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Sintomas Psicofuncionais e Depressão Materna: Um Estudo Qualitativo
Abstract
This study aimed to understand the manifestation of psychofunctional symptoms in infants between six and 12 months, whose
mothers presented depression. For this purpose, multiple case studies with three mother-infant pairs were qualitatively performed,
and the following instruments were administered: interviews on socio-demographic and clinical data, M.I.N.I. PLUS,
Symptom Checklist Questionnaire, EPDS, interview about pregnancy, childbirth and maternity experience, as well as IAP. The
results showed the presence of several risk factors for depression common to all mothers, as well as singular psychodynamic
aspects related to their life story. Also, we identified difficulty in the mother-infant interaction in all cases, indicating that depression
damages the mother in the exercise of motherhood and in the tasks that this period demands, especially in interpreting to
the baby what his/her body is expressing. Therefore, the psychofunctional symptom can be seen as a defensive response by the
infant to maternal difficulties of understanding the baby’s body manifestations and interpreting them.
Keywords: maternal depression, psychofunctional symptom, mother-infant relationship
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Maternal depression is associated with disturbances in mother-child interaction and child development. This study compared mother-child interaction when the child was 18 months old in dyads with mothers who had depression indicators (clinical group) and in dyads with mothers who did not have depression indicators (nonclinical group), according to two assessments carried out when the child was one and 18 months old. Sixteen mother-child dyads participated, divided into the two groups. The Beck Depression Inventory (BDI) and a mother-child interaction observation session were used. The results revealed only one difference indicating that the mothers in the clinical group were more intrusive while interacting with their children than the mothers in the nonclinical group. The implications of maternal intrusiveness for mother-child interaction, and the importance of the study of comorbidities and chronicity of maternal depression in future investigations are discussed.
Introduction: Postpartum depression (PPD) is a mood disorder that might occur in women in the first year after delivery. Previous epidemiological studies varied with regards to methodology and showed conflicting results regarding the prevalence of PPD. There is no consensus on whether the prevalence of PPD is greater in developing countries than in developed ones, or not. Objective:Using systematic literature review followed by meta-analysis, we aimed to identify regional and methodological variables of primary studies that contributed to the differences in the prevalence of PPD; and check if there was a difference between the prevalence of PPD in developed countries and developing ones, keeping control of methodological variables.Methods:This thesis made a documental research, which searched 14 electronic databases for specialized studies, using strategies with the terms "postpartum depression" and "prevalence", without time restrictions. Inclusion criteria were applied for two reviewers to obtained records in three stages: titles, abstracts and full text. Data on the prevalence of PPD as well as methodology from the included studies were collected. The Loney Scale was used to assess the methodological quality. Statistical techniques were applied to analyze the heterogeneity among the included studies and synthesize the results, generating weighted average prevalence subgroups for analysis. A meta-regression model was constructed, using methodological variablesof the studies as predictors and the prevalence of PPD as a dependent variable. Results:Records from 1881 original studies published between 1980 and 2012 were obtained, of which 778 were evaluated for full text and 337 were included. The methodological quality of the studies was considered weak. The prevalence of PPD ranged from 0.5% in Singapore to 62.8% in United States of America, observing high heterogeneity. The meta-regression model indicated that the variables tool to identify DPP, human development index (HDI) of the country, research design and sample size were significant predictors of the prevalence of PPD. The city where the study was conducted, inserted as a cluster to control the dependency between studies, was significant. Higher average prevalence was found in studies that used self-assessment tools to identify PPD, compared to those which used clinical interview; in cross-sectional surveys, compared to longitudinal; in countries with lower HDIs, and in studies with smaller sample sizes. Discussion: We constructed an explanatory model for the prevalence of PPD from regional and methodological characteristics of primary studies, indicating that method led to biases in the results of those studies. Even controlling for methodological variables, the prevalence of PPD was higher in developing countries than in developed ones.Therefore, social, economic and cultural rights may influence the occurrence of this disorder.Conclusions: PPD was more prevalent in developing countries than in developed ones, even taking into accountmethodological issues of the included studies.However, this conclusion cannot be considered definitive, due to the poor quality of the primary studies.
The present paper intends to alert about the impact of mother’s depression on child development. Thus, we used a clinical case in order to reflect upon depression impact and its vicissitudes, as well as on the potential ways to work out its outcomes. With this in mind, we employed the theoretical basis of the mother-infant psychoanalytic psychotherapy, as well as of psychoanalysis. Some opportune questions are addressed, namely: the best intervention for depressed mothers and their babies; the best moment to carry out an intervention for depressed mothers and their babies; cases that need to be adressed to a mental health professional.
ResumoO estudo avaliou a prevalência de depressão pós-parto (DPP) e fatores associados em mulheres que deram à luz em dois hospitais da cidade de São Paulo: um público e outro privado. Foram aplicados questionários padronizados, a Escala de Depressão Pós-parto de Edimburgo (EDPE) e a Escala de Apoio Social de MOS (EAS) a 462 mulheres: 205, no hospital público e 257, no privado. Foram obtidos dados sociodemográficos, psicossociais, obstétricos e do recém-nascido (RN). Consideraram-se deprimidas mulheres com 12 ou mais pontos na EDPE, aplicada no 3º ou 4º mês após o parto. No hospital público, a prevalência de DPP foi de 26% e, no privado, de 9%. Características dos RN foram semelhantes nas duas amostras; idade, escolaridade, número de visitas de pré-natal e de cesarianas das mães foram maiores no hospital privado. Análise de regressão envolvendo características psicossociais das participantes revelou associação positiva de DPP com depressão anterior e com frequência de conflitos com o parceiro e relação negativa com anos de escolaridade e escore de apoio social.
