Screening for symptoms of depression, prenatal anxiety and psychosocial risk factors among users of prenatal control services. Reflections on creation of the protocol
Abstract
Introduction. In recent years, mental health problems during the prenatal period have become a priority in the public health field. The weakness of the healthcare systems’ response to this situation adds to the adverse effects that an altered state of mental health can pose for the well-being of the mother and her child. In Colombia, the figures of prevalence of any mental health problem during pregnancy are still unknown, which hinders the possibility of providing care that considers the specific nature of the context. The objective is to design a protocol to screen for depression, prenatal anxiety and related psychosocial risk factors among users of the prenatal control service of a hospital in east Colombia. Methodology. The creation of the protocol consists of a formal method in accordance with the classification carried out by the Colombian Ministry of Social Protection for the Clinical Practice Guidelines. It includes the review, summary and analysis of literature on prenatal depression and anxiety (together with the related psychosocial risk factors), as well as the detection and response strategies for them. This review served as a basis to prepare a preliminary version of the protocol, which was subject to an external review to verify its validity, clarity and suitability, before proceeding with the design of the final version. Results. In accordance with the literature, the protocol includes the application of instruments to identify symptoms of anxiety and depression, as well as related psychosocial risk factors, such as sociodemographic variables (age, level of education, occupation and financial income); the perceived social support and quality of the couple relationship; personal and family psychological and psychiatric history; factors related to pregnancy, such as previous complications or negative experiences; personality characteristics; and experience of adverse and stressful life events. Conclusions. The protocol responds to the gap in the identification of and response to mental health problems among pregnant women.
References
Glover V, Kammerer M. The biology and pathophysiology of peripartum psychiatric disorders. Prim Psychiatry [Internet]. 2004 [citado 23 de enero de 2018];11(3):37–41. Recuperado a partir de: https://bit.ly/2mH8xNu
Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):25-35. doi: 10.1016/j.bpobgyn.2013.08.017
Chung TK, Lau TK, Yip AS, Chiu HF, Lee DT. Antepartum Depressive Symptomatology Is Associated With Adverse Obstetric and Neonatal Outcomes. Psychosom Med 2001;63(5):830–834. doi: 10.1097/00006842-200109000-00017
Davis E, Snidman N, Wadhwa P, Glynn L, Dunkel Schetter C, Sandman, C. Prenatal Maternal Anxiety and Depression Predict Negative Behavioral Reactivity in Infancy. Infancy 2004;6(3):319–331. doi: 10.1207/s15327078in0603_1
Dayan J, Creveuil C, Marks MN, Conroy S, Herlicoviez M, Dreyfus M, Tordjman S. Prenatal Depression, Prenatal Anxiety, and Spontaneous Preterm Birth: A Prospective Cohort Study Among Women With Early and Regular Care. Psychosom Med 2006; 68(6):938–946. doi: 10.1097/01.psy.0000244025.20549.bd
Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A Meta-analysis of Depression During Pregnancy and the Risk of Preterm Birth, Low Birth Weight, and Intrauterine Growth Restriction. Arch Gen Psychiatry 2010;67(10):1012-1024. doi: 10.1001/archgenpsychiatry.2010.111
Hoffman S, Hatch M. Depressive Symptomatology During Pregnancy: Evidence for an Association With Decreased Fetal Growth in Pregnancies of Lower Social Class Women. Health Psychol 2000;19(6):535-543. doi: 10.1037/0278-6133.19.6.535
Li D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod 2009;24(1):146–153. doi: 10.1093/humrep/den342
O'Connor TG, Heron J, Golding J, Beveridge M, Glover V. Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years: Report from the Avon Longitudinal Study of Parents and Children. Br J Psychiatry 2000;180(6):502-508. doi: 10.1192/bjp.180.6.502
Orr S, James S, Blackmore Prince S. Maternal Prenatal Depressive Symptoms and Spontaneous Preterm Births among African-American Women in Baltimore, Maryland. Am. J. Epidemiol 2000;156(9):797-802. doi: 10.1093/aje/kwf131
Surkan P, Kennedy C, Hurley K, Black, M. Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis. Bull World Health Organ 2011;89:608–615E. doi: 10.2471/BLT.11.088187
Kingston D, Austin MP, Hegadoren K, McDonald S, Lasiuk G, McDonald S, Heaman M, Biringer A, Sword W, Giallo R, Patel T, Lane-Smith M, van Zanten SV. Study protocol for a randomized, controlled, superiority trial comparing the clinical and cost- effectiveness of integrated online mental health assessment-referral-care in pregnancy to usual prenatal care on prenatal and postnatal mental health and infant health and development: the Integrated Maternal Psychosocial Assessment to Care Trial (IMPACT). Trials. 2014;6(15):72. doi: 10.1186/1745-6215-15-72
Atif N, Lovell K, Rahman A. Maternal mental health: The missing "m" in the global maternal and child health agenda. Semin Perinatol. 2015;39(5):345-52. doi: 10.1053/j.semperi.2015.06.007
Osma Zambrano SE, Lozano Osma MD, Mojica Perilla M, Redondo Rodriguez S. Prevalencia de depresión y ansiedad y variables asociadas en gestantes de Bucaramanga y Floridablanca (Santander, Colombia). MedUNAB. 2019;22(2):171-185. doi:10.29375/0123-7047.3586
Ministerio de la Protección Social, Colciencias. Centro de Estudios e Investigación en Salud de la Fundación Santa Fé de Bogotá, Escuela de Salud Pública de la Universidad de Harvard. Bogotá: Guía Metodológica para el desarrollo de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud Colombiano; 2010.
Gouda R, Hasman A, Strijbis AM, Peek N. A parallel guideline development and formalization strategy to improve the quality of clinical practice guidelines. International Journal of Medical Informatics. 2009;78:513–520. doi:10.1016/j.ijmedinf.2009.02.010
Swinglehurst D. Evidence-based guidelines: The theory and the practice. Evidence-Based Healthcare & Public Health. 2005;9:308–314. doi:10.1016/j.ehbc.2005.05.012
Austin MP, Highet N and the Guidelines Expert Advisory Committee. Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Melbourne: beyondblue: the national depression initiative; 2011.
Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review. Journal of Affective Disorders. 2016;19: 62–77. doi:10.1016/j.jad.2015.11.014
Coates AO, Schaefer CA, Alexander JL: Detection of postpartum depression and anxiety in a large health plan. J Behav Health Serv Res. 2004;31:117–133. doi: 10.1007/BF02287376
Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J: Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gynecol. 2000;183:759–769 doi: 10.1067/mob.2000.106580
Milgrom, J. & Gemmill, A.W. (2014). Screening for perinatal depression. Best Practice & Research Clinical Obstetrics and Gynaecology. 28:13–23. doi: 10.1016/j.bpobgyn.2013.08.014
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-876. doi: 10.1192/bjp.150.6.782
Zung WW. A rating instrument for anxiety disorders. Psychosomatics. 1971;12(6):371-9. doi: 10.1016/S0033-3182(71)71479-0
Beck AT, Brown G, Epstein N y Steer RA. An Inventory for Measuring Clinical Anxiety: Psychometric Properties. Journal of Consulting and Clinical Psychology 1.988; 56:893-7.
Austin MP, Middleton P, Reilly NM, Highet NJ. Detection and management of mood disorders in the maternity setting: the Australian Clinical Practice Guidelines. Women Birth 2013;26(1):2-9. doi: 10.1016/j.wombi.2011.12.001
Carroll JC, Reid AJ, Biringer A, Midmer D, Glazier RH, Wilson L, Permaul JA, Pugh P, Chalmers B, Seddon F, Stewart DE. Effectiveness of the Antenatal Psychosocial Health Assessment (ALPHA) form in detecting psychosocial concerns: a randomized controlled trial. CMAJ. 2005;173(3):253-259. doi: 10.1503/cmaj.1040610
Honikman S, van Heyningen T, Field S, Baron E, Tomlinson M. Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa. PLoS Med. 2012; 9(5): e1001222. doi: 10.1371/journal.pmed.1001222
National Institute for Health and Clinical Excellence (NICE). Antenatal and postnatal mental health: The NICE guidelines on clinical management and service guidance CG45. National Collaborating Centre for Mental Health. The British Psychological Society & The Royal College of Psychiatrists; 2007.
National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance. NICE clinical guideline 192. London: The British Psychological Society & The Royal College of Psychiatrists; 2014.
Thoppil J, Riutcel TL, Nalesnik SW. Early intervention for perinatal depression. Am J Obstet Gynecol. 2005;192(5):1446-8. doi: 10.1016/j.ajog.2004.12.073
Austin M-P, Hadzi-Pavlovic D, Leader L, Saint K, Parker G. Antenatal screening for the prediction of postnatal depression: validation of a psychosocial Pregnancy Risk Questionnaire. Acta Psychiatrica Scandinavica 2005;112(4):310-7. doi: 10.1111/j.1600-0447.2005.00594.x
Austin MP, Colton J, Priest S, Reilly N, Hadzi-Pavlovic D. The antenatal risk questionnaire (ANRQ): acceptability and use for psychosocial risk assessment in the maternity setting. Women Birth. 2013; 26(1):17-25. doi: 10.1016/j.wombi.2011.06.002.
Gordon TE, Cardone IA, Kim JJ, Gordon SM, Silver RK. Universal perinatal depression screening in an Academic Medical Center. Obstet Gynecol. 2006;107:342-7. doi: 10.1097/01.AOG.0000194080.18261.92
SIGN. Management of perinatal mood disorders (SIGN Publication no. 127). [Internet] Edinburgh: Scottish Intercollegiate Guidelines Network; 2012 [citado el 23 de enero de 2018]. Recuperado a partir de: http://www.sign.ac.uk/assets/sign127.pdf
Segre LS, O'Hara MW, Brock RL, Taylor D. Depression screening of perinatal women by the Des Moines Healthy Start Project: program description and evaluation. Psychiatr Serv. 2012;63(3):250-5. doi: 10.1176/appi.ps.201100247.
Ministerio De Salud. Protocolo de Detección de la Depresión durante el Embarazo y Posparto, y Apoyo al Tratamiento; 2014 [citado 23 de enero de 2018] Santiago: Minsal. Recuperado a partir de: https://bit.ly/2laVjbn
O’Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary Care Screening for and Treatment of Depression in Pregnant and Postpartum Women. Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2016; 315(4):388-406. doi:10.1001/jama.2015.18948
Gaynes, BN., Gavin, N., Meltzer-Brody, S., Lohr, KN., Swinson, T., Gartlehner, G., Brody, S. & Miller, WC. Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes. Evidence Report/Technology Assessment. [Internet] 2005 [citado 23 de enero de 2018];(119):1-8. Recuperado a partir de: https://bit.ly/2laY9x3
Gibson, J., McKenzie-McHarg, K., Shakespeare, J., Price, J. & Gray, R. A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand 2009;119(5):350-64. doi: 10.1111/j.1600-0447.2009.01363.x.
De la Ossa, S.; Martinez, Y.; Herazo, E. & Campo, A. Estudio de la consistencia interna y estructura factorial de tres versiones de la escala de Zung para ansiedad. Colomb. Med. [Internet]. 2009 [citado 23 de enero de 2019];40(1):71-77. Recuperado a partir de: https://bit.ly/2la81ab
Downloads
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
