Desenvolvimento infantil: associação com estresse, ansiedade e depressão materna, da gestação ao primeiro ano de vida
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Data
2016-02-04
Autores
Schiavo, Rafaela de Almeida [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Ainda são escassas as pesquisas longitudinais sobre o papel da saúde mental materna, nos períodos antes e após o nascimento, no desenvolvimento do bebê e nas práticas e cuidados parentais. O objetivo deste trabalho foi estudar a associação entre os sintomas de ansiedade, estresse e depressão, desde o terceiro trimestre de gestação até 14 meses após o parto para o desenvolvimento da criança durante o primeiro ano de vida, e o papel de variáveis sociodemográficas e de práticas educativas. Participaram da primeira fase deste estudo 320 gestantes no último trimestre gestacional, usuárias do Sistema Único de Saúde, de três cidades do interior paulista. Elas responderam a uma entrevista inicial e a questionários para avaliar ansiedade (IDATE), estresse (ISSL) e depressão (BDI). Seis meses após o nascimento do bebê, a pesquisadora agendava uma visita na residência da mãe para nova avaliação. Na segunda fase, participaram 200 díades mãe-bebê. As mães responderam aos mesmos instrumentos aplicados na fase anterior e o desenvolvimento da criança foi avaliado por meio de um teste de rastreio (Escala de Denver II). Aos 14 meses, reavaliou-se o desenvolvimento de 149 crianças, as mães responderam novamente aos questionários para avaliação de saúde mental, além de um questionário de práticas de cuidados parentais e a importância atribuída a esses aspectos (E-CPPC). Primeiramente, procedeu-se à análise descritiva; em seguida, realizaram-se análises bivariadas e, com as associações significativas, com valor de p < 0,20, foram montados modelos de regressão logística para identificar fatores de risco e proteção para os sintomas mentais e para o desenvolvimento da criança. O nível de significância adotado foi de p < 0.05. Houve risco para o desenvolvimento aos seis meses em 40% das crianças e 31% aos 14 meses. A porcentagem de mulheres com sintomas de ansiedade, estresse e depressão foi significativamente maior na gestação, decresceu no pós-parto, com baixa incidência aos 6 e 14 meses. Dentre todas as variáveis estudadas, o atraso na área de linguagem aos 14 meses se associou com estresse materno no 14º mês pós-parto e com crenças maternas inadequadas de estimulação. A falta de associação entre problemas mentais maternos e desenvolvimento pode ter ocorrido por se tratar de uma relação mais complexa e não linear, que envolve outras variáveis da mãe, da criança e a interação entre elas, que devem ser levadas em conta em pesquisas futuras. A porcentagem de mães com problema de saúde mental gestacional e atrasos no desenvolvimento infantil, mostra a importância de políticas públicas a serem executadas nos serviços de pré-natal, que poderiam ajudar na prevenção e promoção de saúde mental materna e o desenvolvimento da criança.
Longitudinal studies about the maternal mental health’s role in the antenatal and postpartum period, during child development and in parental practice and care are still scarce. The arm of this research was to study the association between anxiety symptoms, stress and depression, since the third trimester until fourteen months after birth to the child’s development during the first year, and the role of socio demographic variables and educational practices.320 pregnant women in their last trimester, users of SUS (Brazilian National Health Program) from three São Paulo State’s cities took part in this study. They answered an initial interview and questionnaires to evaluate anxiety (IDATE), stress (ISSL) and depression (BDI).Six months after birth, the researcher would schedule an interview in the mother’s residence to reevaluate. During the second phase, 200 mother-baby dyads participated. Mothers responded to the same materials applied in the previous phase and child development was evaluated through a screening test (Denver Scale II).At 14 months, the development of 149 children was reassessed, the mothers once more answered the questionnaires to evaluation of mental health and also a questionnaire about parental care practice and attributed importance (E-CPPC). First, descriptive statistics were developed and next bivariate analysis and, with significant associations, with a p < 0.20 value logistic regressions models were built to identify risk factors and protection to mental symptoms and to child development. The significance level adopted was of p < 0.05.A development risk was identified at six months in 40% of children and 31% at 14 months. The percentage of women with anxiety, stress and depression symptoms were significantly higher during gestation, decreased in afterbirth, with low incidence at 6 and 14 months. Amongst all variables studied, a delay in the language area at fourteen months was associated with maternal postpartum stress in the fourteenth month afterbirth and with inadequate maternal beliefs about stimulation. The lack of association between maternal mental issues and development may have occurred because it is a more complex relationship that has other variables of mother, child and the interaction between them, which should be looked at in future research. The percentage of mothers with mental health gestational issues shows the importance of public politics to be executed at pre-natal services, which could help with prevention and promotion of maternal mental health and child development.
Longitudinal studies about the maternal mental health’s role in the antenatal and postpartum period, during child development and in parental practice and care are still scarce. The arm of this research was to study the association between anxiety symptoms, stress and depression, since the third trimester until fourteen months after birth to the child’s development during the first year, and the role of socio demographic variables and educational practices.320 pregnant women in their last trimester, users of SUS (Brazilian National Health Program) from three São Paulo State’s cities took part in this study. They answered an initial interview and questionnaires to evaluate anxiety (IDATE), stress (ISSL) and depression (BDI).Six months after birth, the researcher would schedule an interview in the mother’s residence to reevaluate. During the second phase, 200 mother-baby dyads participated. Mothers responded to the same materials applied in the previous phase and child development was evaluated through a screening test (Denver Scale II).At 14 months, the development of 149 children was reassessed, the mothers once more answered the questionnaires to evaluation of mental health and also a questionnaire about parental care practice and attributed importance (E-CPPC). First, descriptive statistics were developed and next bivariate analysis and, with significant associations, with a p < 0.20 value logistic regressions models were built to identify risk factors and protection to mental symptoms and to child development. The significance level adopted was of p < 0.05.A development risk was identified at six months in 40% of children and 31% at 14 months. The percentage of women with anxiety, stress and depression symptoms were significantly higher during gestation, decreased in afterbirth, with low incidence at 6 and 14 months. Amongst all variables studied, a delay in the language area at fourteen months was associated with maternal postpartum stress in the fourteenth month afterbirth and with inadequate maternal beliefs about stimulation. The lack of association between maternal mental issues and development may have occurred because it is a more complex relationship that has other variables of mother, child and the interaction between them, which should be looked at in future research. The percentage of mothers with mental health gestational issues shows the importance of public politics to be executed at pre-natal services, which could help with prevention and promotion of maternal mental health and child development.
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Palavras-chave
Saúde mental materna, Práticas Parentais, Desenvolvimento infantil, Delineamento longitudinal, Maternal mental health, Parental practice, Child development, Longitudinal, Delineation