Dorothy Smith (1987) says investigations often begin with ‘a feeling of uneasiness’. Smith’s insistence of the importance of starting with women’s standpoint, to redress the way in which women’s lives have been negated or neglected in research, informs the methodological premise of this inquiry. The unease that prompted this project emerged in conversations I had with women diagnosed with a psychiatric disorder whilst working as a practitioner at a women’s health centre. The frequency with which the discourses of biomedicine figured in these women’s narrated experiences engendered a collective commitment to make problematic ‘living with a label’. Loosely connected as mental health service recipients, the women I researched with are often positioned as ‘subject’ to an objective medical gaze. Disrupting dichotomies that these women are accustomed to in clinical settings, and destabilising notions of neutral and detached research, our investigations were contingent, reflexive and relational. Recognising that all were intrinsic to the knowledge production processes, this project was cast in the feminist ‘with’, rather than the ‘on’. Together we explored how women read and respond to a psychiatric diagnosis in their daily lives, to generate understandings that can be used by the women who joined this project. This included close consideration of social relations shaping the lived actualities these women described, and their agency in sustaining and unsettling these. / Acknowledging these women’s capacity to have expertise not only as reporters, but as theorists too, experience and analysis were conflated in our explorations of ‘living with a label’. Congruent with feminist philosophy, our methodology had a praxis orientation as well, ‘to produce different knowledge and to produce knowledge differently’ as Patti Lather (2001) suggests. The attendant opportunities to research the process of researching and contemplate how we might participate in change-oriented activities were thus integral to this project. Our experience of researching together, and allowing the ‘researched’ room to know and act, produced possibilities, and also created conundrums, perhaps less frequently encountered in more conventional research – all of which gave rise to celebration!

Allt fler barn i Sverige lider av psykisk ohälsa. Det finns ett behov av bättre kunskapsunderlag för att hitta de barn som visar tidiga tecken på psykisk ohälsa. Syftet med studien var att undersöka vad personal inom förskolan har för inställning till att utföra skattning av barns sociala och känslomässiga utveckling med formulär. Tretton intervjuer genomfördes och materialet analyserades med kvalitativ innehållsanalys. Resultatet visade att det fanns en olust bland förskollärare att möta föräldrars reaktion och oro inför en eventuell bedömning. Att redovisa formulärets svar för föräldrarna kändes inte heller helt lätt. Förskollärarna ansåg att förskolan är ett bra forum för att bedöma socialt beteende och att formuläret kan resultera i en tydlig och rättvis bild av barnen. Men lärarna var också rädda för att stämpla barn. En del ansåg att bedömningar av enskilda barns utveckling är ett förlegat arbetssätt. Personalen hade delade meningar i frågan om tidsbrist skulle utgöra ett hinder för skattningsarbetet. I alla intervjuer fanns en vilja från lärarnas sida att se till barnets bästa. Slutsats: Skattning av barns beteende med hjälp av formulär i förskolan är komplext. Ett eventuellt införande av metoden ställer krav på tydlig information om metoden och syftet till såväl förskollärare som föräldrar. / An increasing number of Swedish children suffer from psychiatric disorders. There is a need for better knowledge to detect children that show early signs of psychiatric disorders. The purpose of this study was to investigate what attitude preschool staffs have to perform evaluations of children’s social and mental development using a questionnaire. A total number of thirteen interviews have been performed and the material have been analysed according to a qualitative content analysis. The results showed a discomfort amongst preschool teachers to meet the parents’ reaction and concern in relation to a possible evaluation. The preschool is considered to be a good forum when to assess children´s behaviour and the actual questionnaire is considered to be a useful tool. But the teachers were worried that they would put a label on the children. Some of the teachers believed that assessing children is an outdated way to work. There were different opinions whether lack of time is an obstacle to use the questionnaire. There was generally an intention to ensure the children´s best. Conclusion: Evaluations of the children´s behaviour using the questionnaire in preschool is a complex issue. An implementation of the method requires extensive information to preschool teachers and parents.

Bipolar disorder is a psychiatric illness characterized by recurrent fluctuations in mood and increased risk of suicide. Twin and family studies have identified the highly heritable nature of the disorder, but the limitations of the current DNA-centric paradigm underscore the need for a new perspective to gain a clearer understanding of its basis. This project investigates various facets of bipolar disorder from an epigenetic standpoint. We used mass spectrometry-based mapping of individual DNA modification differences of the brain-derived neurotrophic factor gene. Moreover, the epigenetic basis of suicidal behaviour in bipolar disorder was investigated using DNA methylation microarrays. We also used a newly-developed enrichment technique, mTAG, to interrogate chromosome-wide DNA modification profiles using tiling microarrays in post-mortem brains of bipolar disease patients and controls. Findings from these experiments highlight observable features of epigenomes of patients affected with mood disorders, and may further the understanding of the molecular origin of psychiatric diseases.

Bipolar disorder is a psychiatric illness characterized by recurrent fluctuations in mood and increased risk of suicide. Twin and family studies have identified the highly heritable nature of the disorder, but the limitations of the current DNA-centric paradigm underscore the need for a new perspective to gain a clearer understanding of its basis. This project investigates various facets of bipolar disorder from an epigenetic standpoint. We used mass spectrometry-based mapping of individual DNA modification differences of the brain-derived neurotrophic factor gene. Moreover, the epigenetic basis of suicidal behaviour in bipolar disorder was investigated using DNA methylation microarrays. We also used a newly-developed enrichment technique, mTAG, to interrogate chromosome-wide DNA modification profiles using tiling microarrays in post-mortem brains of bipolar disease patients and controls. Findings from these experiments highlight observable features of epigenomes of patients affected with mood disorders, and may further the understanding of the molecular origin of psychiatric diseases.

Abnormal activation of brain microglial cells is widely implicated in the pathogenesis of schizophrenia. The disrupted balance of microglia phenotypes has been hypothesized to influence the clinical course of the disease and affect symptom severity. Previously, the pathophysiology of microglial activation was considered to be intrinsic to the central nervous system. We hypothesised that due to their perivascular localization, microglia can also be activated by factors present in circulating blood. We applied a high-content functional screening platform, to characterize alterations in microglial intracellular signalling cascades induced by schizophrenia patient serum relative to control serum. Using automated sample preparation, fluorescent cellular barcoding and flow cytometry, the applied platform is capable of detecting multiple parallel cell signalling responses in microglia. First, we exposed a human microglia cell line to serum isolated from first-onset drug-naïve schizophrenia patients (n=60) and healthy controls (n=79). We were able to show that peripheral blood serum obtained from schizophrenia patients induced differential microglial cell signalling network responses in vitro. We subsequently assessed whether antipsychotic drug-treatment can normalise the abnormal microglial signalling responses previously identified by exposing microglia cells to serum from antipsychotic treated schizophrenia patients (n=15) and controls (n=17). In addition, in order to assess microglia activation in vivo, we obtained positron emission tomography (PET) imaging data from collaborators, who used a radiotracer to assess potential altered microglia activation in patients suffering from schizophrenia. Finally, as a proof of concept study, we attempted to validate these findings by assessing the effect of serum collected from first-onset drug-naïve schizophrenia patients (n=9), controls (n=12) as well as serum isolated from the same patients subjected to six weeks of clinical treatment with the antipsychotic olanzapine (n=9). This study aimed to identify normalisation of previously detected differences in microglia signalling pathways based on successful in vivo treatment. We demonstrate that peripheral blood serum isolated from schizophrenia patients, independent of their treatment status, is sufficient to trigger microglial cell signalling network responses in vitro, which are indicative of altered STAT3 signalling. We further explored the composition of the serum for differential expression of analytes, previously associated with neuropsychiatric disorders, and the utility of the detected microglial cellular phenotype as a target for novel drug discovery.

Introdução: Ideação suicida e tentativas de suicídio são geralmente complicações dos transtornos psiquiátricos. O estudo da freqüência e fatores associados podem contribuir para uma abordagem mais adequada por profissionais de saúde mental. Objetivos: Estimar a prevalência de tentativas e pensamentos suicidas, em pessoas com transtornos mentais graves (TMG) e as associações com características sócio-demograficas, diagnóstico, ajustamento social, sintomas psiquiátricos, uso de substâncias psicoativas, envolvimento familiar e tratamentos realizados. Método: Foram entrevistados e avaliados 192 pessoas que apresentavam TMG, com idade entre 18 e 65 anos e que tiveram contato com os serviços de saúde mental de três regiões definidas do município de São Paulo em período determinado. Utilizou-se anamneses estruturadas com questionários padronizados e escalas psicométricas. As entrevistas foram realizadas no domicílio do paciente. Realizou-se análise descritiva, análise univariada e análise multivariada. Resultados: Da amostra estudada predominaram as pessoas do sexo masculino (53,1%), solteiras (57,3%), com diagnóstico de esquizofrenia (58,3%). Poucas pessoas apresentavam abuso ou dependência de álcool (7,3%) e apenas três pessoas (1,6%) não utilizaram medicações psiquiátricas no período de um ano anterior à entrevista. Cento e nove (57,7%) entrevistados apresentaram pensamentos suicidas ao longo da vida e nos 12 meses anteriores a entrevista, trinta e oito (20,1%) tiveram tais pensamentos. Cinqüenta e nove (30,9%) pessoas já haviam tentado suicídio durante a vida e oito (4,2%) apresentaram tentativas nos 12 meses anteriores à entrevista. Para todas as variáveis de desfecho, apresentaram associação estatística, a presença de sentimentos de culpa e sintomas depressivos. Na análise multivariada, o uso de neurolépticos apresentou associação com pensamentos e tentativas de suicídio ao longo da vida. Conclusão: Ideação e tentativas de suicídio foram bastante prevalentes na população estudada devendo sempre ser investigadas pelos profissionais de saúde mental, para que se possa tomar as devidas condutas, como o manejo dos sentimentos de culpa e depressão, além do ajuste correto da medicação para o transtorno mental. / Introduction: Suicidal ideation and suicidal attempts are usually complications of psychiatric disorders. The study of the frequency and associated factors may contribute for the mental health professionals to have a more appropriate approach. Aims: Estimate the prevalence of attempts and suicidal thoughts, in people who have serious mental disorder (SMD) and the association with social-demographic characteristics, diagnosis, social adjustment, psychiatric symptoms, use of psychoactive substances, family involvement and treatments they have gone though. Method: One hundred ninety two subjects, age 18 - 65, showing SMD and having been in touch with mental health services in three defined zones in the city of Sao Paulo, in the determined period, were evaluated and interviewed. The researchers used structured anamnesis with standardized questionnaires and psychometric scales, the subjects were interviewed at home and a descriptive analysis, a univariate analysis and a multivariate analysis were used. Results: From the sample we studied we’ve found a predominance of men (53,1%), single people (57,3%), having a diagnose of schizophrenia (58,3%). Few people presented abuse or dependence of alcohol (7,3%) and only three people (1,6%) hadn’t used psychiatric medications within one year before the interview. One hundred nine (57,7%) people who where interviewed showed suicidal thoughts during their lives and during 12 months prior to the research, thirty eight (20,1%) had that kind of thoughts. Fifty nine (30,9%) people had tried to commit suicide during their lives and eight (4,2%) showed attempts to it within 12 months before the interview. The presence of guilt feelings and depressive symptoms showed statistics association to all dependant variables. The multivariate analyses showed statistics association to attempts and suicidal thoughts during the patients’ lives to the occasional use of neuroleptics. Conclusion: The presence of suicidal ideation and attempts to suicide were prevalent in the studied population and they should always be investigated by the health mental professionals in order for them manage the prosper procedures, such as the handling of guilt feelings and depression and be able to stablish the proper medication, for the mental disorder.

京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第21919号 / 情博第702号 / 新制||情||120(附属図書館) / 京都大学大学院情報学研究科システム科学専攻 / (主査)教授 石井 信, 教授 松田 哲也, 教授 加納 学, 川人 光男 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

A presente pesquisa teve o objetivo de atualizar os parâmetros psicométricos do Psicodiagnóstico Miocinético PMK. Foi estudada uma amostra composta por 210 sujeitos adultos, todos destros, divididos em quatro grupos, um com 50 mulheres depressivas, um com 50 pacientes esquizofrênicos (35 homens e 15 mulheres), um com 50 reincidentes do sexo masculino do Sistema Prisional do Estado de São Paulo, que cometeram crimes de furto e/ou roubo e um grupo de controle, com 60 participantes (29 mulheres e 31 homens). Os instrumentos utilizados foram a entrevista clínica estruturada para o DSM-IV-TR, também conhecida como SCID-NP, com a finalidade de observar a presença de morbidades entre os presos e o grupo controle e de comorbidades entre os depressivos e esquizofrênicos, o Teste Palográfico, usado como critério no estudo de validade, e o PMK. A precisão foi obtida por meio do teste-reteste, somente com os protocolos da amostra controle e a validade, pelo método de grupos contrastantes e pelo método de validade simultânea. Para a precisão, foi calculado o coeficiente de correlação de Pearson e também utilizado o teste t para determinar se existiam diferenças entre os resultados das duas aplicações. Para os grupos contrastantes foi utilizada a ANOVA de um fator e o teste Post hoc de Tukey, com a finalidade de observar possíveis diferenças significativas das medidas do PMK entre os grupos. Nesta análise, os resultados foram comparados de acordo com o gênero dos participantes. Para a validade simultânea, os dados do Tônus Vital e da Agressividade do PMK e os da Produtividade, Direção das Linhas e Ganchos do Palográfico foram transformados em nota z e correlacionados por meio do coeficiente de correlação de Pearson, primeiramente com a amostra total e posteriormente com o grupo de depressivas e com o grupo de presos, separadamente. Os resultados do estudo de precisão indicaram que boa parte das medidas e dos traçados do PMK apresentou satisfatória estabilidade temporal, não sendo encontrada nenhuma diferença significativa entre teste e reteste. Ao todo, 64% das correlações foram superiores a 0,60, e as maiores médias das correlações foram para o Tônus Vital, a Agressividade e a Dimensão Tensional. As obtidas para o Predomínio Tensional foram as que apresentaram valores mais baixos, embora as correlações entre as aplicações tenham sido, todas, moderadas. Os resultados da validade entre grupos contrastantes demonstraram que, entre as mulheres, as diferenças significativas ocorreram, principalmente, no Tônus Vital, na Emotividade e na Dimensão Tensional. Entre os homens, na Agressividade, na Emotividade (com e sem sinal no DS) e na Dimensão Tensional. Os resultados da validade simultânea revelaram que as maiores correlações ocorreram entre as medidas da Agressividade do PMK com os Ganchos à direita do Palográfico. As correlações obtidas para o Tônus Vital também foram, na maior parte dos casos, significativas. A partir desses resultados, considerou-se que o PMK possui parâmetros científicos que permitem afirmar que ele é um teste preciso e válido para discriminar quadros clínicos de não clínicos / The present research had the purpose to update psychometric parameters of the Myokinetic Psychodiagnosis PMK. Participated a sample of 210 adult subjects, all right handed, divided into four groups, the first composed by 50 depressed women, the second by 50 schizophrenic patients (35 men and 15 women), the third by 50 male prisoners from the Prison System of the São Paulo State who had rescinded thefts and/or steals crimes, and a control group with 60 participants (29 women and 31 men). The instruments used were the Structured Clinical Interview for the DSM-IV-TR, also known as SCID-NP, in order to observe the presence of morbidity among prisoners and the control group and the co morbidity among depressed and schizophrenics. The Test Palográfico, was used as the validity criterion of the PMK test. The reliability was obtained by test-retest, restricted to the control sample and validity by the method of contrasting groups and the simultaneous validity. For the reliability was calculated the Pearson correlation coefficient and also the t test was used to verify if there were differences between the test-retest results. To evaluate the validity by contrasting groups it was used the one-way ANOVA and Pos hoc Tukey test, in order to determinate possible differences of PMK measures between groups. For simultaneous validity, data from PMK Vital Tonus and Aggressiveness and Productivity, Direction Lines and Hooks of Palográfico were transformed in z scores and then correlated by Pearson correlation coefficient, using data from the total sample and from the depressive group and the prisoner group independently. Results of the reliability study indicated that most of measures of PMK had a satisfactory temporal stability and no significant difference between test and retest means was found. Altogether, 64% of correlations were above 0.60 and higher means of correlations were for the Vital Tonus, Aggressiveness and Tensional Dimension. Correlations for Tensional Predominance showed the lowest values, although they can be considered moderate. Results of contrasting groups showed that, among women, significant differences were observed mainly in Vital Tonus, Emotionality and Tensional Dimension, and among men in Aggressiveness, Emotionality (with an without DS signal) and Tensional Dimension. The concurrent validity showed that significant correlations occurred mainly between PMK Aggressiveness measures and Palográfico Hooks at right. Vital Tonus correlations were in most cases significant. These results indicate that the PMK Test presents scientific parameters that allow to confirm that its a reliable and valid test to discriminate clinical cases from those non-clinical

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.

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.