RESUMEN
BACKGROUND: Given the high incidence of perinatal maternal depression, implementation of preventive actions is crucial. In France, two prenatal preventive measures are available to the general population: early prenatal interview (EPI) and antenatal classes (ANC). OBJECTIVE: To explore the independent associations between EPI and / or ANC and maternal depressive symptoms at 2 months postpartum. METHOD: We used data from the Etude Longitudinale Française depuis l'Enfance (ELFE), a French national representative cohort of children and their parents, followed-up from birth to early adulthood. Data concerning characteristics were collected from the mothers during the maternity stay and between 6/8 weeks' post-partum. The level of depressive symptoms was scored by the French version of the Edinburgh Postnatal Depression Scale (EPDS) between 6/8 weeks' post-partum. We considered EPDS score ≥10 indicative of postnatal psychological distress (PPD) and EPDS ≥12 for postnatal depressive symptoms (PNDS). After data imputation, multivariate logistic regression analysis was performed. RESULTS: Among the 16,411 mothers included in our sample, 26% benefited both from EPI and ANC, 31.1 % of ANC, 7.7% of an EPI and 35% of neither; 20,1% presented PPD and 12,1% PNDS. The likelihood of presenting PPD was significantly higher in mothers who had neither had EPI nor ANC (OR = 1.15 (95% CI : 1.01-1.30). There was no association between receiving or not an EPI and/or ANC and presenting PNDS. CONCLUSIONS: Antenatal preventive measures may be helpful to prevent PPD at 2 months' post- partum, while PNDS do not seem to be influenced by these actions.
Asunto(s)
Depresión Posparto , Depresión , Adulto , Niño , Estudios de Cohortes , Depresión Posparto/diagnóstico , Depresión Posparto/epidemiología , Depresión Posparto/prevención & control , Femenino , Humanos , Madres , Embarazo , Factores de RiesgoRESUMEN
OBJECTIVES: Early prenatal interview (Entretien prénatal précoce [EPP]) is aimed at defining with couples their physical, psychological and social needs during perinatal period. Antenatal education for childbirth and parenthood (Préparation à la naissance et à la parentalité [PNP]) is aimed at promoting global perinatal health. The objective was to identify the psychological, demographic and obstetrical characteristics independently associated with participation in: (i) an EPP; (ii) a PNP. MATERIALS AND METHODS: Multivariate analyses were applied to data collected during the maternity stay of mothers whose children were included in the French cohort French Longitudinal Study since the Childhood (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. RESULTS: Among the 14,595 mothers of the sample, 33% had an EPP and 52% a PNP. Primiparous mothers, born in France, with high educational level, employed or unemployed, with psychological difficulties more often benefit from EPP and/or PNP. Women who were young, benefiting from free health insurance (Couverture Maladie Universelle [CMU]), with unplanned pregnancy, with less antenatal care and obstetrical complications less often benefit from PNP. CONCLUSION: The EPP and the PNP reach high sociodemographic level populations. They should be integrated into a wider system of prevention and care, in order to reach the most vulnerable populations and to contribute to the improvement of the psychological and social environment of all the women during the perinatal period.
Asunto(s)
Entrevista Psicológica , Evaluación de Procesos y Resultados en Atención de Salud , Educación Prenatal/métodos , Adulto , Femenino , Francia , Humanos , Estudios Longitudinales , Embarazo , Adulto JovenRESUMEN
BACKGROUND: Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care. METHODS: We used data from the French cohort Étude Longitudinale Française depuis l'Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses. RESULTS: Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad. LIMITATIONS: Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics. CONCLUSIONS: Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.
Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud Mental , Visita a Consultorio Médico/estadística & datos numéricos , Complicaciones del Embarazo/psicología , Mujeres Embarazadas/psicología , Estrés Psicológico/terapia , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/psicología , Escolaridad , Femenino , Francia , Personal de Salud , Humanos , Estudios Longitudinales , Trastornos Mentales/complicaciones , Trastornos Mentales/tratamiento farmacológico , Madres/psicología , Pobreza/psicología , Embarazo , Embarazo no Planeado/psicología , Embarazo no Deseado/psicología , Psicotrópicos/administración & dosificación , Factores de Riesgo , Autoinforme , Fumar/efectos adversos , Fumar/psicología , Estrés Psicológico/etiología , Adulto JovenRESUMEN
PURPOSE: This study assessed the underexplored factors associated with significant improvement in mothers' mental health during postpartum inpatient psychiatric care. METHODS: This study analyzed clinical improvement in a prospective cohort of 869 women jointly admitted with their infant to 13 psychiatric Mother-Baby Units (MBUs) in France between 2001 and 2007. Predictive variables tested were: maternal mental illness (ICD-10), sociodemographic characteristics, mental illness and childhood abuse history, acute or chronic disorder, pregnancy and birth data, characteristics and mental health of the mother's partner, and MBU characteristics. RESULTS: Two thirds of the women improved significantly by discharge. Admission for 25% was for a first acute episode very early after childbirth. Independent factors associated with marked improvement at discharge were bipolar or depressive disorder, a first acute episode or relapse of such an episode. Schizophrenia, a personality disorder, and poor social integration (as measured by occupational status) were all related to poor clinical outcomes. DISCUSSION: Most women improved significantly while under care in MBUs. Our results emphasize the importance of the type of disease but also its chronicity and the social integration when providing postpartum psychiatric care.
Asunto(s)
Trastornos Mentales/terapia , Salud Mental , Madres/psicología , Atención Dirigida al Paciente/métodos , Atención Posnatal/métodos , Periodo Posparto/psicología , Adolescente , Adulto , Femenino , Humanos , Lactante , Recién Nacido , Pacientes Internos/psicología , Clasificación Internacional de Enfermedades , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Embarazo , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
UNLABELLED: This research is intended to validate the Edinburgh Postnatal Depression Scale (EPDS) in a high-risk pregnant population. METHOD: Sixty women attending antenatal consultations for pregnancy complication in a major Parisian maternity facility were included. They completed the EPDS and were then interviewed according to a standardised psychiatric interview. RESULTS: The study of its sensitivity, specificity and predictive values, with a DSM-IV diagnosis of major depression as the reference, found that 11.5 was the optimal cut-off score (Se 0.80; Sp 0.80). Its validity as an index of severity of depression was also good as well as internal consistency and reliability. Factor analysis showed that its internal structure is composed of two subscales (F2 "depression" and F1 with items reflecting depression and other disorders, including anxiety). CONCLUSION: The French version of the EPDS would be a valid instrument to identify pregnant women who are likely to have clinical major depression. The results may have to be confirmed on a community sample before clinical use.
Asunto(s)
Depresión Posparto/diagnóstico , Tamizaje Masivo/métodos , Atención Posnatal/métodos , Embarazo de Alto Riesgo , Encuestas y Cuestionarios/normas , Adulto , Depresión Posparto/epidemiología , Femenino , Francia/epidemiología , Humanos , Recién Nacido , Persona de Mediana Edad , Madres/psicología , Embarazo , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Sensibilidad y EspecificidadRESUMEN
The material was presented during a symposium on "Mother-Baby joint admission for mental health care in different countries" at the Marcé Society International Biennial Scientific Meeting in Sydney (Australia) in 2002 (25-27 September 2002). The introduction stresses the main contribution of each of the six papers. It discusses the general context of perinatal psychiatry and offers guidelines for perinatal health care.
Asunto(s)
Relaciones Madre-Hijo , Madres/psicología , Atención Posnatal/normas , Servicio de Psiquiatría en Hospital/normas , Calidad de la Atención de Salud , Alojamiento Conjunto/normas , Australia , Europa (Continente) , Femenino , Humanos , Lactante , Recién Nacido , Atención Posnatal/métodosRESUMEN
Until fairly recently, mentally ill mothers were separated from their new-borns because of the potential danger to the baby. Over the past 50 years, however, we have learned more about the perinatal period, with the development of child psychiatry and interest in maternal postpartum disorders. This knowledge has led psychiatric departments to develop new ways to provide care without separating mentally ill mothers from their babies. Joint full-time admissions began in Great Britain in 1948. The first Mother-Baby Unit (MBU) in France opened in 1979 and in Belgium in 1990. In 2003, there are 17 MBUs in France and 3 in Belgium. From 1995 to 1998, Odile Cazas and Nine Glangeaud, working with a group of child and adult psychiatrists and psychologists, adapted the English Marcé Checklist to the French and Belgian health and child protective systems and added items useful for research.
Asunto(s)
Trastornos Mentales/terapia , Relaciones Madre-Hijo , Madres/psicología , Atención Posnatal/historia , Servicio de Psiquiatría en Hospital/historia , Alojamiento Conjunto/historia , Adulto , Bélgica , Depresión Posparto , Femenino , Francia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Lactante , Recién Nacido , Trastornos Mentales/diagnóstico , Atención Posnatal/organización & administración , Servicio de Psiquiatría en Hospital/organización & administración , Escalas de Valoración Psiquiátrica , Alojamiento Conjunto/organización & administraciónRESUMEN
The French version of the Marcé checklist was used to collect data for 176 joint admissions to 11 psychiatric mother-baby units in 1999 and 2000. Mean age of the babies at admission ranged from 4 to 16 weeks. Two units also admitted older children. Mothers admitted were diagnosed with schizophrenia or chronic delusional disorders (n = 44), acute transitory psychosis "Bouffée délirante" (n = 20), bipolar disorders (n = 20), depressive illness (n = 38), personality disorders or intellectual disability (n = 39), and other disorders (n = 15). The mean duration of hospitalisation was 11 weeks. Units that also offered day-care admission in the same or a near-by unit had shorter mean admissions. More than half the women's partners (or babies' fathers) had mental health problems. Women with schizophrenia or chronic delusional disorders and personality disorders or intellectual disability remained hospitalised longer, improved less, and were more often separated from their babies, or discharged with supervision, than women admitted with other diagnoses.
Asunto(s)
Trastornos Mentales/epidemiología , Relaciones Madre-Hijo , Madres/psicología , Atención Posnatal/organización & administración , Servicio de Psiquiatría en Hospital/organización & administración , Alojamiento Conjunto/estadística & datos numéricos , Adulto , Bélgica/epidemiología , Recolección de Datos , Femenino , Francia/epidemiología , Humanos , Lactante , Recién Nacido , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Madres/estadística & datos numéricos , Atención Posnatal/métodos , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Escalas de Valoración Psiquiátrica , Resultado del TratamientoRESUMEN
BACKGROUND: Postnatal depression seems to be a universal condition with similar rates in different countries. However, anthropologists question the cross-cultural equivalence of depression, particularly at a life stage so influenced by cultural factors. AIMS: To develop a qualitative method to explore whether postnatal depression is universally recognised, attributed and described and to enquire into people's perceptions of remedies and services for morbid states of unhappiness within the context of local services. METHOD: The study took place in 15 centres in 11 countries and drew on three groups of informants: focus groups with new mothers, interviews with fathers and grandmothers, and interviews with health professionals. Textual analysis of these three groups was conducted separately in each centre and emergent themes compared across centres. RESULTS: All centres described morbid unhappiness after childbirth comparable to postnatal depression but not all saw this as an illness remediable by health interventions. CONCLUSIONS: Although the findings of this study support the universality of a morbid state of unhappiness following childbirth, they also support concerns about the cross-cultural equivalence of postnatal depression as an illness requiring the intervention of health professionals; this has implications for future research.
Asunto(s)
Comparación Transcultural , Depresión Posparto/etnología , Adulto , Actitud del Personal de Salud , Actitud Frente a la Salud , Depresión Posparto/psicología , Depresión Posparto/terapia , Métodos Epidemiológicos , Familia/psicología , Femenino , Felicidad , Humanos , Relaciones Madre-HijoRESUMEN
BACKGROUND: Little is known about the availability and uptake of health and welfare services by women with postnatal depression in different countries. AIMS: Within the context of a cross-cultural research study, to develop and test methods for undertaking quantitative health services research in postnatal depression. METHOD: Interviews with service planners and the collation of key health indicators were used to obtain a profile of service availability and provision. A service use questionnaire was developed and administered to a pilot sample in a number of European study centres. RESULTS: Marked differences in service access and use were observed between the centres, including postnatal nursing care and contacts with primary care services. Rates of use of specialist services were generally low. Common barriers to access to care included perceived service quality and responsiveness. On the basis of the pilot work, a postnatal depression version of the Service Receipt Inventory was revised and finalised. CONCLUSIONS: This preliminary study demonstrated the methodological feasibility of describing and quantifying service use, highlighted the varied and often limited use of care in this population, and indicated the need for an improved understanding of the resource needs and implications of postnatal depression.
Asunto(s)
Depresión Posparto/terapia , Investigación sobre Servicios de Salud/métodos , Servicios de Salud Mental/provisión & distribución , Adulto , Comparación Transcultural , Depresión Posparto/etnología , Europa (Continente) , Femenino , Humanos , Servicios de Salud Mental/estadística & datos numéricos , Permiso Parental/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Atención Posnatal/organización & administración , Atención Posnatal/estadística & datos numéricos , Factores SocioeconómicosRESUMEN
Joint psychiatric admission to a Mother-Baby Unit (MBU) enables a mother to obtain care for psychiatric disorders and simultaneously receive support in developing her identity as a mother. This care is meant to prevent attachment disorders and mother-baby separation. Outcome at discharge, however, may differ according to the mother's admission diagnosis. Demographic data, clinical features of parent and child, and clinical outcome of 92 consecutive admissions of mothers and their children to a MBU in Marseille were collected over a period of eight years (1991-1998). Separations occurred in 23% of the joint admissions. Women with acute postpartum psychoses and major depressive disorders had better outcomes than those with chronic psychoses: at discharge, the latter were more often separated from their children. In those cases, however, MBU admission provided time to arrange the best placement for the child. Outcome was less predictable for non-psychotic personality disorders and depended not only on the mother's disease but also on her family and social context.