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To examine associations between household food insecurity and children’s physical activity and sedentary behaviors.
Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013-2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-day Physical Activity Behavior Recall instrument. Data were analyzed using multilevel statistical modeling.
130 communities in the US.
5,138 US children ages 4-15 years.
No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviors was observed (P=0.03).
Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilizing food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.
The home is the natural setting for the development of informal care. The work that nurses are required to develop in this context (the carer/the elderly dependent/the home) focuses on training and educational activities to assist these two groups, such as demonstrating care activities to help dependent seniors, instruction in self-care techniques and teaching strategies for the use of human and material resources.
This article analyzes care education interventions performed by nurses, and the factors that facilitate, or limit, health care training.
This is a qualitative, descriptive study designed to be flexible and openly analytical in its approach to the research problem and the dynamic nature of the home environment. Triangulation of the methodological techniques and study subjects was applied.
Nursing interventions related to professional attitudes, such as encouraging communication and facilitating teaching; communication interventions in health education and counseling; and technical interventions aimed at improving access to health information and support for the informal carer. Lack of will, the advanced age of the carer, emotional state and work overload are factors that undermine care instruction, which if reversed, would become learning facilitators. The lack of time and resources in the home are the major limiting factors on care teaching, according to nurses. Evidence from our study suggests that care in the home is considered a key primary health care strategy, one in which nurses play a significant role.
In strong electromagnetic regimes, gyrokinetic simulations have linked a substantial ion-scale turbulence stabilization to the presence of supra-thermal particles, capturing qualitatively well the experimental observations in different devices worldwide. An explanation for the underlying physical mechanism responsible for the fast-ion-induced turbulent transport reduction observed in the numerical simulations has been proposed only recently by Di Siena et al. (Nucl. Fusion, vol. 59, 2019, p. 124001; Nucl. Fusion, vol. 60, 2020, p. 089501). It involves a nonlinear cross-scale coupling (nonlinear interaction involving different modes at different wavenumbers) between ion-temperature-gradient and marginally stable Alfvén eigenmodes, which in turn increases zonal flow activity. In view of an optimization of this turbulence-stabilizing effect, the key parameters controlling the nonlinear cross-scale coupling are here identified. At the same time, these findings provide useful insights for reduced-turbulence models and integrative approaches, which might be trained on the results presented in this paper to grasp the underlying physics and the parameter scaling of the beneficial effects of fast particles on plasma turbulence.
Structure M13-1 is a public monumental building in the heart of ancient El Perú-Waka’, Petén, Guatemala, and is the location of Burial 61, an entombed Late Classic (seventh-century) ruler. In this report, we discuss mortuary evidence that we believe permits identification of the interred as the historically known queen, Lady K'abel.
There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
Describe the prevalence and characteristics of psychotic symptoms in the context of cocaine injection use in a harm reduction program.
To find associations between intravenous cocaine use and other drug use in cocaine dependent patients suffering from cocaine induced psychosis (CIP). Cannabis was found to be a risk factor for developing CIP in non-intravenous cocaine dependence.
During a period of 6 months professionals from our Outpatient Drug Clinic completed a confidential questionnaire to describe the adverse clinical effects following cocaine injection. It included age, gender, ethnic group, daily consumption rate and other drugs used in the last 30 days.
Survey was achieved with a sample of 75 Caucasians patients, 69 men and 6 women with an average age of 32 years old. Seventeen percent (13/75) had psychotic symptoms, of which 84% (11/13) had hallucinations (visuals 4/11, auditive 7/11 and kinaesthetic 2/11), 15% (2/13) illusions.
Eighteen percent (14/75) had stereotypy movements and 3% (2/75) had aggressive behaviour. Drugs used by CIP patients, the previous 30 days were: 61% (8/13) cannabis, 31% (4/13) opiates and 15% (2/13) alcohol.
Intravenous cocaine use produced acute psychotic symptoms in 17% of our patients, of which 61% used cannabis. Despite the ethical and practical implications of this type of study, it is necessary to do more observational studies with bigger surveys to conclude these results with statistically significance.
Different studies have confirmed the association between cannabis use and psychosis and, also, the relationship between age at first cannabis use and age at onset of psychosis (Henquet et al 2005, Barnes et al 2006). In a young psychiatric sample, we aimed to investigate the correlation between cannabis use and the age at onset of psychotic and non-psychotic symptoms and whether this relationship is modulated by the genetic variability at COMT, CNR1 and CHRNA7genes.
The sample comprised 157 Caucasian patients (mean age: 17.01 (3.6)) diagnosed following DSM-IV-TR criteria: 80 patients with schizophrenia-spectrum disorders, 77 patients with affective or conduct disorders. Cannabis use was assessed with UNICA-A and DIGS scales (Nurnberger 1994) and 49% individuals were classified as consumers. SNPs were genotyped using Taqman 5′-exonuclease assays.
We observed a positive relationship between age at first cannabis use and age at onset in, both, schizophrenia-spectrum (β = 1.44 p < 0.001) and other psychiatric disorders (β = 0.56 p < 0.002). An interaction was observed between COMT Val158Met polymorphism and cannabis use specifically within schizophrenia-spectrum disorders’ group (β = −2.72 p = 0.04), with Val/Val genotype carriers showing an earlier age of onset than Val/Met carriers, and these, lower than the Met/Met carriers. No modulation effect of CNR1 or CHRNA7 polymorphisms was observed.
Our results seem to indicate the importance of maturation timing and brain development in which exposition to cannabis occurs. We provide new evidence about the COMT modulation effect on the association between cannabis use and age at onset of symptoms, specifically in individuals affected by schizophrenia-spectrum disorders.
The aim of this study was to identify risk factors in early postpartum that predict postpartum depression (PPD) at 6-8 weeks.
A prospective cohort of 309 women was studied between the 2nd-3rd days postpartum and at 6-8 weeks postpartum. Initially we administered a general information questionnaire that included obstetrical variables and history of personal and family affective disorders. Between the 2nd and 3rd days postpartum they filled out the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS), Spielberg Anxiety Trait and State Inventory (STAI-R/S), Neuroticism Dimension (EPQ), St Paul Ramsey Questionnaire (life events) and Duke Social Support Scale. At 6-8 weeks postpartum they filled out again the EPDS. Women who scored ≥10 were screened as having PPD.
The incidence of PPD at 6-8 weeks was 14.6%. After Bonferroni correction, univariated analysis showed that previous personal history of depression (p<0.001), high neuroticism (p<0.001), low social support (p<0.002) and high EPDS (p<0.001) in the immediate postpartum were associated with PPD. Logistical regression analysis identified previous personal history of depression and high initial level of depression (OR=14.6; 95%CI=4.8-12.2; p<0.001) as risk factors for PPD. The absence of signification of the Hosmer-Lemersshow test (x2 =9.654; df=8; p=0.290) indicated the goodness-of-fit of the prediction model.
A previous history of depression and EPDS≥10 in the immediate postpartum allow to identify women with high risk of PPD before leaving the Obstetric Ward.
This study has been supported in part by grants: Instituto Carlos III: GO3/184; FIS: PI041783 and FIS 05/2565.
To examine whether the postpartum depression (PPD) subgroup with positive antithyroid antibodies (Ab+) compared with the PPD subgroup without positive presence of Ab (Ab -) have a different psycho-social and psychopathological characteristics.
One hundred three (N=103) patients with PPD according with DSM-IV criteria were included. Autoimmune status of the thyroid (Thyroperoxidasa antibodies, Thyroglobulin antibodies), severity of depression and anxiety (EPDS and 21-item Hamilton and STAI-S scales), psychosocial variables (Early Trauma Inventory, Saint Paul Ramsey Questionnaire, Marital Adjustment Test) were assessed joint with other several demographics and reproductive variables.
The presence of childhood sexual abuse in PPD women increase the probability of Ab(+) (OR= 2,528 ; 95% CI =1,00-6,39). The levels of Thyroid peroxidase antibodies (TPOAb) titers have a strongly correlation (p<0,000) with the levels of the Early Trauma Inventory.
The results of our study give a link between early stress, the immune system, and postpartum depression.The implication of the immunitary system in the etiopathogenesis of the PPD through the long lasting sensitization of the inflammatory response system and the endocrine system in front to stress behind the CNS and their transmisors and receptors activation is discussed.
Few studies have evaluated personality traits as a risk factor of postpartum depression (PPD). The Vulnerable Personality Style Questionnaire (VPSQ; Boyce et al. 2001), is a 9-item self-report scale developed to evaluate personality vulnerability to PPD with satisfactory psychometric properties. It assesses 9 personality dimensions: Coping, Nervy, Timidity, Sensitivity, Worrier, Obsessive, Volatility Organized and Expressive.
To study the vulnerable personality style in a Spanish postpartum sample.
A case-control study: 145 PPD women visited at the Psychiatry Perinatal Unit were compared to 203 healthy women from a postpartum population based study. All women were assessed with the VPSQ (Spanish adaptation), the Edinburgh Postnatal Depression Scale and the Structured Clinical Interview (DSM-IV) axis I. Personality traits were evaluated after full clinical remission. The study was approved by the Institution board.
Univariated analysis showed that women with PPD obtained higher scores (p<.000) in seven VPSQ personality dimensions: Coping, Nervy, Timidity, Sensitivity, Worrier, Obsessive, and Volatility, as well as the VPSQ total score (p<.000). Personal history of depression (p<.000) was also associated with PPD. In the logistic regression analysis; an increase of one point on the VPSQ total score increased the OR in 1.151 fold (95%CI:1.095-1.210) the association with PPD. Other variables associated were age and personal history of depression. The Hosmer-Lemershow test (p=.706) indicated the goodness-of-fit of the model.
Women with PPD had higher scores in the Vulnerable Personality Style Questionnaire. They were more nervous, timid, sensitive, obsessive, worried, angry and cope poorly than healthy postpartum women.
To assess the adaptation of employed mothers one year after childbirth depending on 6-weeks psychiatric status and received treatment.
A prospective study was designed. A randomly stratified group (according to EPDS score) of 325 employed mothers was interviewed at 6-weeks postpartum to establish psychiatric diagnosis according to DSM-IV criteria (SCID-I). Some cases were treated (mostly diagnosed of major depressive and panic attack disorders). 258 mothers were reassessed with the same procedure one year later. Chi-square was calculated to determine if psychiatric diagnosis one year after childbirth is related with psychiatric diagnosis at 6-weeks postpartum. Odds ratio (OR) were calculated to determine the increased risk of having a disorder at one year according to 6-weeks psychiatric diagnosis.
At one year, 50% of women in our sample were psychiatric cases and were significantly associated with clinical diagnosis at 6-weeks (X2=52.91; gl 2, p<0.001). The risk of being a psychiatric case at one year was three times higher (OR: 3.35; CI95%: 1.62-6.93) for non treated cases and nine times (OR: 9.46; CI95%: 4.96-18.06) for treated cases.
Half of our sample received a clinically relevant psychiatric diagnosis at one year.
Our results support the hypothesis that maternity is a vulnerable period for psychiatric disorders. Additionally many cases receiving treatment do not remit or remit partially and tend to chronification. The special characteristics of this population suggest that specific treatment units with specialized professionals are needed.
This study has been supported in part by grant 13/00 from Institute of Women, Spain.
To examine the postpartum thyroid dysfunction (PPTD) and positive thyroid antibodies (Ab+) frequency in the Postpartum Depression (PPD) and to investigate if the PPD patients subgroup with PPTD and/or Ab+ have different characteristics.
Eighty one (N=81) patients with PPD, according with DSM-IV criteria, were included. Thyroid function (Free T3, Free T4,TSH), autoimmune status of the thyroid (Thyroperoxidasa antibodies, Thyroglobulin antibodies) and severity of depression (EPDS and 21-item Hamilton scales), were assessed joint with other several demographics, psycho-social and reproductive variables.
Twenty per cent of the patients with PPD had positive thyroid antibodies and 14% present PPTD. Prior history of early stressors in the PPD patients were significantly related with the presence of Ab+: the presence of childhood maltreatments and/or sexual abuse increased thirteen times the probability of Ab+ (OR: 13,01, 95% CI, 2.01-84.02). Greater number of total stressors were associated with Ab+ (p< 0,030), and Ab+ women showed a higher average of total stressors (2,1) than antibody negative women (1,52). Depressed women with PPTD had positive correlation with previous depressive episodes (p< 0,008).
The depressed postpartum women with dysregulation of pituitary-thyroid axis have more early childhood stressors and previous depressive episode. The implication of the inmunitary system and the HPT axis in the etiopathogenesis of the PPD through the activation of the response in front to stress is discussed.
Metabolic Syndrome (MS) is constituted by a set of specific metabolic alterations being postulated that the main dysfunction is insulin resistance. Estimates point to higher prevalence of MS in bipolar patients, between 30 to 35%. Cost-effective screening methods, not recurring to blood test, have been researched.
Analyse knowledge and importance given to MS in bipolar patients. Test the viability of MS screening without blood tests.
Observational, cross-sectional study. Random sample of 15 adult bipolar patients, in euthymic phase. Semi-structured interview, YMRS, HAMD were applied. MS diagnosis investigated according to the International Diabetes Federation (IDF) criteria. MS screening was defined positive if blood pressure ≥ 130/85 or anti-hypertensive medication and abdominal perimeter > 90 in males or > 80 in females. A questionnaire about knowledge, attitudes and concerns on MS was applied.
14 patients completed the investigation protocol. Five (36%) met IDF criteria for metabolic syndrome. Screening sensitivity was 80% and specificity 78%. Twelve patients (80%) were overweigh or obese. Mean IMC in patients that met IDF criteria for MS was 30 while in the other group mean IMC was 26. Only 3 (20%) have ever heard about MS, but the majority of the patients were concerned, in decreasing order, about weight gain, blood pressure cholesterol and hyperglycemia control.
Although limited by small sample size, this study strengthens the idea that MS screening can be effective in clinical practice, it also indicates the need to educate BP patients about MS and to prevent overweight.
The prevalence of mood disorders (anxiety and depression) during pregnancy seems to be similar to the women of the same group without pregnancy. Women with recurrent depression and euthimic women who discontinued antidepressants medication during pregnancy are particularly at high risk for depressive illness. Data about perinatal effects of SSRI antidepressants are gradually accumulating and are controversial. Two meta-analyses and some controlled studies don't find increased risk for major malformations in SSRI-exposed newborn. However, other studies find an increased risk of congenital malformations, poor birth outcomes and neonatal complications.
Neonatal morbidity in infant newborn of women treated with antidepressant drugs.
We examine the relation between the pharmacological treatment of the maternal anxiety/depression during the pregnancy and acute morbidity in infant newborns.
Materials and Methods
Study group of 66 infant newborn of pregnant women with a diagnoses of major depressive episode or defined anxiety disorders according to DSM-IV, who were in treatment with antidepressant drugs during pregnancy. Control group: 120 newborn of healthy pregnant women, who did not receive any treatment, and were contemporary of the same gestational age and sex. Criteria of exclusion: demonstrated toxic consumption (alcohol, cocaine, cannabis, opiates, drug of synthesis). Studied variables: Type of childbirth and analgesia; weight and age of gestation; pH of umbilical artery and Apgar test; presence of malformations; morbidity; feeding; withdrawal syndrome.
Infant newborn of mothers exposed to the antidepressant treatment suffered from more pathology than those of the control group (16/66 vs. 14/114; 24.2% vs.12.3%; p=0.038). Two smaller malformations in the study group were observed, a preauricular appendix (group A) and one moderate pielocilicilar ectasy (group C), both in mothers who received paroxetine (2/60; 3.3% vs. 0/114; 0%, p=0.05, Fisher p=0.118, NS). Only one infant newborn displayed compatible clinical signs with moderate withdrawal syndrome (irritability, vomits) from a mother treated with venlafaxine. No case of convulsions was observed. Breast feeding was less frequent in the group of antidepressant treated mothers (38/66, 57.6% vs. 86/116, 74,1%, p=0.032).
The treatment with antidepressant drugs during pregnancy is necessary for some women. The clinician must weigh the relative risks of various treatment options and take into account individual patient wishes. Although the antidepressant drugs suppose an increased risk for the newborn, it could be assumable for the benefit that represents maintain the mother in an euthimic situation.
We propose to discuss the clinical management, as well as, the accuracy of the psychiatric and obstetric controls to minimize the neonatal complications.
Suicide and suicidal behaviours are a growing concern among adolescents.
Describe discriminating characteristics of adolescents with suicidal behaviours followed by our psychiatric consultations.
A cross-sectional sample of 100 adolescents (aged 12 to 21), from the adolescent psychiatry and youth suicide consultations, at Hospital Santa Maria Psychiatry Department, were submitted to a semi-structured interview. The sample was divided in two groups: with and without suicidal behaviour (the first being defined has previous suicide attempt, parasuicidal gestures or self-mutilation). Demographic, psychosocial and psychopathological data was taken and compared.
98 completed protocol. Suicidal behaviour group included 48 subjects. Age, years of education, family type, sex differences, psychosocial difficulties (school, family, peers, affective), therapeutic objectives (exception on family relations) were not statistically discriminating. Suicidal ideation as consultation motive, emergency room referral, previous attempts of follow-up, not having as objective improvement of family relationships, were highly associated to the suicidal behaviour group (p≤0.001). A non significant tendency was observed towards depressive syndrome in the latter.
Identifying adolescents at risk for suicidal behaviours isn't an easy task, most characteristics are not discriminating. The most effective way seems to be asking directly about suicidal ideas. Awareness should increase in emergency room referrals motivated by suicidal ideas, in adolescents who tried multiple follow-ups and that seem to be disappointed by family support.
Pregnancy and postpartum both imply high risk for developing psychiatric disorders in women.
To study the relationship between life events (LE) and social support degree (SS) during pregnancy and depressive symptoms in early postpartum period.
A cross-sectional study of 309 consecutive Spanish women, evaluated the second day postpartum. They were all over 18 years old and have signed the informed consent. We excluded: illiteracy, cognitive impairment or severe medical illness, psychiatric disorders during pregnancy and decease of the newborn. We collected socio-demographic and obstetrical data, as well as family and personal psychiatric history, the Edinburgh Postnatal Depression Scale (EPDS), LE (Saint Paul Ramsey) and SS (DUKE-UNK).
Mean age (SD) was 31.6 (4.7). Most of women were married, had intermediated or high level of education. Sixty-one percent were primiparous. Twenty-six percent had family history and 22% had personal psychiatric history. Mean (SD) of LE was 0.95 (0.89) and of SS was 53.1 (7.6). The prevalence of depressive symptoms according to EPDS scores was 18%. This subgroup of depressed women had more psychiatric family history (p=0.046), less LE (p< 0.001) and more SS during pregnancy (p=0.048). Logistic regression analysis showed that SS was the only significant variable (OR=1.085; 95%CI=0.997-0.994; p=0.001). LE did not achieve statistical significance (OR=1.085; 95%CI=0.997-1.180; p=0.059).
Low social support degree during pregnancy is associated with depressive symptoms during immediate postpartum.
This study has been done in part with grants Instituto Carlos III: G03/184, FIS: PI04178; 05/2565.
Although it is well know that the substance use during pregnancy has a negative impact on mother and child health, there are few data on pregnancy - related substance use as a risk factor for postpartum depression and child outcomes.
Aims: To determine maternal and child outcomes at 8 and 32 weeks postpartum of women who reported substance use during pregnancy.
This is a cohort study of 1804 Caucasian women in postpartum. Exclusion criteria: psychiatric disorders during pregnancy. Women were evaluated at 2-3 days, 8 and 32 weeks postpartum. Socio-demographic, obstetric, personal and family psychiatric history and substance use during pregnancy; the Edimburgh Postpartum Depression Scale (EPDS) were assessed. All women with EPDS>9 at 8 and 32 weeks were evaluated by a structured interview (DIGS) for DSM-III major depression.
The mean (SD) age was 31.7 (4.6). Forty-six percent of them were primiparous. Thirty-one percent has a family and 16% a psychiatry history. Fifty percent of women reported substance use during pregnancy: 42% caffeine, 21.6% nicotine, 8% alcohol and 0.6% cannabis. Incidence of major postpartum depression was: 12.7%. Incidence of: Apgar scores < 7 at 5 min after birth:0.4%, gestational age at delivery < 37 weeks:7.3%, birth weigt < 2.5 Kg:7.3%, and congenital malformations:1.4%.
In the presentation, the maternal and child perinatal outcomes of women exposed to licit and ilicit drugs will be summarize and will include a discussion of the future clinical and research implications. This work has been done in part with Grants: GO3/184;FIS:PI04178;PI041635,PI041783,PI041779,PI041758,PI041761,PI041791,PI041766,PI041782,RD06/0001/1009; CIBER-SAM.
To assess the psychometric properties of the Spanish version of the Index of Spouse Abuse (ISA), and validate it against external criteria of intimate partner violence (IPV).
A case control, transversal study was designed. Spanish version of the ISA was administered to 405 women (223 controls and 182 IPV cases). Spanish items weights were developed. Internal consistency was assessed through Cronbach's alfa, and factor structure by means of principal component analysis (PCA). Receiver operating characteristic (ROC) analysis was used to validate the ISA against external criteria.
PCA analysis yielded two factors that accounted the 69% of variance, and reproduced partially the original factors: physical (ISA-P) and non-physical (ISA-NP). Internal consistency coefficients oscillated between 0,88 and 0,98. For the ISA global score, the AUC value for detecting IPV was 0,99; and 0,89 for detecting physical IPV. The optimal cut-off scores were 13 for detecting IPV, and 15 for detecting physical IPV. For the ISA subscales, 6 was the optimal cut-off score for the ISA-P, and 13 was the optimal cut-off for the ISA-NP.
The Spanish version of the ISA is a valid and reliable instrument for detecting and measuring the intensity of the IPV in Spanish women population.
Studying inpatient clinical population's features allows a better understanding of readmissions. Factors associated with higher levels of readmission may give clues concerning better treatment planning and follow-up.
To detect psychosocial and clinic factors associated with readmissions in an inpatient general psychiatric population.
107 patients consecutively admitted to an inpatient unit were characterized in terms of psychosocial, clinical, treatment and discharge plan features. Readmission was defined as the number of previous admittances in the last two years.
Patients characteristics: Average age 44 (SD: 16); 58% female; 10 (SD:5) years of education; average disease duration of 128 (SD:115) months. Main diagnosis: 30,8% schizophrenia; 14% bipolar I disorder; 13,1% major depression; 11,2% recurrent major depression; 5,6% cluster B personality; 3,8% bipolar II disorder and 2,9% schizoaffective disorder. From more to less frequent diagnosis implicated in readmissions were schizophrenia, schizoaffective disorder, recurrent major depression, bipolar I, bipolar II and major depression episode. Readmissions were not associated with inpatient treatment or disease duration, nor toxics or axis II diagnosis. Nonetheless, beginning a depot antipsychotic medication was related to an increase in previous admissions.
These are preliminary results of a small sample, but they point towards the usefulness of a systematic evaluation of inpatient populations, mainly in what concerns complex clinical situations like major pathology readmissions.
There is no empirical research on the occurrence of postnatal psychiatric morbidity in Spanish population. To determine the prevalence rate of DSM-IV psychiatric disorders in postpartum Spanish mothers.
A two-phase cross-sectional epidemiological study. Women consecutively attending in the routine postnatal check-up (at six weeks after delivery) in the Department of Obstetric and Gynaecology of the Clinic Hospital during one year were included. In the first phase, 1453 women were screened with the EPDS. In the second phase, based upon EPDS outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation with the Structured Clinical Interview (SCID) for DSM-IV to determine psychiatric status. Weighted prevalence and its 95% Confidence Intervals (95%CI) were obtained for DSM-IV diagnostic groups.
The overall 6-weeks prevalence rate for postpartum psychiatric disorders was 18.1% (95% CI 15.0-21.8). The most prevalent DSM-IV diagnostic group was mood disorders (9.8%; 95% CI 7.9-12.1), follow-up by adjustment disorders group (4.3%; 95% CI 3.0-6.3), anxiety diagnostic group (3.9%; 95% CI 2.5-5.8) and “other” disorders group (1.1%; 95% CI: 0.3-3.8%).
This results shows the heterogeneity of postnatal psychiatric morbidity. We found that DSM-IV diagnosis of mood disorders in postpartum women were more prevalent than anxiety disorders, in contrast with recent studies in postnatal community women. Clinical and research evaluation of mental health in postpartum women should include a full range of mental disorders.
This study has been supported in part by grant 13/00 from Ministery of Work and Social Affairs, Institute of Women, Spain.