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Salud mental en estudiantes de educación superior en Chile: una revisión de alcance con meta-análisis
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Martínez, Pablo

; Jiménez-Molina, Álvaro

; Mac-Ginty, Scarlett

; Martínez, Vania

; Rojas, Graciela

Terapia psicológica

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dec 2021, Volume 39 N. 3 Pages 405 - 426

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract We conducted a scoping review on the prevalence of psychological symptoms, factors associated with mental health, barriers and facilitators to help-seeking, and effectiveness of mental health interventions in higher education students in Chile. We searched for indexed reports up to October 15, 2019, in CINAHL, Google Scholar, PubMed, Virtual Health Library/BIREME, and Web of Science databases. We assessed the quality of prevalence studies and explored the pooled prevalence of psychological symptoms using meta-analyses. We included 32 published studies, 20 on the prevalence of psychological symptoms – 10 of sufficient quality to be included in meta-analyses. We observed substantial heterogeneity in the exploration of combined prevalence of psychological symptoms, with ranges from 22.9% to 40.7% for psychological distress, 16.5% to 38.8% for depressive symptoms, 16.5% to 23.7% for anxious symptoms, 19.7% to 29.7% for cannabis use in the past 12 months, and 84.0% to 92.6% for alcohol use in the past 12 months. Female sex was consistently associated with mental health problems. More studies evaluating access to treatment, help-seeking barriers and facilitators, and interventions to improve the mental health of the target population are needed.

Resumen Realizamos una revisión de alcance sobre la prevalencia de síntomas psicológicos, factores asociados a la salud mental, barreras y facilitadores para la búsqueda de ayuda, y la efectividad de intervenciones de salud mental en estudiantes de educación superior en Chile. Buscamos reportes indexados hasta el 15 de octubre de 2019 en las bases de datos CINAHL, Google Scholar, PubMed, Virtual Health Library/BIREME y Web of Science. Evaluamos la calidad de los estudios de prevalencia y exploramos la prevalencia combinada de síntomas psicológicos mediante meta-análisis. Incluimos 32 estudios publicados, 20 sobre prevalencia de síntomas – 10 con la calidad suficiente para ser incluidos en el meta-análisis. Observamos una heterogeneidad sustantiva en la exploración de prevalencia combinada de síntomas, con rangos entre 22,9% a 40,7% para malestar psicológico, 16,5% a 38,8% para síntomas depresivos, 16,5% a 23,7% para síntomas ansiosos, 19,7% a 29,7% para consumo de cannabis en los últimos 12 meses, y 84,0% a 92,6% para consumo de alcohol en los últimos 12 meses. El sexo femenino se asoció consistentemente con problemas de salud mental. Es necesario realizar más estudios que evalúen el acceso a tratamiento, facilitadores y barreras para la búsqueda de ayuda, e intervenciones para mejorar la salud mental de la población objetivo.

819 downloads

Salud mental primaria para niños, niñas y adolescentes institucionalizados: perspectiva de equipos de salud
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Fernández, Olga M.

; Irarrázaval, Matías

; Ortega, Beatriz

; Carrasco, Paula

; Martínez, Pablo

; Rojas, Graciela

; Mundt, Adrian P.

Revista Latinoamericana de Ciencias Sociales, Niñez y Juventud

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aug 2021, Volume 19 N. 2 Pages 103 - 121

Abstract: Es En Pt | Text: Es En Pt | PDF: Es | PDF: En | PDF: Pt

Resumen (Analítico) La salud mental de los niños, niñas y adolescentes institucionalizados en hogares es un desafío clínico y ético para Chile y América Latina. Con el objetivo de explorar experiencias y desafíos percibidos por profesionales de la atención primaria de salud que atienden esta población, se realizó una investigación cualitativa, utilizando un cuestionario con preguntas abiertas. Los datos se analizaron mediante teoría fundamentada. Los resultados mostraron que la atención era parcializada y discontinua. La información sobre el desarrollo vital, la familia, los contextos de vulneración e institucionalización era insuficiente y fragmentada. Además, existía escasa coordinación entre las instituciones que intervienen simultáneamente con los niños, niñas y adolescentes. Se discuten las implicancias para la formación de equipos de salud mental de la atención primaria de salud y la implementación efectiva del trabajo intersectorial y multinivel.

Abstract (analytical) Mental health care for vulnerable and institutionalized children and adolescents is a clinical and ethical challenge in Chile and Latin America. This study explores experiences and challenges encountered when providing mental health care among primary health care professionals. Qualitative research was conducted using an open-ended questionnaire for interviewing professionals in a rural area of Chile. The data was analyzed using Grounded Theory. The results show a fragmented and discontinuous delivery of care as a large portion of the children's clinical and social history is unknown. There is lack of coordination with other institutions that intervene in this area. The authors discuss implications for primary health care training for children’s mental health teams and the need for the implementation of effective integrated and multilevel care systems.

Resumo (Analítico) A saúde mental de crianças e adolescentes vulneráveis e institucionalizados é um desafio clínico e ético no Chile e na América Latina. O presente estudo explorou experiências e desafios do cuidado por profissionais da atenção primária à saúde que atendem esta população. A pesquisa qualitativa foi realizada utilizando um questionário de perguntas abertas para entrevistar profissionais da área rural do Chile. Os dados foram analisados usando a Grounded Theory. Os resultados mostraram um atendimento fragmentado e descontínuo. As informações sobre parte da história clínica e social das crianças, e os contextos de vulnerabilidade e institucionalização são insuficientes. Além disso, existia pouca coordenação entre as instituições que intervêm simultaneamente com os crianças e adolescentes. São discutidas implicações para o treinamento de equipes de saúde mental na atenção primária à saúde e para a implementação de sistemas efetivos de atendimento integrado e multinível.

https://doi.org/10.11600/rlcsnj.19.2.4175 272 downloads

Determinantes socioeconómicos y brechas de género de la sintomatología depresiva en Chile
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Jiménez-Molina, Álvaro

; Reyes, Pablo

; Rojas, Graciela

Revista médica de Chile

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apr 2021, Volume 149 N. 4 Pages 533 - 542

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: There are marked differences associated with socio-economic factors in the prevalence of depressive symptoms (DS) in men and women. Aim: To estimate the association between socioeconomic status and DS in Chile and to estimate the gender gaps in this association. Material and Methods: The Patient Health Questionnaire-9 (PHQ-9) was applied as part of a socioeconomic survey carried out in a representative community sample (n = 2913). Using this information, we analyzed the influence of social status (education level, occupation, household income) and other psychosocial factors (gender, perceived social support, stressful life events) on DS. Results: The prevalence of DS was 23.2% in women and 13.4% in men. A socioeconomic gradient was found in the distribution of DS. This gradient was more pronounced for women than for men. Gender, social support and stressful life events were the most important predictors of severe DS, with an estimated risk twice as high among women and almost three times as high among those with low social support. Conclusions: There is a combined effect between socio-economic and gender inequalities on DS. This partially explains the greater vulnerability of poor women and the DS gap between men and women.

https://doi.org/10.4067/s0034-98872021000400533 333 downloads

Validación inicial de Patient Health Questionnaire 2-Item para detectar síntomas depresivos en diabéticos y/o hipertensos en la atención primaria de salud
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Martínez, Pablo

; Soto-Brandt, Gonzalo

; Brandt, Sebastián

; Guajardo, Viviana

; Rojas, Graciela

Revista médica de Chile

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nov 2020, Volume 148 N. 11 Pages 1614 - 1618

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: Patient Health Questionnaire (PHQ-9) has nine questions and is used in diabetic or hypertensive patients to detect depressive symptoms. The PHQ-2 uses the first two questions of the PHQ-9 to rapidly detect those patients that should answer the whole questionnaire. Aim: To validate the PHQ-2 to detect depressive symptoms in diabetic or hypertensive patients consulting at Primary Health Care (PHC). Material and Methods: Secondary analysis of data obtained during the baseline assessment of a clinical trial. Diabetic and hypertensive patients aged 18 years or more, attending a public health care clinic of Metropolitan Santiago, were invited to participate. Those accepting, answered the Patient Health Questionnaire (PHQ-9), consisting in nine questions about depressive symptoms. Demographics and health data were also collected. The PHQ-2 capacity to discriminate PHQ-9 scores equal or higher than 10 and 15 and the correlation between both versions, were assessed. Results: Ninety-four participants aged 64 ± years (73% women) answered the questionnaire. A cut-off score of 3 or more points in the PHQ-2 achieved the best tradeoff between sensitivity and specificity for discriminating PHQ-9 scores equal or higher than 10 (area under the receiver operating characteristic curve (ROC) = 0.92, 95% confidence interval [95% CI] = 0.87 to 0.97) and 15 points (area under the ROC curve = 0.95, 95% CI = 0.92 to 0.99). Both versions had a high positive correlation (r = 0.87). Conclusions: The PHQ-2 allows a stepped, simple and accurate screening for depressive symptoms. Diabetic or hypertensive patients with 3 or more points should be immediately assessed with the remaining questions of the PHQ-9.

317 downloads

Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities
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Mascayano, Franco

; Alvarado, Ruben

; Andrews, Howard F.

; Jorquera, Maria Jose

; Lovisi, Giovanni Marcos

; Souza, Flavia Mitkiewicz de

; Pratt, Charissa

; Rojas, Graciela

; Restrepo-Toro, Maria E.

; Fader, Kim

; Gorroochurn, Prakash

; Galea, Sandro

; Dahl, Catarina Magalhães

; Cintra, Jacqueline

; Conover, Sarah

; Burrone, Maria Soledad

; Baumgartner, Joy Noel

; Rosenheck, Robert

; Schilling, Sara

; Sarução, Keli Rodrigues

; Stastny, Peter

; Tapia, Eric

; Cavalcanti, Maria Tavares

; Valencia, Eliecer

; Yang, Lawrence H.

; Susser, Ezra

Cadernos de Saúde Pública

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2019, Volume 35 N. 4 elocation e00108018

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Diversos países latino-americanos já alcançaram avanços notáveis na oferta de assistência em saúde mental para pessoas com psicoses. No entanto, as clínicas de saúde mental geralmente realizam atividades de extensão muito limitadas dentro das comunidades, tendem a ter vínculos fracos com a assistência primária, raramente envolvem os próprios pacientes nos cuidados e poucas vezes prestam serviços orientados para a recuperação. O artigo descreve um estudo piloto randomizado e controlado sobre a Critical Time Intervention-Task Shifting (CTI-TS), que teve como objetivo analisar essas limitações. O estudo piloto foi realizado em Santiago (Chile) e no Rio de Janeiro (Brasil). Teve como meta a inclusão de 110 pessoas com psicose, recrutadas no momento da entrada em clínicas comunitárias de saúde mental. Os participantes foram randomizados para o CTI-TS ou para os cuidados usuais. Aqueles alocados ao grupo da intervenção receberam os cuidados usuais e os serviços de CTI-TS ao longo de 9 meses. Os desfechos primários incluíram a qualidade de vida (WHO Quality of Life Scale - Brief Version) e as necessidades não atendidas (Camberwell Assessment of Needs) no acompanhamento aos 18 meses. Os desfechos primários aos 18 meses serão analisados com a técnica de Equações de Estimação Generalizadas (GEE), com as observações agrupadas dentro dos locais do estudo. Serão utilizados modelos em três níveis para examinar as tendências temporais nos desfechos primários. Procedimentos semelhantes serão utilizados para analisar os resultados secundários. Espera-se que o estudo forneça uma base para planejar um estudo randomizado e controlado em grande escala e em múltiplos locais para estabelecer a eficácia da intervenção orientada para a recuperação, a exemplo da CTI-TS, na América Latina.

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.

resumen está disponible en el texto completo

https://doi.org/10.1590/0102-311x00108018 1600 downloads

Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities
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Mascayano, Franco

; Alvarado, Ruben

; Andrews, Howard F.

; Jorquera, Maria Jose

; Lovisi, Giovanni Marcos

; Souza, Flavia Mitkiewicz de

; Pratt, Charissa

; Rojas, Graciela

; Restrepo-Toro, Maria E.

; Fader, Kim

; Gorroochurn, Prakash

; Galea, Sandro

; Dahl, Catarina Magalhães

; Cintra, Jacqueline

; Conover, Sarah

; Burrone, Maria Soledad

; Baumgartner, Joy Noel

; Rosenheck, Robert

; Schilling, Sara

; Sarução, Keli Rodrigues

; Stastny, Peter

; Tapia, Eric

; Cavalcanti, Maria Tavares

; Valencia, Eliecer

; Yang, Lawrence H.

; Susser, Ezra

Cadernos de Saúde Pública

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2019, Volume 35 N. 4 elocation e00108018

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

resumen está disponible en el texto completo

https://doi.org/10.1590/0102-311x00108018

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

; Guajardo, Viviana

; Martínez, Pablo

; Fritsch, Rosemarie

Revista médica de Chile

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sep 2018, Volume 146 N. 9 Pages 1001 - 1007

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

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 check-up 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 check-ups. 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.

https://doi.org/10.4067/s0034-98872018000901001 2868 downloads

Tamizaje de episodio depresivo en adolescentes. Validación del instrumento PHQ-9
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Borghero, Francesca

; Martínez, Vania

; Zitko, Pedro

; Vöhringer, Paul A.

; Cavada, Gabriel

; Rojas, Graciela

Revista médica de Chile

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apr 2018, Volume 146 N. 4 Pages 479 - 486

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: There is a paucity of validated instruments for screening depression in adolescent populations in Chile. Aim: To determine the diagnostic accuracy of the adolescent version of Patient Health Questionnaire-9 (PHQ-9). Material and Methods: The PHQ-9 was transculturally adapted and administered to adolescents aged 15 to 19 years residing in Santiago de Chile, who were then evaluated with a semi structured interview (Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version or K-SADS-PL) and the Beck Depression Inventory. Internal validity, concurrent validity, and discriminatory power of the PHQ-9 were analyzed. Results: We evaluated 245 adolescents aged 16.2 ± 1 years (71% females). Two hundred and ten presented with a depressive episode and 35 were healthy. The sensitivity and specificity of the scale were 86.2 and 82.9% for 11 points, with a positive likelihood ratio of 5.02. Conclusions: The PHQ-9 is sensitive and specific enough to be used as a screening tool in adolescents with suspected depression. At a 11-point cut-off score as proposed, the likelihood to find a positive result in a subject with depression is five times higher.

https://doi.org/10.4067/s0034-98872018000400479 7483 downloads

Propiedades psicométricas del inventario de depresión de Beck IA para la población chilena
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Valdés, Camila

; Morales-Reyes, Irma

; Pérez, J. Carola

; Medellín, Adriana

; Rojas, Graciela

; Krause, Mariane

Revista médica de Chile

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aug 2017, Volume 145 N. 8 Pages 1005 - 1012

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: According to the Chilean National Health Survey (2009-2010), 17% of people aged 15 years or more have depressive symptoms. Thus, freely-available, easily-administered, and highly sensitive screening tests for depression are needed in clinical and research settings. Aim: To evaluate the psychometric properties of a Spanish version of the Beck Depression Inventory (BDI-IA) in adult Chilean population. Material and Methods: The inventory was applied to a sample of 1.105 adults aged between 18 to 73 years (94% women). Ninety nine participants were outpatients receiving treatment for affective disorders, 932 were parents and/or guardians of students enrolled in schools and 73 were university students (sample with no known depressive disorder). To perform data analysis, two groups from the random combination of both samples were generated. Results: The inventory showed an appropriate degree of internal consistency (Cronbach alpha = .92). An exploratory factor analysis suggested a one-factor solution. This solution was reinforced with a confirmatory factor analysis, which displayed an adequate goodness of fit. The cutoff score, based on the Youden Index, was 13/14 points. It was able to discriminate between depressed and non-depressed participants. Conclusions: These results indicate that the BDI-IA is an appropriate instrument to assess depressive symptoms in Chilean adults.

https://doi.org/10.4067/s0034-98872017000801005 6410 downloads

10.

Comorbilidad en personas con depresión que consultan en centros de la atención primaria de salud en Santiago, Chile
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Martínez, Pablo

; Rojas, Graciela

; Fritsch, Rosemarie

; Martínez, Vania

; Vöhringer, Paul A

; Castro, Ariel

Revista médica de Chile

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jan 2017, Volume 145 N. 1 Pages 25 - 32

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: International evidence has shown the complex interaction between depression and chronic physical diseases. Depression in scenarios involving multiple comorbidities has not received enough attention in Chile. Aim: To characterize the depressed people who consult at Primary Health Care Centers (PHCCs), taking into account the presence of chronic physical or psychiatric comorbidity. Materials and Methods: A secondary analysis of databases used in a clinical trial. Two hundred fifty six adults seeking professional help were recruited in four PHCCs located in the Metropolitan Region. These people had a major depressive episode, identified with a structured psychiatric interview (MINI), and gave their informed consent to participate. Socio-demographic information was collected, depressive symptomatology was measured with the patient health questionnaire 9 (PHQ-9), psychiatric morbidity was assessed using the Mini International Neuropsychiatric Interview (MINI), and chronic physical diseases were self-reported by the patients. Descriptive analyses of all the variables were conducted. Results: Seventy percent of patients had a history of depression, with a median of two prior depressive episodes. Depressive symptoms were mostly considered as moderate to severe and severe and 31% of the patients had high suicide risk. Seventy eight percent displayed a physical or psychiatric comorbidity. Of these patients, 29% only had a chronic physical comorbidity, while 46% suffered from an additional psychiatric disorder. Conclusions: Depressed individuals who seek help at PHCCs constitute an especially complex population that must be treated taking into account multiple comorbidities.

6226 downloads

11.

Supraoptimal ethylene acts antagonistically with exogenous gibberellins during Solanum lycopersicum (Solanaceae) hypocotyl growth
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Mignolli, Francesco

; Rojas, Graciela Beatriz

; Vidoz, María Laura

Boletín de la Sociedad Argentina de Botánica

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jun 2016, Volume 51 N. 2 Pages 235 - 242

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

In many plant species, ethylene and gibberellins interact to regulate plant growth and development. In some cases, these hormones can act in a synergistic way whereas in others they can be antagonistic. To date, the control of hypocotyl elongation by ethylene and gibberellins has been poorly explored in tomato. In this paper, we report that, application of exogenous ethylene to tomato seedlings or high endogenous ethylene production, as in the epinastic mutant, strongly prevent the effect of gibberellic acid (GA3) application. Moreover, constitutive activation of gibberellin signal in a DELLA deficient mutant is not able to counteract the inhibitory effect of ethylene on hypocotyl elongation, suggesting that ethylene acts independently from DELLA-mediated gibberellin response. Interestingly, when ethylene perception is blocked, the GA3 promotive effect on hypocotyl length is less effective, indicating that the presence of a basal level of ethylene could synergistically enhance hypocotyl growth. Taken together, these observations may suggest that, in tomato, supraoptimal concentrations of ethylene are able to antagonize gibberellin effect but normal levels seem to promote gibberellin-induced hypocotyl elongation.

En muchas especies de plantas, el etileno y las giberelinas interactúan para regular el crecimiento y desarrollo. En algunos casos, estas hormonas pueden actuar de manera antagónica mientras que en otros son sinérgicas. Hasta la fecha, en el tomate, el control de la elongación del hipocótilo por el etileno y las giberelinas ha sido poco explorado. En este trabajo se informa que la aplicación de etileno exógeno en plántulas de tomate o la alta producción de etileno endógeno, como en el mutante epinastic, reducen fuertemente el efecto de la aplicación de ácido giberélico (GA3). Por otra parte, la activación constitutiva de la señal de las giberelinas en un mutante deficiente en DELLA no es capaz de contrarrestar el efecto inhibidor del etileno en la elongación del hipocótilo, lo que sugiere que el etileno actúa independientemente de la respuesta a las giberelinas mediada por DELLA. Es interesante destacar que cuando la percepción del etileno está bloqueada, el efecto promotor de la elongación del hipocótilo por GA3 es menos eficaz, lo que indica que la presencia de un nivel basal de etileno podría aumentar el crecimiento del hipocótilo sinérgicamente. En síntesis, estas observaciones sugieren que, en el tomate, las concentraciones supraóptimas de etileno son capaces de antagonizar el efecto de las giberelinas pero los niveles normales parecen promover el alargamiento del hipocótilo inducido por dichas hormonas.

350 downloads

12.

Barriers to access to treatment for mothers with postpartum depression in primary health care centers: a predictive model
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Martínez, Pablo

; Vöhringer, Paul A.

; Rojas, Graciela

Revista Latino-Americana de Enfermagem

Journal Metrics
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2016, Volume 24 elocation e2675

Abstract: En Es Pt | Text: En Es Pt | PDF: En | PDF: Es | PDF: Pt

Objective to develop a predictive model to evaluate the factors that modify the access to treatment for Postpartum Depression (PPD). Methods prospective study with mothers who participated in the monitoring of child health in primary care centers. For the initial assessment and during 3 months, it was considered: sociodemographic data, gyneco-obstetric data, data on the services provided, depressive symptoms according to the Edinburgh Postpartum Depression Scale (EPDS) and quality of life according to the Short Form-36 Health Status Questionnaire (SF-36). The diagnosis of depression was made based on MINI. Mothers diagnosed with PPD in the initial evaluation, were followed-up. Results a statistical model was constructed to determine the factors that prevented access to treatment, which consisted of: item 2 of EPDS (OR 0.43, 95%CI: 0.20-0.93) and item 5 (OR 0.48, 95%CI: 0.21-1.09), and previous history of depression treatment (OR 0.26, 95%CI: 0.61-1.06). Area under the ROC curve for the model=0.79; p-value for the Hosmer-Lemershow=0.73. Conclusion it was elaborated a simple, well standardized and accurate profile, which advises that nurses should pay attention to those mothers diagnosed with PPD, presenting low/no anhedonia (item 2 of EPDS), scarce/no panic/fear (item 5 of EPDS), and no history of depression, as it is likely that these women do not initiate treatment.

Objetivo desarrollar un modelo predictivo para evaluar los factores que modifiquen el acceso a tratamiento para la DPP. Métodos estudio prospectivo de madres que asistieron a control de niño sano en centros de atención primaria. En evaluación basal y 3 meses, se registraron: datos sociodemográficos, gineco-obstétricos, variables de uso de servicios, síntomas depresivos con la Escala de Depresión Posparto de Edimburgo (EPDS) y calidad de vida con el Cuestionario de Salud SF-36. El diagnóstico de depresión se hizo con el MINI. Se siguió a madres que en evaluación basal tenían DPP. Resultados se construyó un modelo estadístico para determinar los factores que impidieron el acceso a tratamiento, compuesto por: ítems del EPDS 2 (OR 0,43, IC95%: 0,20-0,93) y 5 (OR 0,48, IC95%: 0,21-1,09), e historia previa de tratamiento de depresión (OR 0,26, IC95%: 0,61-1,06). Área bajo la curva ROC para el modelo=0,79; valor de p para la prueba de Hosmer-Lemershow=0,73. Conclusión se elaboró un perfil simple, bien calibrado y discriminante, que sugiere que los/las enfermeros/as estén atentos/as a aquellas madres con DPP que presenten baja/nula anhedonia (ítem 2 EPDS), escaso/nulo pánico/miedo (ítem 5 EPDS), y sin antecedentes de depresión, ya que es probable que estas mujeres no ingresen a tratamiento.

Objetivo desenvolver um modelo preditivo para avaliar os fatores que modificam o acesso a tratamento para a DPP. Métodos estudo prospectivo com mães que participaram do acompanhamento da saúde da criança em centros de atenção primária. Na avaliação inicial e durante 3 meses, foram registrados: dados sociodemográficos, gineco-obstétricos, dados sobre o uso dos serviços, sintomas depressivos de acordo com a Escala de Depressão Pós-parto de Edimburgo (EPDS) e qualidade de vida de acordo com o Questionário de Saúde SF-36. O diagnóstico de depressão foi feito com o MINI. Foram acompanhadas as mães que tinham DPP na avaliação inicial. Resultados foi construído um modelo estatístico para determinar os fatores que impediram o acesso a tratamento, constituído por: item 2 da EPDS (OR 0,43, IC95%: 0,20-0,93) e 5 (OR 0,48, IC95%: 0,21-1,09), e história prévia de tratamento para depressão (OR 0,26, IC95%: 0,61-1,06). Área sob a curva ROC para o modelo=0,79; valor de p para o teste de Hosmer-Lemershow=0,73. Conclusão foi elaborado um perfil simples, bem padronizado e preciso, que recomenda que os/as enfermeiros/as estejam atentos/as àquelas mães com DPP que apresentem anedonia baixa/nula (item 2 da EPDS), pânico/medo escasso/nulo (item 5 da EPDS) e sem antecedentes de depressão, já que é provável que estas mulheres não entrem em tratamento.

https://doi.org/10.1590/1518-8345.0982.2675 90 downloads

13.

Barriers to access to treatment for mothers with postpartum depression in primary health care centers: a predictive model
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Martínez, Pablo

; Vöhringer, Paul A.

; Rojas, Graciela

Revista Latino-Americana de Enfermagem

Journal Metrics
- Sobre o periódico
- SciELO Analytics

2016, Volume 24 elocation e2675

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/1518-8345.0982.2675 8887 downloads

14.

Intervención grupal para reducir la sintomatología depresiva y promover la sensibilidad materna en embarazadas chilenas
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Olhaberry, Marcia

; Escobar, Marta

; Mena, Constanza

; Santelices, Pía

; Morales-Reyes, Irma

; Rojas, Graciela

; Martínez, Vania

Suma Psicológica

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jul 2015, Volume 22 N. 2 Pages 93 - 101

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

La sintomatología depresiva es frecuente en el embarazo y repercute en el posparto y en el vínculo madre-bebé. Se reportan los resultados de una intervención grupal de 5 sesiones para reducir la sintomatología depresiva y promover una adecuada sensibilidad materna. Participaron 134 embarazadas con antecedentes de depresión (grupo experimental = 88 y grupo control = 46). Se evaluó sintomatología depresiva (Inventario para la Depresión de Beck), resolución de problemas sociales (Inventario de Resolución de Problemas Sociales Abreviado), sensibilidad materna, cooperatividad infantil y riesgo vincular (Índice Experimental de Relación Niño-Adulto) en ambos grupos. Se observó una reducción significativa de la sintomatología depresiva, así como un incremento de las habilidades para la resolución de problemas sociales en el grupo intervenido. Este grupo muestra también puntajes significativamente mayores en sensibilidad materna y cooperatividad infantil, así como menores frecuencias de riesgo vincular en la evaluación postintervención. Se discute la relevancia de desarrollar estrategias de intervención durante el embarazo, considerando su impacto en la sensibilidad materna, en la calidad de las interacciones madre-bebé y en las habilidades de las madres para resolver problemas.

Depressive symptoms are frequently observed during pregnancy, and these affect the mother and her relationship with her baby during the post-partum period. Results are reported on a 5-session group intervention for reducing depressive symptoms and promoting maternal sensitivity. The participants included 134 pregnant women with a history of depression (experimental group = 46 and control group = 88). Depressive symptoms (Beck Depression Inventory), social problem-solving strategies (Social Problem-Solving Inventory-Revised), maternal sensitivity, infant cooperativeness and bonding risk (Child-Adult Relatinoship Experimental Index) were assessed in both groups. The group intervened showed a significant reduction of depressive symptoms and an improvement of social problem-solving strategies. This group also shows significantly higher scores in maternal sensitivity, and infant cooperativeness, as well as lower frequencies of bonding risk in the post-intervention assessment. The importance of considering intervention strategies during pregnancy, including its impact on maternal sensitivity, the quality of mother-baby interactions and the problem-solving abilities of the mothers, is discussed.

https://doi.org/10.1016/j.sumpsi.2015.08.002 986 downloads

15.

Análisis etnográfico en salas de espera de centros de salud primaria: implicancias para la detección y tratamiento de la depresión posparto
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Martínez, Pablo

; Rojas, Graciela

; Magaña, Irene

Terapia psicológica

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jul 2015, Volume 33 N. 2 Pages 59 - 68

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

In Chile, universal screening and treatment for postpartum depression has been implemented at a national level, however it remains under-detected and under-treated. To describe and analyze barriers to postpartum depression detection and treatment implied in maternal-infant health care production at general practice waiting rooms, an ethnographic study was carried out at six primary care clinics belonging to the Metropolitan Area of Santiago, Chile. Discourses and practices on maternity enacted at waiting room, reveals a conflicting condition for postpartum women, implying a differential overburden with domestic work and care tasks, demanding constant mobilization between formal and informal health care sources. The grade of integration between remunerated work and women's self-care is debated.

Chile cuenta con tamizaje y acceso universal para el tratamiento de la depresión posparto, no obstante, ésta es una patología sub-detectada y sub-tratada. Con el objetivo de describir y analizar las barreras de acceso para la detección y tratamiento de la depresión posparto implicadas en la producción de cuidados materno-infantiles en las salas de espera de consultorios, se llevó a cabo un estudio etnográfico en seis centros de salud primaria Santiago de Chile. La maternidad, como objeto de discursos y prácticas reproducidos en los espacios comunes del consultorio, se constituye en una condición conflictiva para las puérperas, implicando una sobrecarga diferencial de trabajo doméstico y de cuidados, exigiendo su movilización entre instancias formales e informales del cuidado de la salud. Se problematiza en torno al grado de integración entre trabajo remunerado y el cuidado de la salud en las mujeres.

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