Prenatal and postnatal depression among low income Brazilian women

Postnatal depression is poorly covered in specialized textbooks, is rarely encountered by obstetricians, and may not be featured in teaching. Most cases of such depression do not receive a correct diagnosis and are not properly medicated, even though the condition affects 10-15% of mothers . The finding that the children of such depressed mothers may show behavioral disturbances at 3 years of age or cognitive defects at 4 years of age suggests that postnatal depression may have a long-term negative impact on the family. Several risk factors have been associated with postnatal depression but data are contradictory and more studies are necessary in order to clarify our understanding of mood disorders after birth . The risk factors associated with postnatal depression include an unsatisfactory relationship with the mother and emergency cesarean sections . Marital status has been reported to be important in some cases but not in others . Although the symptom pattern of postnatal depression is not different from that of major depression , it may not be easily recognized. The mother generally feels inadequate, worthless and a failure in her new task. It is difficult for her to confess such feelings when she should be delighted with her child, unless of course the practitioner is approachable, supportive and aware of the problem.

Results indicate that in low income Brazilian women the prevalence of episodes of depression in the third trimester of pregnancy is 38% and that during the first six months after delivery 43% of the women may present at least one depressive episode. It should be remembered that the EPDS scale is not specific for depression since it is also influenced by symptoms of increased irritability and anxiety . Nevertheless, because of its simplicity and widespread use in several countries, it proved to be a good instrument for the present study. The Brazilian version of the EPDS scale was validated in this study. Values of sensitivity and specificity of the Brazilian version were close to the values of 80% and 90.8%, respectively found in a German validation . The sample size in this study may be considered small when compared to other studies. However, this study has the value of being a prospective one with a careful design requiring home interviews and control of the living conditions. All women who became pregnant and were indicated to the researchers by the community over a one-year period were invited to take part in the study. The evaluation methods used in this study were sensitive enough to detect the strongest associations between environmental or biological variables and maternal depression. Other associations between depression and, for example, pregnancy acceptance, job before pregnancy and previous psychiatric treatment could have reached statistical significance had the sample size been larger.

Even when only women with a complete follow-up were considered for analysis (in order to control for the decrease in sample size during postnatal evaluation), the proportion of volunteers without partner support was still significantly higher among depressed women compared to not depressed women.Compared to women with no onset of affective disorders, depressive women were characterized as having received a negative response from the husband to news of the pregnancy. This finding, in a Japanese sample, is very similar to our results in Brazilian women. It is important to note that in our study all of the women belonged to the same social class, living in similar conditions, i.e., small, poor, crowded houses. It would be interesting to investigate whether acceptance of pregnancy by the partner has the same grade of importance for women with higher levels of education and economic support. In the study , other factors such as living in a crowded flat were also important in the onset of prenatal depression. It is possible that poverty and the lack of psychological support interact synergistically to influence the incidence of prenatal depression. Prenatal depression, has been a long-neglected area, warranting further investigation. To our knowledge, the consequences of prenatal depression in terms of the success of breast feeding have not been systematically investigated. Our study suggests that mild depression in the third trimester of pregnancy does not affect breast feeding significantly. However, studies of more severe cases and involving the observation of mother-infant relationships would certainly improve our understanding of this subject.

In conclusion, this study indicates that the prenatal period may be more susceptible to some socioenvironmental factors that lead to depression, and suggests a high incidence of depression among Brazilian women already suffering the consequences of poverty. Further investigation of this problem is necessary before general conclusions can be reached about such depression in other parts of Brazil.

CREDITS:
http://www.scielo.br/
V.A. Da-Silva, A.R. Moraes-Santos, M.S. Carvalho, M.L.P. Martins and N.A. Teixeira

For more Brazil News Click Here