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Background: Maternal mental health problems are a serious public health concern. Previous data reported that pregnancy might have a protective effect against suicide. In contrast, more recent studies suggested that the prevalence of suicidal ideation (SI) is higher among pregnant women compared to the general population. Using a nationally representative population-based sample of Brazilian reproductive-aged women, this study aims to assess whether SI is more prevalent among pregnant women in comparison with nonpregnant woman. Methods: We used data from the Brazilian National Health Survey (PNS) of 2019, a cross-sectional study that comprised a representative sample of residents in private households in Brazil. For the analysis of this study, we selected women aged between 15 and 49 years old who have answered the questionnaire of the Selected Resident of the PNS, which comprised a sample of 27,249 women. Logistic regression models were performed to obtain crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI) for the association between pregnancy status and SI. Results: The prevalence of SI during pregnancy was 6.8% (95% CI: 6.2-7.4). The association between pregnancy status and SI was modified according to the recent clinical diagnosis of depression (interaction term: OR = 41.72, 95% CI: 5.64-308.45, p < 0.001). Our findings indicated that among nondepressed women, pregnancy status seems to decrease the probability of SI. Additionally, SI is associated with a vulnerable profile that includes being an adolescent, having an unpartnered/not married status, lower family income, lower education, and a recent clinical diagnosis of depression. Conclusion: SI is a common problem for reproductive-age women. In the presence of a recent depression clinical diagnosis, pregnancy increases the risk of SI. Management of SI among pregnant women should correctly identify sociodemographic risk factors and the presence of a recent clinical diagnosis of depression.
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Background: Suicide is a leading cause of death during the perinatal period in high-income countries (HIC). There remains a lack of population-based studies about suicidal ideation (SI) during pregnancy among low and middle income countries (LMIC). Objectives: Using the case of Brazil, we aim to estimate the prevalence of SI during pregnancy and its association with antenatal depression (AD) and sociodemographic factors in a LMIC. Method: We used data from the Brazilian National Survey (PNS-2019), a population-based study, with a complex and probabilistic sampling method. Of the 27,136 women of reproductive age (15 to 49 years old) who participated in the PNS, a total of 769 women reported being pregnant at the time of the interview. All PNS participants answered the Patient Health Questionnaire-9 (PHQ-9) and a questionnaire with sociodemographic data. SI was defined as any answer to the PHQ-9 item 9 other than 0 (not at all). Logistic regression models were performed to obtain crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the association between explanatory variables and SI during pregnancy. Results: Among 769 women, 33 (3.9%, 95% CI: 3.0-5.1%) reported SI during pregnancy. In the adjusted analysis, higher odds of SI were associated with being 20 to 34 years old (aOR:0.24, 95% CI: 0.08-0.74) or 35 to 49 years old (aOR:0.15; 95% CI: 0.04-0.50), having 9 to 11 years of education (aOR 0.23, 95% CI: 0.61-0.86), acheiving the highest family income category (aOR:0.08, 95% CI: 0.01-0.58), not living in the South/Southeast regions of Brazil (aOR:5.52, 95% CI: 2.36-12.9), and having probable mild AD (aOR:10.5 95% CI: 2.3-47.9) or moderate AD (aOR:241.3, 95% CI: 58.4-996.7). Conclusions: In Brazil, SI affects almost 4% of pregnant women and is associated with sociodemographic vulnerability. Clinically, women with mild symptoms of depression may also experience SI during pregnancy. These findings are important for designing effective perinatal mental health interventions in LMICs.
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Objective: Given the lifelong implications of extended postpartum depression (PPD), research is needed to examine the social factors implicated in its development (such as relationship quality) and associated predictors. This study sought to examine the association of partner relationship quality (PRQ) and decline of sexual life (DSL) with maternal PPD at 12-15 months after childbirth. Methods: Prospective study of 294 low-income postpartum women. A structured questionnaire and the Patient Health Questionnaire-9 (PHQ-9) captured responses for the main outcome variable and covariates. Results: The prevalence of the main outcome (PPD at 12-15 months) was 19.1%. Using logistic regression models, low PRQ (risk ratio [RR] = 1.58, 95%CI 1.01-2.49) and DSL (RR = 1.97, 95%CI 1.23-3.15) were associated with PPD at 12-15 months even after controlling for perinatal depression. Conclusions: Late PPD (12 to 15 months after giving birth) is very common among low-income women, and is independently associated with different aspects of the couple's relationship. Improving PRQ may prevent late PPD. Future investigations are warranted.
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Humanos , Feminino , Gravidez , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Depressão , Período Pós-PartoRESUMO
OBJECTIVE: Given the lifelong implications of extended postpartum depression (PPD), research is needed to examine the social factors implicated in its development (such as relationship quality) and associated predictors. This study sought to examine the association of partner relationship quality (PRQ) and decline of sexual life (DSL) with maternal PPD at 12-15 months after childbirth. METHODS: Prospective study of 294 low-income postpartum women. A structured questionnaire and the Patient Health Questionnaire-9 (PHQ-9) captured responses for the main outcome variable and covariates. RESULTS: The prevalence of the main outcome (PPD at 12-15 months) was 19.1%. Using logistic regression models, low PRQ (risk ratio [RR] = 1.58, 95%CI 1.01-2.49) and DSL (RR = 1.97, 95%CI 1.23-3.15) were associated with PPD at 12-15 months even after controlling for perinatal depression. CONCLUSIONS: Late PPD (12 to 15 months after giving birth) is very common among low-income women, and is independently associated with different aspects of the couple's relationship. Improving PRQ may prevent late PPD. Future investigations are warranted.
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Depressão Pós-Parto , Depressão , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , Período Pós-Parto , Gravidez , Prevalência , Estudos Prospectivos , Fatores de RiscoRESUMO
The objective of the present study is to evaluate the association of postpartum depression and low maternal confidence in a sample of women who had depression during pregnancy. Cross-sectional study performed from 2013 to 2015 with 346 postpartum women who had participated in an intervention to treat their depression during pregnancy. This study used the Maternal Confidence Questionnaire and the Patient Health Questionnaire 9-item scale. The prevalence ratio, adjusted and non-adjusted, and the 95% CI were calculated using Poisson regression with robust variance. Multivariate models estimated the Prevalence Ratios between postpartum depression and low maternal confidence adjusted for socio-demographic variables and maternal characteristics. Statistical analysis was performed with the STATA12. Among a sample of women who were depressed during pregnancy, only 19% had probably moderate to severe depression and nearly half, 48%, reported high maternal confidence in the postpartum period. In the fully adjusted model, women with moderate/severe probable depression showed increased risk of lower maternal confidence in comparison to women without probable depression Prevalence Ratio = 1.37 (95% CI 1.10-1.71). The results reinforce the importance of the evaluation of maternal confidence feelings in primary care particularly for women with more severe forms of depression.
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Transtorno Depressivo/epidemiologia , Mães/psicologia , Mães/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Autoeficácia , Adulto , Estudos Transversais , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , Gravidez , Índice de Gravidade de Doença , Adulto JovemRESUMO
Background: We evaluated the association between mother-child bonding and maternal depression at 6-8 months after birth with bonding impairment at 12-15 months in a sample of mothers at high risk of postnatal depression.Methods: A prospective cohort study with 346 low-income postpartum women with antenatal depression. The Postpartum Bonding Questionnaire (PBQ) and the Patient Health Questionnaire-9 (PHQ-9) were used, at 6-8 and 12-15 months after delivery, to assess the mother-infant bonding and postnatal depression (PPD), respectively.Results: The percentage of the main outcome, bonding impairment (BI) at 12-15 months, was 9.9% (95% CI 6.6-13.7). Using logistic regression models, BI was associated with: having an occupation (OR = 2.82; 95% CI 1.00-7.94, p = .049), unplanned pregnancy (OR = 3.46; 95% CI 1.01-11.8, p = .047), and presence of BI at 6-8 months (OR= 13.0; 95% CI 3.76-45.4, p ≤ .001). Maternal depression was marginally associated with BI at 12-15 months.Conclusions: BI affects 1 in 10 mothers, and although BI and PPD are strongly associated at 6-8 and 12-15 months after delivery, BI at 6-8 months is the main predictor of later BI. Based on the study findings, PPD screening in combination with BI assessment is highly recommended during the first year of child's life.
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Depressão Pós-Parto/psicologia , Relações Mãe-Filho/psicologia , Apego ao Objeto , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Lactente , Questionário de Saúde do Paciente , Pobreza , Estudos Prospectivos , Adulto JovemRESUMO
BACKGROUND: Although intimate partner violence (IPV) during perinatal period is more common than during other maternal health conditions, it receives less attention within research on maternal mortality rates. Given the risks for maternal mortality because of suicidality, the purpose of this investigation is to examine the risk of suicidal ideation (SI) among postpartum women exposed to IPV. MATERIALS AND METHODS: In this cross-sectional study, participants were recruited between May 2005 and March 2007 from primary care clinics in São Paulo, Brazil. A total of 701 postpartum women were included in the analysis. Postpartum SI was assessed using the clinical interview schedule-revised. IPV was assessed using a structured questionnaire previously validated in Brazilian populations. Crude and adjusted risk ratios with 95% confidence intervals (95% CI) were estimated using Poisson regression with robust variance to examine the association between IPV and the risk for postpartum SI. RESULTS: The prevalence of postpartum SI was 4%. Among those with postpartum SI, 70% reported IPV during the postpartum period. Compared with non-IPV counterparts, postpartum women who reported IPV had an increased risk for SI (relative risk [RR] 7.25, 95% CI: 3.23-16.27). In the fully adjusted model, the risk for SI remained significantly higher for women who experienced IPV than for those who did not (RR 3.02, 95% CI: 1.29-7.07). CONCLUSIONS: Postpartum women exposed to violence had a threefold greater risk of having suicidal thoughts.
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Depressão Pós-Parto/epidemiologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Período Pós-Parto , Ideação Suicida , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Depressão Pós-Parto/psicologia , Feminino , Humanos , Violência por Parceiro Íntimo/psicologia , Pobreza , Gravidez , Prevalência , Fatores de Risco , Parceiros Sexuais , Fatores Socioeconômicos , Maus-Tratos Conjugais/psicologia , Maus-Tratos Conjugais/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Adolescent pregnancy has social, economic, and educational consequences and is also linked to adverse perinatal outcomes. However, studies show a positive relationship between pregnancy and increased social status among low-income adolescents. This study aims to assess the association between planned pregnancy and years of schooling among low-income Brazilian adolescents. This is a secondary analysis of a cohort study conducted from May 2005 to March 2007 in public primary care clinics in São Paulo, Brazil. Participants (n=168) completed a detailed structured questionnaire. Logistic regression was used to examine the association between years of schooling and planned pregnancy. After adjusting for the covariates income, wealth score, crowding, age, marital status, and race, planned pregnancy was independently associated with lower years of education (odds ratio: 1.82; 95% confidence interval: 1.02-3.23). Although this finding may be related to these adolescents having less access to information and health services, another possible explanation is that they have a greater desire to have children during adolescence.
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BACKGROUND: Depression, diabetes and hypertension are major contributors to the global burden of disease; however, the majority of research on depression and co-morbid conditions originates in high-income countries. OBJECTIVE: This study examines the depression identification rate and compares treatment rates of depression with those of diabetes and hypertension among elderly individuals served in primary care through the Family Health Program (FHP) in São Paulo, Brazil. METHOD: A total of 1558 São Paulo Ageing and Health Study participants (low-income adults ≥65 years old living in São Paulo) registered in the FHP were included for analysis. Chart review was performed for participants with an International Classification of Diseases, 10th edition (ICD-10) depression diagnosis (from survey interview) to verify if depression was recorded for these individuals. Depression, diabetes and hypertension treatment were assessed based on clinical assessments and medication checks. RESULTS: Seventy-three participants (4.8%) had ICD-10 depression, 344 (23.2%) had confirmed diabetes and 1207 (79.3%) had confirmed hypertension. The proportion of those identified with depression by medical chart review (n = 63 for individuals whose chart could be found) was 4.8% (n = 3). Nine individuals (12.3%) with ICD-10 depression were treated. Rates of diabetes and hypertension treatment were 72.4% and 77.4%, respectively. CONCLUSION: Levels of treatment of depression in older adults receiving care in the FHP is very low compared to treatment rates of diabetes and hypertension. Collaborative care effectiveness trials for the treatment of depression in the FHP are needed to improve the quality of depression care for this population.
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Envelhecimento/psicologia , Depressão/epidemiologia , Depressão/terapia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Classificação Internacional de Doenças , Masculino , Pobreza , Atenção Primária à SaúdeRESUMO
OBJECTIVES: Tobacco use during pregnancy is a global health concern. To date the majority of research originates in developed countries, thus we have a need to better understand factors related to maternal health in developing countries. We examine the prevalence and correlates of smoking by ethnicity in a sample of pregnant primary care patients in São Paulo, Brazil. DESIGN: Data were obtained from completed surveys during perinatal care visits in primary care clinics. We examine a sample of 811 pregnant women surveyed during 20-30 weeks of pregnancy. Multiple logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: We found significant ethnic differences in smoking during pregnancy. Compared to White women, Black women were more likely to use tobacco during pregnancy (OR: 1.95; 95% CI: 1.16-3.27). In the fully adjusted model, when accounting for common mental disorders, differences in smoking during pregnancy by ethnicity remained (OR: 1.96; 95% CI: 1.14-3.36). CONCLUSIONS: There are ethnic differences in tobacco use during pregnancy. Clinical implications including universal screening for tobacco use during pregnancy and culturally relevant approaches to smoking cessation are suggested.
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População Negra/estatística & dados numéricos , Atenção Primária à Saúde , Fumar/etnologia , População Branca/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/etnologia , Transtornos Mentais/terapia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etnologia , Cuidado Pré-Natal , Prevalência , Setor Público , Fumar/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Tuberculosis (TB) is global health concern and a leading infectious cause of mortality. Reversing TB incidence and disease-related mortality is a major global health priority. Infectious disease mortality is directly linked to failure to adhere to treatments. Using technology to send reminders by short message services have been shown to improve treatment adherence. However, few studies have examined tuberculosis patient perceptions and attitudes towards using SMS technology to increase treatment adherence. In this study, we sought to investigate perceptions related to feasibility and acceptability of using text messaging to improve treatment adherence among adults who were receiving treatment for TB in Callao, Peru. METHODS: We conducted focus group qualitative interviews with current TB positive and non-contagious participants to understand the attitudes, perceptions, and feasibility of using short message service (SMS) reminders to improve TB treatment adherence. Subjects receiving care through the National TB Program were recruited through public health centers in Ventanilla, Callao, Peru. In four focus groups, we interviewed 16 patients. All interviews were recorded and transcribed verbatim. Thematic network analysis and codebook techniques were used to analyze data. RESULTS: Three major themes emerged from the data: limits on health literacy and information posed challenges to successful TB treatment adherence, treatment motivation at times facilitated adherence to TB treatment, and acceptability of SMS including positive perceptions of SMS to improve TB treatment adherence. The majority of patients shared considerations about how to effectively and confidentially administer an SMS intervention with TB positive participants. CONCLUSION: The overall perceptions of the use of SMS were positive and indicated that SMS technology may be an efficient way to transmit motivational texts on treatment, health education information, and simple reminders to increase treatment adherence for low-income TB patients living in Peru.
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Adesão à Medicação/psicologia , Sistemas de Alerta/instrumentação , Envio de Mensagens de Texto/estatística & dados numéricos , Tuberculose Pulmonar/psicologia , Adulto , Antituberculosos/uso terapêutico , Feminino , Grupos Focais , Humanos , Estudos Longitudinais , Masculino , Motivação , Satisfação do Paciente/estatística & dados numéricos , Peru , Projetos de Pesquisa , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
BACKGROUND: Although depressive disorders are associated with increased health care utilization in the elderly living in high-income countries, few studies have examined this relationship in Latin America. METHOD: The present study is part of the São Paulo Ageing and Health Study, a population-based epidemiological study of mental disorders in 2072 low-income adults ≥ 65 years old living in São Paulo, Brazil. Depressive disorders defined as major depressive disorder (MDD) and clinically relevant depressive symptoms (CRDS) were assessed with the Geriatric Mental State and the Neuropsychiatric Inventory. We examined the association between depressive disorders/symptoms and health care utilization (outpatient visits, hospital admissions and medication use in the past 3 months) using count models. RESULTS: The prevalence of MDD and CRDS was 4.9% and 21.4%, respectively. In the fully adjusted model, older adults with MDD were 36% more likely to have one more outpatient visit (RM: 1.36, 95% CI: 1.11-1.67), while older adults with CRDS were 14% more likely to have one more outpatient visit (RM: 1.14, 95% CI: 1.02-1.28). Elderly individuals with MDD had a prevalence of hospital admissions in the previous 3 months that was twice that of those without depression (PR=2.02, 95% CI: 1.09-3.75). Significant differences were not found for medication use. CONCLUSION: Among low-income older adults living in Brazil, those with MDD are more likely to have a recent hospital admission and outpatient service use than those without depression. Future studies are needed to examine the effectiveness of depression treatments for this population in order to both decrease the burden of illness as well as to minimize health care utilization related to depression.
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Assistência Ambulatorial/estatística & dados numéricos , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Hospitalização/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Transtorno Depressivo/epidemiologia , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , MasculinoRESUMO
The aim of this study was to estimate the prevalence and correlates of suicidal ideation among low-income pregnant women living in Brazil. We performed a cross-sectional analysis of 831 women surveyed during 20 to 30 weeks of pregnancy using the Self-Report Questionnaire-20. The prevalence of suicidal ideation was 6.3%. The factors associated with suicidal ideation were common mental disorders, single partner status, past psychiatric history, and smoking tobacco. All cases of suicidal ideation were associated with common mental disorders.