Depresión posparto: tamizaje, uso de servicios y barreras para su tratamiento en centros de atención primaria

Abstract

Screening and barriers for treatment of postpartum depression in Chilean public primary health care centers Background: Postpartum depression (PPD) is a public health issue, and appropriate screening may lead to clinical gains. Aim: To describe the screening for PPD, its relationship with the use of health care services, and treatment access barriers in Chilean public primary health care (PHC) centers. Material and Methods: Puerperal women attending PHC centers for a well-child checkup were assessed for the presence of PPD using the Edinburgh Postnatal Depression Scale and a structured psychiatric interview. PPD cases were assessed by telephone three months later. Also, women with PPD and PHC workers were interviewed to explore treatment barriers. Results: Of the 305 women assessed, 21% met diagnostic criteria for PPD. Sixty five percent of assessed women were previously screened for PPD while attending well-child checkups. The results of the screening were communicated to 60% of them and 28% received some management indication. After three months of follow up, 70% of PPD cases continued to be depressed, and two thirds of them did not consult a health care provider and most of them rejected psychotherapy or medical treatment. Conclusions: Management of postpartum depression should be substantially improved in public PHC from screening to treatment.

Detección temprana de la depresión posparto

“…Otros factores asociados son la baja autoestima, trastornos de la personalidad, bajo nivel económico (apego inseguro), poco apoyo social, violencia familiar, bajo nivel escolar, poco apoyo emocional parental, pobre acceso a la salud, consumo de alcohol, tabaco, drogas, situaciones de estrés en el embarazo y parto (5,6).…”

“…La historia clínica completa estructurada es de suma importancia, en conjunto con el examen del estado mental y físico para determinar antecedentes de depresiones previas, abuso de sustancias, coexistencia de otras condiciones médicas y heredofamiliares, para valorar si existe deterioro funcional y detectar acontecimientos de estrés y/o traumáticos (6).…”

“…Para su diagnóstico se utiliza la clasificación del DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), su inclusión se encuentra en el apartado de "Trastorno Depresivo durante el período perinatal" y del CIE-10 (Clasificación Internacional de las Enfermedades), las cuales describen los trastornos psiquiátricos (6).…”

A Chilean survey of perinatal women and health care professionals’ views towards perinatal apps

“…Treatment comprises psychotherapy, alone or combined with pharmacotherapy ( 31 ). Despite all these measures, perinatal depression prevalence in Chile is high and is still underdiagnosed and undertreated ( 32 ).…”

Sintomas de depressão pós-parto e sua associação com as características socieconômicas e de apoio social

“…Em países da América Latina, o Chile mostrou uma prevalência de 21% de sintomas de DPP. 12 Já no Brasil, diferentes estudos já observaram importantes oscilações da prevalência, indo de 6,7% em São Paulo 13 a 25,8% em estudo nacional. 14 Diversas variáveis podem estar relacionadas à ocorrência dos sintomas de DPP, como ter idade jovem, não ter parceiro, uso de tabaco antes da gestação, consumo de bebida alcóolica e história de aborto.…”