Um estudo com mais de 10 mil puérparas publicado no JAMA Psychiatry traz alguns dados surpreendentes relativos a depressão pós-parto.
Das mulheres com depressão pós-parto, 30% já tiveram episódios antes da gravidez, 30% depois da gravidez e 40% durante. Dois terços tinham algum transtorno ansioso…
O suicídio decorrente de depressão é a segunda causa de mortalidade pós-parto por lá, compreendendo 20% dos óbitos.
Claro que numa epidemiologia bem diferente da nossa no Brasil, mas de qualquer forma, para os clínicos, eles sugerem:
“Clinicians need to know that the most common clinical presentation in the post-birth period is more complex than a single episode of depression,” said Dr. Wisner. “The depression is recurrent and superimposed on an anxiety disorder.”
Surprising Rate of Women Have Depression After Childbirth
CHICAGO -- March 15, 2013 -- A surprisingly high number of women have postpartum depressive symptoms, according to a study published in the March 14 edition of JAMA Psychiatry.
The study is the largest scale depression screening of postpartum women and the first time a full psychiatric assessment has been done in a study of postpartum women who screened positive for depression.
The study, which included a depression screening of 10,000 women who had recently delivered infants at single obstetrical hospital, revealed a large percentage of women who suffered recurrent episodes of major depression.
The results underscore the importance of prenatal as well as postpartum screening. Mothers’ and infants’ health and lives hang in the balance. The lives of several women who were suicidal when staff members called them for the screening were saved likely as a result of the study’s screening and immediate intervention.
“In the US, the vast majority of postpartum women with depression are not identified or treated even though they are at higher risk for psychiatric disorders,” said lead author Katherine L. Wisner, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois. “It’s a huge public health problem. A woman’s mental health has a profound effect on fetal development as well as her child’s physical and emotional development.”
“A lot of women do not understand what is happening to them,” she added. “They think they’re just stressed or they believe it is how having a baby is supposed to feel.”
In the study, 14% of the women screened positive for depression. Of that group, 826 received full psychiatric assessments during at-home visits.
In women who screened positive for depression, 19.3% thought of harming themselves.
“Most of these women would not have been screened and therefore would not have been identified as seriously at risk,” said Dr. Wisner. “We believe screening will save lives.”
Suicide accounts for about 20% of postpartum deaths and is the second most common cause of mortality in postpartum women.
Many women who screened positive for major depression postpartum had already experienced at least 1 episode of depression previously and, in addition, had an anxiety disorder. The study found 30% of women had depression onset prior to pregnancy, 40% postpartum, and 30% during pregnancy. More than two-thirds of these women also had an anxiety disorder.
“Clinicians need to know that the most common clinical presentation in the post-birth period is more complex than a single episode of depression,” said Dr. Wisner. “The depression is recurrent and superimposed on an anxiety disorder.”
Of the women who screened positive for major depression, 22% had bipolar disorder -- the majority of whom had not been diagnosed by their physicians.
There is often a delay in correctly diagnosing bipolar disorder, which depends on identifying not only the depressed phase but the manic or hypomanic phase as well. But postpartum is the highest risk period for new episodes of mania in a woman’s life.
“That’s a very high rate of bipolar disorder that has never been reported in a population screened for postpartum depression before,” said Dr. Wisner. “It is significant because antidepressant drug treatment alone can worsen the course of bipolar disorder.”
In addition, women who have been pregnant in the past year are less likely to seek treatment for depression than women who have not been pregnant, previous research has shown.
Maximising a woman’s overall mental and physical health in pregnancy and after childbirth is critically important.
Maternal prenatal stress and depression is linked to preterm birth and low infant birth weight, which increases the risk of cardiovascular disease.
Depression also affects a woman’s appetite, nutrition, and prenatal care and is associated with increased alcohol and drug use. Women with untreated depression have a higher body mass index preconception, which carries additional risks.
When a new mother is depressed, her emotional state can interfere with child development and increases the rate of insecure attachment and poor cognitive performance of her child, said Dr. Wisner said. Screening prenatal and postpartum are essential, but the healthcare field must develop cost effective and accessible treatment, she emphasised. “If we identify patients we must have treatment to offer them,” she said.
SOURCE: Northwestern University
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