DEPRESSION IN THE PERIPARTURITION PERIOD: SCREENING IN PRIMIPAROUS OF A HIGH RISK MATERNITY USING HORMONAL, CLINICAL AND EPIDEMIOLOGICAL ANALYSIS
PHQ-9; cortisol; epidemiology; gestation; primiparous, peripartum depression
Parental behavior involves neurobiological mechanisms that are influenced by physiological, genetic, socio-environmental and economic factors and that can be modulated by psychological and neuroendocrine changes, applied by pregnancy and by the expectation of treatment by parents. These changes can make pregnant women more vulnerable to psychiatric disorders, among depressive symptoms. Major depressive disorder (MDD) is currently a public health problem, affecting more than 300 million people worldwide. This situation is of serious importance in the postnatal period, when women may develop depressive symptoms associated with the effects of sex hormones and the hypothalamic-pituitary-adrenal axis related to both the gestational state and the peripartum, with negative effects for the mother, or newborn, or both. The objectives of this study were (1) to describe the sample's characteristics in terms of the socioeconomic and epidemiological aspects of prenatal care, and (2) to model the risk of depression in primiparous women. The experimental design consists of a cross-
sectional and quantitative study in which 116 women, over 18 years old, with children born alive, were interviewed within 48 hours after delivery. The socio-epidemiological questionnaire and two screening questionnaires for depression were used: Patient Health Questionnaire 9 (PHQ-9, cut-off point 10) and Edinburgh Puerperal Depression Scale (EPDS, cut-off point 10) and performed a blood collection for cortisol measurement.
The statistical analysis showed that the average age of the participants was 24.37 years, 61.26% (n = 71) had a family income of up to 1 minimum salary, 75% (n = 84) had a stable union, with 72.41 % (n = 84) declaring to receive a good or a very good support from the partner. The general average of prenatal consultations was 8.65 with consultations beginning at around 9.39 weeks. 68.96% (n = 80) said they had not been asked about their mood during prenatal care. Only 13.80% (16) reported previous psychiatric problems. Of this total, 27 (23.28%) were positive on the EPDS and 61 (52.59%) were positive on the PHQ-9. It was possible to collect samples from 107 women the day after the application of the questionnaires for analysis of cortisol. From the total number of parturient, two groups of women with an income of up to 1 minimum salary were selected: 21 participants who had a positive screening in EPDS and another 25 participants with both negative screenings (EPDS and PHQ-9). The modeling of the risk of depression in the peripartum was performed using a logistic regression model. Predictors were age, cortisol, previous psychiatric history, quality of support from the father and assessment of expectation about pregnancy during prenatal care, whose analysis is under development. From the conclusion of the analysis of the results obtained, it is expected to contribute to propose adjustments to the high-risk prenatal program of the studied maternity and a screening for better management of patients at risk of depression.