Sintomas depressivos e fatores associados em mulheres no período periparto

Abstract

During the gravid-puerperal cycle, the challenges of conceiving and providing development to a being are actions that can result in conflicts and suffering. Peripartum depression is a subtype of major depressive disorder prevalent in this phase. The objective was to identify the prevalence of depressive symptoms and associated factors in pregnant women assisted by Primary Health Care, as well as the incidence and related risk factors in the postpartum period. The first study is an epidemiological, cross-sectional, analytical study conducted in a city in the northern region of Minas Gerais, Brazil. The population consisted of pregnant women registered in the Family Health Strategy (FHS) teams in the urban area in 2018, and data collection took place between October 2018 and November 2019 through a questionnaire. The dependent variable was depressive symptoms in pregnant women, and the independent variables included sociodemographic characteristics (age, marital status, education, family income), social support, obstetric characteristics (gestational trimester, parity), sexuality, and health conditions (self-reported pathologies, perceived stress). Sociodemographic variables were assessed using questions elaborated by the researchers, while instruments such as the Center for Epidemiological Studies Depression Scale (CES-D), Medical Outcome Studies (MOS), Female Sexual Quotient (QS-F), Body Attitudes Questionnaire (BAQ), and Perceived Stress Scale (PSS-14) were used for the other variables. Descriptive analysis was performed using frequency distributions to describe categorical variables, and prevalence estimates were calculated with a 95% confidence interval for the categories of the depressive symptom variable: no symptoms, moderate symptoms, and severe symptoms. Bivariate analyses were conducted using the chi-square test, and variables with a descriptive level below 0.20 were selected for multiple analysis. The multinomial logistic regression model was used, and odds ratios (ORs) were estimated with a 95% confidence interval and a significance level of 0.05. The study included 1279 pregnant women. The prevalence of moderate and severe depressive symptoms was 16.2% and 25.2%, respectively. The following variables were associated with the presence of moderate and severe depressive symptoms: low social support, low sexual performance, high perceived stress, and the first trimester of pregnancy was associated with the presence of severe symptoms. Pregnant women assisted by Primary Health Care present considerable prevalences of depressive symptoms. The second study aimed to analyze the incidence and associated factors of postpartum depressive symptoms through a narrative literature review. The bibliographic search was conducted in the Virtual Health Library (BVS), specifically the LILACS and MEDLINE databases. Eligible studies were observational and longitudinal, using the Edinburgh Postnatal Depression Scale, with full-text articles published in English, Portuguese, or Spanish between 2019 and 2020. Seventeen articles were included. Postpartum depressive symptoms are present in a significant proportion of postpartum women, with an incidence ranging from 0.18% to 27.87%. The associated risk factors were a previous history of depression, stress level, low social support, presence of anxiety or other psychiatric disorders, and negative birth experience. Postpartum depressive symptomatology remains a public health problem, and studies in the national context can identify other factors associated with this condition.