exists an objective lack of therapeutic services with fast access, particularly in rural areas (Köllner, 2012). Secondly, uncertainties on the side of the therapist concerning the psychotherapeutic and/or psychopharmacological treatments and the treatment setting (bringing the newborn to therapy, mother-child-treatment, Weidner et al., 2012) can be identified. Finally, women in pregnancy and postpartum period hardly seek professional help, which can be explained through fears of stigmatization or of possible side effects, knowledge about supply deficits in psychological health care, and problems with treatment organization (Freed et al., 2012). To overcome these deficits, a cross-sector multidisciplinary treatment for women with perinatal mental disorders was established in Dresden. A significant part of this treatment service is the special consultation hour called "Psychisch gesund für Zwei", offered by the Department of Psychotherapy and Psychosomatics at University Hospital Dresden. In the present work the special consultation was evaluated in order to show the status quo, identify supply gaps, compare objective treatment needs and treatment utilization, analyze influencing factors for psychotherapy use, as well as to analyze the psychopathology over time in relation to psychotherapy use. Objectives: The research questions included: (1) How are the women visiting the special consultation hour characterized? (2) The general evaluation of the consultation service: How is the assignment mode? How long do patients have to wait for their first contact? How many consultations are attended and how satisfied are the patients with the recommended treatments and the offered support concerning re-assignments? (3) What kind of treatment was how often recommended and utilized by the women within a period of six months? (4) Which factors influence the utilization of psychotherapy? (5) How does the mental condition change in the course of psychotherapy utilization? Methods: This research is based on a supply sample with two measurement time points: N=147 women (49 pregnant, 98 postpartal; mean age 29.9 ± 5.3 years SD; aged from 18 to 45 years) were interviewed at their first contact (t0) and 6 months later (t1). At t0, socio-demographic data, information concerning pregnancy and birth, psychopathology by SKID-I, BSI, EPDS and GAF-scale, style of personality by PSSI, social support by F-SozU, and evaluations of the special consultation hours (assignment mode, satisfaction with the special consultation, therapeutic relationship) were assessed with the help of a self-designed questionnaires. At t1, the degrees of satisfaction with treatment recommendations, transfer to an appropriate form of treatment and active support in seeking recommended treatment were also assessed by self-designed questionnaires. Women, to whom the utilization of psychotherapy had been recommended at t0, were interviewed regarding their psychotherapy utilization at t1. At t1, the sample size was 102 women which corresponds to a participation rate of 69,4%. Results: Women who attended the special consultation hours had a high level of education and were living together with a partner or were married. Two thirds of them were primiparae. Woman who joined the consultation service already during pregnancy were more likely to have an unplanned and unwanted pregnancy than women who were participating postpartum. Most frequently, anxiety and depressive disorders were diagnosed, followed by adjustment disorders. Almost 75% of women reported mental disorders in their personal medical history and 60% indicated pregnancy or birth complications. There was a high level of satisfaction with the consultation at short waiting periods and an average of 2-3 therapeutic contacts. Main assigning healthcare professionals were gynecologists, midwifes and psychotherapists. Altogether, patients were content with treatment recommendations and the support for acquiring further treatment possibilities. Out of 102 women, 88 women (86,3%) were recommended a psychotherapy. If recommended, psychotherapy was utilized in 78,4% of cases. Significant factors influencing the utilization of treatment were the comorbidity of mental disorders, mental disorders in personal medical history, low levels of global functioning, distinct compulsiveness and anxiety, restrained-avoidant-considerate personality traits, a positive therapeutic relationship at initial consultation and active support in seeking recommended psychotherapy. Psychopathology improved in the course of 6 months for both, women who utilized psychotherapy, as well as for those without psychotherapy. Although no statistically significant interaction effect for the utilization of psychotherapy could be proven, the descriptive data indicated a stronger severity of disease at t0 for women who utilized psychotherapy. Conclusions: The opportunity to attend the special consultation was received very well by women suffering from peripartal mental disorders. The consultations offered short-range adequate diagnosis, problem analysis, crisis intervention, short-term treatment, psychopharmacological therapy or the transferal to ambulatory and hospital psychotherapy. Primiparae, women with pregnancy or birth complications, and women with mental disorders in their medical history should be informed about peripartal mental symptoms, their treatability and available mental health services in the context of birth preparation and postnatal care. The majority of patients could be transferred successfully to an appropriate form of treatment, which indicates efficient networking activities among health professionals. The active support by healthcare professionals in seeking psychotherapy had a positive impact on the factual utilization of recommended psychotherapeutic treatments. With regard to the utilization of psychotherapy, the results suggest a self-selection of the patients: Women with increased severity of mental disorders could successfully be motivated to seek psychotherapy; less severe mentally strained women profited from short-term intervention within the consultation through stabilization and relief of strain. Patients with a confident personality, sufficient global level of functioning, slight mental comorbidity and without prior mental charge should be selected early and then motivated to seek short-term psychotherapy. The special consultation hours play an important role in the treatment of peripartal mental disorders and make an important contribution to prevent mother-child attachment disorders and potential behavioral and emotional problems of the growing child. The availability of this professional offer helps potentially re-assigning healthcare professionals to deal with their own uncertainties regarding adequate treatment and encourages them to pay closer attention to this topic, which eventually results in an adequate treatment for mother and child.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objetivo do presente estudo foi investigar a associação entre a depressão pós-parto e a retenção de peso no pós-parto. Trata-se de um estudo longitudinal, com 563 mulheres no baseline acolhidas em unidades de saúde do município do Rio de Janeiro entre 2005 e 2009, acompanhadas até o 6 mês pós-parto, com dados sobre peso e estatura aos 15 dias pós-parto e peso pré-gestacional. O peso retido após o parto foi calculado a partir da diferença entre o peso aferido nas ondas de seguimento (15 dias, 1, 2, 4 e 6 mês) e o peso pré-gestacional. O estado nutricional pré-gestacional foi classificado de acordo com a OMS. A presença de depressão pós-parto foi avaliada a partir da versão em português da Escala de Depressão Pós-parto de Edimburgo (EPDS) aos 15 dias e no 2 mês após o parto, utilizando-se 11/12 da EPDS como ponto de corte. Considerou-se depressão recorrente quando houve presença de depressão nos dois momentos. Inicialmente analisaram-se características da população. Para as análises estatísticas do efeito do estado nutricional pré-gestacional e do efeito da depressão pós-parto sobre a retenção de peso pós-parto empregou-se o proc mixed do pacote estatístico SAS. Dentre os principais achados, destaca-se que 22,7% (IC 95% 19,3-26,4) das mulheres iniciaram a gravidez com sobrepeso e 10,9% (IC 95% 7,0-15,7) apresentaram depressão recorrente. A retenção média de peso foi de 5,6 kg (IC 95% 5,1-6,1) aos 15 dias pós-parto. Na análise das trajetórias no tempo do peso pós-parto por estado nutricional pré-gestacional ajustadas por idade, escolaridade, número de filhos, aleitamento materno e ganho de peso gestacional, observou-se diminuição da retenção de peso pós-parto para os grupos de baixo peso e sobrepeso pré-gestacional e aumento da retenção de peso pós-parto para o grupo de obesidade pré-gestacional. Na análise das trajetórias no tempo do peso pós-parto por depressão pós-parto verifica-se que o efeito entre o tempo e a retenção de peso pós-parto se modifica para mulheres com depressão pós-parto recorrente nas análises bruta e ajustadas por idade, escolaridade, estado nutricional pré-gestacional, número de filhos, ganho de peso gestacional, aleitamento materno e rede social, nas quais observa-se que as mulheres com depressão pós-parto recorrente perdem menos peso. Os resultados permitem identificar que há no pós-parto perda e ganho de peso, apesar de ser esperada perda de peso almejando o retorno ao peso pré-gestacional. Ressalta-se o impacto da depressão pós-parto observado nesta dinâmica de peso, uma vez que mulheres com depressão pós-parto recorrente apresentaram menor perda de peso. Destaca-se a relevância dos resultados deste estudo para o desenvolvimento da promoção da saúde e da segurança alimentar e nutricional, visando um monitoramento do estado nutricional pós-parto e avaliação da saúde mental materna de forma a contribuir para a prevenção da obesidade feminina e comorbidades / The objective of this study was to evaluate the association between postpartum depression and weight retention in the same period. This is part of a cohort study conducted with 563 women in the baseline that were treated in public services from the city of Rio de Janeiro, between 2005 and 2009, followed up to the 6th month after delivery, and data regarding weight and height at 15 days after delivery (baseline) and this pre-pregnancy weight were collected. The retained weight after delivery was calculated as the difference between the weight measured at 15 days, 1, 2, 4 and 6 months after delivery and the pre-pregnancy weight. The womens nutritional status was classified according to WHO. The presence of postpartum depression was evaluated using the portuguese version of the Edinburgh Postpartum Depression Scale (EPDS) at 15 days and 2 months after delivery, and using as cutoff 11/12 points in the Scale. Recurrent depression was considered when there was presence of depression at both times. Firstly, general, characteristics of the population were analyzed. To the statistical analysis of the effect of pre-pregnancy nutritional status and the effect of postpartum depression on postpartum weight retention the package proc mixed from SAS was applied. The results show that 22.7% (95% CI 19.3-26.4) of the women started pregnancy overweight, 10.9% (95% CI 7.0-15.7) presented recurrent depression. The average weight retention was 5.6 kg (95% CI 5.1-6.1) at 15 days postpartum. When the time trajectories of weight after delivery according to pre-pregnancy nutritional status were analyzed adjusted for age, schooling years, number of children, breastfeeding and gestational weight gain, it was observed a reduction of weight retention after delivery to those women who were classified as underweight and overweight before pregnancy and an increased in the same trajectory for the who were obese. When the time trajectories of weight after delivery according to postpartum depression were analyzed it was showed that the effect between time and weight retention changes for women with recurrent postpartum depression in the crude and adjusted analyzes by age, schooling years, pre-pregnancy nutritional status, number of children, gestational weight gain, breastfeeding and social network, in this analysis women with recurrent postpartum depression lose less weight. The results show that during the postpartum period the impact of postpartum depression in this dynamic weight is important, since women with recurrent postpartum depression showed less weight loss. The results of this study present the importance of it to the development of health promotion and food and nutrition security, assessment of maternal mental health in order to contribute to the prevention of female obesity and comorbities

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A depressão pós-parto (DPP) é uma condição prevalente que afeta globalmente as mulheres puérperas. Uma hipótese evolutiva aborda a depressão, e consequentemente a DPP, como uma resposta proveniente da evolução do comportamento humano ao longo da História, através da seleção natural. A teoria do investimento parental sugere que os pais não investem automaticamente em toda prole; o investimento é direcionado para que o sucesso reprodutivo seja máximo. No caso de os riscos superarem os benefícios reprodutivos, sintomas de depressão se desenvolvem como sinal de alerta. O objetivo do estudo foi identificar fatores associados à DPP que fossem compatíveis com a teoria do investimento parental. Estudo transversal realizado com 811 mães de lactentes até cinco meses de idade, no município do Rio de Janeiro. A presença de DPP foi definida com base no escore da Escala de Edinburgh (EPDS). Fatores potencialmente associados à DPP foram analisados através de regressão logística com ajuste para fatores de confundimento. Os fatores significativamente associados à DPP foram: apoio social inadequado (OR 3,38; IC 95% 2,32-4,94), baixa escolaridade (OR 2,82; IC 95% 1,69-4,70), violência física entre parceiros íntimos na gestação (OR 2,33; IC 95% 1,56-3,47), idade materna inferior a 35 anos (OR 2,20; IC 95% 1,05-4,64), falta de companheiro (OR 1,90; IC 95% 1,16-3,12), internações durante a gestação (OR 1,87; IC 95% 1,12-3,14) e prematuridade do recém-nascido (OR 1,87; IC 95% 1,02-3,42). Em suma, identificamos alguns fatores associados à DPP que podem ser úteis no rastreamento e acompanhamento de mulheres de risco. Alguns dos fatores associados à DPP podem ser explicados através das hipotéses evolutivas contempladas neste estudo. Entretanto, os achados encontrados não são suficientes para esgotar o conhecimento referente a esta questão. Futuras pesquisas devem focar em diferentes abordagens desta condição e acompanhamento das consequências para as mulheres e suas famílias. / Postpartum depression (PPD) is a prevalent condition that affects women globally after they have given birth. An evolutionary hypothesis deals with depression, and consequently PPD, as a response from the evolution of human behavior throughout history, through natural selection. The parental investment theory suggests that parents do not automatically invest in all offspring, so that the investment is directed towards maximum reproductive success. If the risks outweigh fittness benefits, symptoms of depression develop as a warning sign. The objective of the study was to identify factors associated with PPD that were consistent with parental investment theory. Cross-sectional study with 811 mothers of infants up to five months of age in the municipality of Rio de Janeiro. The presence of PPD was defined based on scores on the Edinburgh Scale (EPDS). Factors potentially associated with PPD were analyzed by logistic regression with adjustment for confounding factors. Factors significantly associated with PPD were: inadequate social support (OR 3,38; 95% CI 2,32-4,94), low educational level (OR 2,82; 95% CI 1,69-4,70), physical violence between partners in gestation (OR 2,33; 95% CI 1,56- 3,47), maternal age under 35 years (OR 2,20; 95% CI 1,05-4,64), lack of partner (OR 1,90; 95% CI 1,16-3,12), hospitalization during pregnancy (OR 1,87; 95% CI 1,12- 3,14) and prematurity of the newborn (OR 1,87; 95% CI 1,02- 3,42). In summary, we identified factors associated with PPD which can be useful in tracking and monitoring women at risk. Some of the factors associated with PPD can be explained through the evolutionary hypotheses considered in this study. However, the findings are not sufficient to exhaust the knowledge regarding this question. Future research should focus on different aspects of this condition and monitoring of the consequences for women and their families.

O presente estudo investigou as mudanças na leitura materna sobre seus sintomas depressivos e sobre os sintomas psicofuncionais do bebê em um contexto de Psicoterapia Mãe-Bebê em Grupo. Participaram deste estudo uma díade mãe-bebê em que a mãe apresentava depressão pós-parto, de acordo com a Escala de Depressão Pós-Parto de Edimburgo (EPDS) e pela Entrevista MINI e confirmados através da Entrevista sobre a Gestação e Parto e também pela Entrevista sobre a Experiência da Maternidade. Já o bebê tinha sintomas psicofuncionais detectados através do Questionário Symptom Check List (SCL). Essa dupla participou de uma Psicoterapia Mãe-bebê em Grupo no período de maio a agosto de 2015. Foi utilizado o delineamento de estudo de caso único, a fim de analisar as mudanças na leitura materna sobre seus sintomas depressivos e sobre os sintomas psicofuncionais do bebê ao longo das sessões de psicoterapia. Para tanto, foi realizada uma análise qualitativa, relacionando os materiais clínicos provenientes das 11 sessões de psicoterapia com os conhecimentos teóricos existentes na literatura, a partir de uma compreensão psicanalítica. Os sintomas depressivos maternos considerados nessa análise foram tristeza, labilidade emocional e irritabilidade e os sintomas psicofuncionais do bebê foram sono, alimentação e comportamento, em especial os que envolvem separação. Os resultados revelaram mudanças na leitura da mãe acerca dos seus sintomas depressivos e sobre os sintomas psicofuncionais do bebê ao longo das sessões da Psicoterapia Mãe-Bebê em Grupo. Além disso, verificou-se que os sintomas depressivos maternos e os sintomas psicofuncionais do bebê estavam mutuamente associados e que a partir da intervenção utilizada houve uma melhora dos sintomas tanto da mãe quanto do bebê. Palavras-chave: leitura materna, depressão pós-parto, sintomas psicofuncionais do bebê, psicoterapia mãe-bebê em grupo. / The present study investigated the changes in maternal read about their depressive symptoms and on psychofunctional symptoms baby in a context Psychotherapy Brief Mother-Baby Group. The study included a mother-baby dyad in which the mother had postpartum depression, according to Depression Scale Postpartum Edinburgh (EPDS) and Interview MINI and confirmed through the interview about Pregnancy and Childbirth and also the interview on the Maternity Experience. But the baby had psychofunctional symptoms detected by the Symptom Check List Questionnaire (SCL). This double attended a Mother-Baby Group Brief Psychotherapy in the period May-August 2015. We used a single case study design in order to analyze the changes in the mother reading about her depressive symptoms and about the baby psychofunctional symptoms along the psychotherapy sessions. For this, a qualitative analysis was conducted, linking clinical materials from 11 psychotherapy sessions with existing theoretical knowledge in literature, from a psychoanalytic understanding. Maternal depressive symptoms were considered in this analysis sadness, emotional lability and irritability and the baby’s psychofunctional symptoms were sleeping, feeding and behavior, in particular those involving separation). The results revealed changes in the mother's reading about their depressive symptoms and about the baby-s symptoms psychofunctional during the sessions of brief mother-infant psychotherapy group. In addition, it was found that maternal depressive symptoms and the baby psychofunctional symptoms were mutually associated and was a improvement in symptoms of both mother and baby with the intervencion.

Background: Postnatal depression (PND) is one of the most common maternal mental health problems for women worldwide. Yet the wide range of reported rates of PND in different countries raises questions about how PND is experienced by women in different cultures and whether interventions developed in western cultures are appropriate in very different settings. It is important to establish how PND is defined, experienced and managed in different cultures in order to create culturally relevant interventions. No previous studies of experience of PND and its management have been conducted in Malaysia. The aim of this study was to explore women’s experiences and healthcare practitioners’ (HCPs) perspectives of PND in a multicultural country, Malaysia. Methods: This was a qualitative study informed by a critical realist approach. Semi-structured interviews were carried out with 33 women (from three different cultural backgrounds) attending for child or postnatal care and 18 HCPs in six purposively selected maternal and child health (MCH) clinics and a female psychiatric ward in Kuala Lumpur, Malaysia. Data were analysed using framework analysis. Findings: There were some differences in the women’s perceptions of PND experience across three different cultural backgrounds in Malaysia. Malay women were more likely to describe the symptoms of PND based on a combination of emotional and behavioural changes, whereas Chinese and Indian women talked more about emotional changes. Traditional postnatal practices were described as contributing to PND by some Malay women but were accepted as promoting maternal and infant well-being by the majority of Indian women. Religious activities were reported as an effective strategy for the Malay women but were not seen as helpful by the majority of Chinese women. Considering HCPs, it appeared that the absence of a clear and specific policy and guideline in the management of PND within the Malaysian healthcare system has resulted in a lack of professional ownership in the management of PND, especially among HCPs in MCH clinics. Conclusion: The women and the HCPs had distinct ways of conceptualising PND experiences, although they agreed on several symptoms and causal explanations. This study calls for a system-based enhanced PND care with an initiation of culturally appropriate care for PND within the healthcare system.