Ansiedade e depressão em mulheres climatéricas com e sem filhos atendidas na rede básica de atenção à saúde
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Data
2018-03-02
Autores
Mazzetto, Fernanda Moerbeck Cardoso
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Diante das inúmeras transformações sociais dos últimos anos, o climatério tem representado para a mulher momento de estresse e de risco para a ansiedade e a depressão. Objetivo: Analisar os sinais e sintomas de ansiedade, depressão durante o climatério em mulheres com e sem filhos. Compreender a vivência dessas mulheres, a significação de ter tido filhos ou não, as reflexões afetivas e sugestões de melhorias ao atendimento à saúde. Método: Trata-se de um estudo na modalidade quantiqualitativa, transversal e de campo. Utilizou-se, na parte qualitativa, a técnica do Discurso do Sujeito Coletivo. Foram investigadas 204 mulheres na parte quantitativa do estudo, com faixa etária entre 45 e 60 anos, atendidas em unidade da rede de atenção à saúde em município do estado de São Paulo. E na parte qualitativa foram entrevistadas 33 mulheres climatéricas. A coleta de dados deu-se pela entrevista e questionários de Hamilton (HADS) para avaliação da ansiedade e depressão e escala de Índice menopausal de Blatt e Kupperman (IMBK). O início da coleta aconteceu após a aprovação do projeto da pesquisa pela Comissão de Ética em Pesquisa. Resultado: A média etária variou entre os grupos G1 (mulheres com filhos) 48,7(±4,5) e G2 (mulheres sem filhos) 54,0(±5,5). Predominou entre os grupos a cor branca, religião católica, o ensino médio completo, a renda familiar até dois salários mínimos. Considerando os escores das escalas de ansiedade e depressão de Hamilton (HADS) e os escores de Índice Menopausal entre as mulheres do G1 e G2, não houve associação significativa entre os escores de ansiedade, depressão e Ìndice Menopausal e ter ou não ter tido filhos (p>0,05). Porém houve associação significativa dos escores de ansiedade e depressão de Hamilton e Índice Menopausal entre as mulheres que tem vínculos com programas oferecidos pela rede básica de atenção à saúde (p<0,05). As mulheres climatéricas vivem esse período de forma natural, sabem que é o fim da fertilidade, verbalizam dúvidas e desejam estar saudáveis apesar do desconforto psicofísico e do envelhecimento. Percebem alterações nas relações familiares de forma positiva ou conflituosa. Na parte qualitativa, emergiram os temas: Vivência do climatério; Significação de ter ou não ter tido filhos; Relacionando-se afetivamente; Sugerindo melhorias no atendimento à saúde. Conclusão: O estudo evidenciou que não houve associação significativa dos escores de Ansiedade e Depressão de Hamilton e Índice Menopausal e ter ou não ter tido filhos( p>0,05). Porém houve associação altamente significativa dos escores de Ansiedade e Depressão de Hamilton e Índice Menopausal entre as mulheres que possuem vínculos em programas oferecidos pela rede básica de atenção à saúde(p<0,05). Propomos que as mulheres possam reconhecer a fase pela qual estão passando, controlando os fatores que podem auxiliar na redução dos sintomas menopausais e definir grupos que necessitem de maior atenção por parte dos serviços de saúde. O atendimento deve ser feito pela equipe multiprofissional e interdisplinar com diagnóstico precoce de doenças crônicas, atendimento ginecológico e psicoclínico.
Introduction: Faced with the numerous social transformations of recent years, the climacteric period has been represented for women as a moment of stress and risk for anxiety and depression. Purpose: To analyze the signs and symptoms of anxiety and depression during the climacteric period in women with and without children. To understand the experience of these women, the significance of having children or not, the affective reflections and suggestions for improvements in health care. Method: This is a quanti-qualitative, cross-sectional and field study. The technique of Collective Subject Discourse was used in the qualitative part. A total of 204 women, aged between 45 and 60 years old, were investigated in the quantitative part of the study; they were treated at a unit of the health care network in a city in the state of São Paulo. In the qualitative part, 33 climacteric women were interviewed. Data collection was carried out by interview and Hamilton questionnaires (HADS) for evaluation of anxiety and depression and the Menopausal Index scale of Blatt and Kupperman (IMBK) evaluated the climacteric symptoms. Data collection occurred after the approval of the research project by the Research Ethics Committee. Results: The average age varied between G1 (women with children) 48.7 (± 4.5.7) and G2 (women without children) 54.0 (± 5.5). The following characteristics were predominant between the groups: white color, Catholic religion, complete high school, family income up to two minimum wages. Considering the Hamilton Anxiety and Depression Scale (HADS) scores and the Menopausal Index scores among G1 and G2 women, there was no significant association between anxiety, depression scores and Menopausal Index and whether or not they had children ( p> 0.05). However, there was a significant association between Hamilton's anxiety and depression scores and Menopausal Index among women linked to programs offered by the basic health care network (p <0.05). Climacteric women live this period naturally; they know it is the end of fertility; they verbalize doubts and wish to be healthy despite the psychophysical discomfort and aging. They perceive changes in family relationships in a positive or conflictive way. In the qualitative part of the study, the following themes emerged: Climacteric experience; Significance of having or not having had children; Relating affectively; Suggesting improvements in health care. Conclusion: The study showed that there was no significant association between the Hamilton Anxiety and Depression scores and the Menopausal Index and the fact of having had children or not (p> 0.05). However, there was a highly significant association between the Hamilton Anxiety and Depression scores and the Menopausal Index among women linked to programs offered by the basic health care network (p <0.05). We propose that women be able to recognize the phase they are going through, controlling factors that may help reduce menopausal symptoms and define groups that need more attention from the health services. The care must be given by the multiprofessional and interdisciplinary team with early diagnosis of chronic diseases, gynecological and psychoclinic care.
Introduction: Faced with the numerous social transformations of recent years, the climacteric period has been represented for women as a moment of stress and risk for anxiety and depression. Purpose: To analyze the signs and symptoms of anxiety and depression during the climacteric period in women with and without children. To understand the experience of these women, the significance of having children or not, the affective reflections and suggestions for improvements in health care. Method: This is a quanti-qualitative, cross-sectional and field study. The technique of Collective Subject Discourse was used in the qualitative part. A total of 204 women, aged between 45 and 60 years old, were investigated in the quantitative part of the study; they were treated at a unit of the health care network in a city in the state of São Paulo. In the qualitative part, 33 climacteric women were interviewed. Data collection was carried out by interview and Hamilton questionnaires (HADS) for evaluation of anxiety and depression and the Menopausal Index scale of Blatt and Kupperman (IMBK) evaluated the climacteric symptoms. Data collection occurred after the approval of the research project by the Research Ethics Committee. Results: The average age varied between G1 (women with children) 48.7 (± 4.5.7) and G2 (women without children) 54.0 (± 5.5). The following characteristics were predominant between the groups: white color, Catholic religion, complete high school, family income up to two minimum wages. Considering the Hamilton Anxiety and Depression Scale (HADS) scores and the Menopausal Index scores among G1 and G2 women, there was no significant association between anxiety, depression scores and Menopausal Index and whether or not they had children ( p> 0.05). However, there was a significant association between Hamilton's anxiety and depression scores and Menopausal Index among women linked to programs offered by the basic health care network (p <0.05). Climacteric women live this period naturally; they know it is the end of fertility; they verbalize doubts and wish to be healthy despite the psychophysical discomfort and aging. They perceive changes in family relationships in a positive or conflictive way. In the qualitative part of the study, the following themes emerged: Climacteric experience; Significance of having or not having had children; Relating affectively; Suggesting improvements in health care. Conclusion: The study showed that there was no significant association between the Hamilton Anxiety and Depression scores and the Menopausal Index and the fact of having had children or not (p> 0.05). However, there was a highly significant association between the Hamilton Anxiety and Depression scores and the Menopausal Index among women linked to programs offered by the basic health care network (p <0.05). We propose that women be able to recognize the phase they are going through, controlling factors that may help reduce menopausal symptoms and define groups that need more attention from the health services. The care must be given by the multiprofessional and interdisciplinary team with early diagnosis of chronic diseases, gynecological and psychoclinic care.
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Palavras-chave
climatério, saúde da mulher, ansiedade, depressão, climacteric, women's health, anxiety, depression