Eficacia de las intervenciones no farmacológicas en la prevención de la depresión posparto: una revisión sistemática de los resultados en gestantes con y sin factores de riesgo

  • Geraldine Pérez-Miranda Universidad Industrial de Santander
  • Daniela Ortiz-Pinilla Universidad Industrial de Santander
  • Daniel Andrés Niño-Mancera Universidad Industrial de Santander
  • Laura Helena Gómez-Salcedo Universidad Industrial de Santander
  • Karly Vanessa Bayona-Granados Universidad Industrial de Santander

Resumen

Introducción: la depresión posparto es la complicación psiquiátrica más frecuente del periparto, constituye un problema de salud pública debido a consecuencias de corto y largo plazo para madre e hijo. Se considera que el enfoque preventivo tiene gran potencial para reducir su incidencia, así como evaluar la eficacia de las intervenciones según el grupo poblacional al que van dirigidas, contribuye a determinar terapias específicas y disminuir costos en salud. Objetivo: comparar la eficacia de intervenciones no farmacológicas para la prevención de depresión posparto en gestantes con factores de riesgo, respecto a gestantes de la población general. Metodología: se llevó a cabo una búsqueda sistemática en las bases de datos MEDLINE, SCOPUS, CINAHL, EMBASE y LILACS, mediante la cual se identificaron 484 artículos en los idiomas inglés y español, para incluir finalmente, según criterios de elegibilidad y calidad metodológica, un total de 13 ensayos clínicos controlados, que abarcaron una muestra de 5.905 pacientes. Resultados: seis de los siete estudios en gestantes con factores de riesgo impactaron de manera favorable tanto en la disminución de los síntomas como en la disminución del puntaje en las escalas de medición a través del tiempo. En contraste, solo dos de los seis estudios en gestantes de la población general tuvieron impacto significativo. La limitación más importante fue la heterogeneidad de las intervenciones propuestas. Conclusiones: los hallazgos sugieren
que las intervenciones preventivas no farmacológicas tienen mayor eficacia cuando son abordadas en gestantes con factores de riesgo y en el periodo posparto. MÉD.UIS.2021;34(1): 73-90 

Palabras clave: Depresión Posparto, Prevención y control, Factores de Riesgo, Psicoterapia, Ejercicio físico, Atención plena, Apoyo social

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Referencias

1. Afshari, P, Tadayon, M, Abedi, P, Yazdizadeh, S. Prevalence and related factors of postpartum depression among reproductive aged women in Ahvaz, Iran. Health Care Women Int.
019;41(3):1–11.

2. Mendoza C, Saldivia S. Actualización en depresión postparto: el desafío permanente de optimizar su detección y abordaje. Rev. méd. Chile. 2015;143(7):887-894.

3. Asociación Americana de Psiquiatría. Manual Diagnóstico y Estadístico de los Trastornos Mentales, quinta edición (DSM-V). Arlington (VA), EE.UU: American Psychiatric Association Publishing; 2013.

4. Stewart DE, Vigod SN. Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics. Annu. Rev. Med. 2019;70(1):183–196.

5. Norhayati MN, Nik Hazlina NH, Asrenee AR, Wan Emilin WMA. Magnitude and risk factors for postpartum symptoms: Aliterature review. J Affect Disord. 2015;175(1):34–52.

6. World Health Organization. Maternal mental health. [online] Disponible en: http://www.who.int/mental_health/maternalchild/maternal_mental_health/en/.

7. Barrera AZ, Nichols AD. Depression help-seeking attitudes and behaviors among an Internet based sample of Spanishspeaking perinatal women. Rev Panam Salud Publica. 2015;37(3):148–53.

8. Sefogah PE, Samba A, Mumuni K, Kudzi W. Prevalence and key predictors of perinatal depression among postpartum women in Ghana. Int. J. Gynecol. Obstet. 2020;149:203-210.

9. Romero D, Orozco LA, Ybarra JL, Gracia BI. Sintomatología depresiva en el post parto y factores psicosociales asociados. Rev. chil. obstet. ginecol. 2017;82(2):152-162.

10. Rincón-Pabón D, Ramírez-Vélez R. Postnatal depression in Colombian women: secondary analysis of the 2010 Colombian Demographic and Health Survey. Rev. salud pública. 2014;16(4):534-546.

11. Ammerman RT, Scheiber FA, Peugh, JL, Messer EP, Van Ginkel JB, Putnam FW. Interpersonal trauma and suicide attempts in lowincome depressed mothers in home visiting. Child
buse Negl.2019;97:104126.

12. Al Nasr RS, Altharwi K, Derbah MS, Gharibo SO, Fallatah SA, Alotaibi SG, et al. Prevalence and predictors of postpartum epression in Riyadh, Saudi Arabia: A cross sectional study. PLOS ONE. 2020;15(2):e0228666.

13. Martín-Gómez C, Moreno-Peral P, Bellón JA, Conejo-Cerón S, Campos-Paino H, Gómez-Gómez I, et al. Effectiveness of sychological, psychoeducational and psychosocial
nterventions to prevent postpartum depression in adolescent and adult mothers: study protocol for a systematic review and meta-analysisof randomised controlled trials. BMJ Open.
020;10(5):e034424.

14. Cho HJ, Kwon JH, Lee JJ. Antenatal Cognitive-behavioral Therapy for Prevention of Postpartum Depression: A Pilot Study. Yonsei Med J. 2008;49(4):553–562.

15. Tandon SD, Perry DF, Mendelson T, Kemp K, Leis JA. Preventing perinatal depression in low-income home visiting clients: A randomized controlled trial. J Consult Clin Psychol. 2011;79(5):707–712.

16. Stein A., Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child. The Lancet. 2014;384(9956):1800–1819.

17. Guo L, Zhang J, Mu L, Ye Z. Preventing Postpartum Depression With Mindful Self-Compassion Intervention. J Nerv Ment Dis. 2020;208(2):101-107.

18. Maternal depression and child development. J Paediatr Child Health. 2004;9(8):575-598.

19. Beck, CT. Predictors of Postpartum Depression. Nurs Res. 2001;50(5):275–85.

20. Becker M, Weinberger T, Chandy A, & Schmukler, S. Depression During Pregnancy and Postpartum. Curr Psychiatry Rep. 2016;18(3):32.

21. Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289–95.

22. mmittee Opinion No 630. Screening for Perinatal Depression.Obstet Gynecol. 2015;125(5):1268–71.

23. Campo A, Ayola C, Peinado H, Amor M, Cogollo Z. Escala de Edinburgh para depresión posparto: consistencia interna yestructura factorial en mujeres embarazadas de Cartagena,
Colombia. Rev Colomb Obstet Ginecol. 2007;58(4):277-83.

24. Chorwe G, Chipps J. A systematic review of screeningnstruments for depression for use in antenatal services in lowresource settings. BMC Psychiatry. 2017;17(1):112.
2
5. ACOG Committee Opinion No. 757. Obstet Gynecol. 2018;132(5):
208–12.
26. Radloff LS. The CES-D scale a self-report depression scale
for research in the general population. Appl Psychol Meas.
1977;1(3):385–401.
27. Mosack V, Shore E. Screening for Depression among Pregnant andPostpartum Women. J. Community Health Nurs. 2006;23(1):37-47.
28. Records K, Rice M, & Beck CT. Psychometric Assessment of the
Postpartum Depression Predictors Inventory–Revised. J Nurs
Meas. 2007;15(3):189–202.
29. Gorman LL, O’Hara MW, Figueiredo B, Hayes S, Jacquemain
F, Kammerer MH, et al. Adaptation of the Structured Clinical
Interview for DSM-IV Disorders for assessing depression in
women during pregnancy and post-partum across countries and
cultures. Br J Psychiatry. 2004;184(S46):s17–s23.
30. Ruyak SL, Qeadan, F. Use of the Antenatal Risk Questionnaire
to Assess Psychosocial Risk Factors Associated with Risk for
Postpartum Depression: A Pilot Study. J Midwifery Womens
Health. 2018; 63:578-83.
31. Werner E, Miller M, Osborne LM, Kuzava S, Monk C. Preventing
postpartum depression: review and recommendations. Archv
Womens Ment Health. 2014;18(1),41–60.
32. Wang Y, Li H, Peng W, Chen Y, Qiu M, Wang J, et al. Nonpharmacological interventions for postpartum depression.
Medicine (Baltimore). 2020;99(31):e21496.
33. Chabrol H, Teissedre F, Saint-Jean M, Teisseyre N, Roge B,
Mullet E. Prevention and treatment of post-partum depression:
a controlled randomized study on women at risk. Psychol Med.
2002;32(6):1039–47.
34. Cho HJ, Kwon JH, Lee JJ. Antenatal cognitive-behavioral therapy
for prevention of postpartum depression: a pilot study. Yonsei
Med J. 2008;49(4):553–62.
35. Milgrom J, Schembri C, Ericksen J, Ross J, Gemmill AW.
Towards parenthood: an antenatal intervention to reduce
depression, anxiety and parenting difficulties. J Affect Disord.
2011;130(3):385–94.
36. Stephens S, Ford E, Paudyal P, Smith H. Effectiveness of
Psychological Interventions for Postnatal Depression in Primary
Care: A Meta-Analysis. Ann Fam Med. 2016;14(5):463-72.
37. Records K, Rice M, Beck CT. Psychometric Assessment of the
tpartum Depression Predictors Inventory–Revised. J Nurs
Meas. 2007;15(3):189–202.
38. Gorman LL, O’Hara MW, Figueiredo B, Hayes S, Jacquemain
F, Kammerer MH, et al. Adaptation of the Structured Clinical
Interview for DSM-IV Disorders for assessing depression in
women during pregnancy and post-partum across countries and
cultures. Br J Psychiatry Suppl. 2004;184(S46): s17–s23.
39. Duncan LG, Cohn MA, Chao MT, Cook JG, Riccobono J, Bardacke
N. Benefits of preparing for childbirth with mindfulness training:
a randomized controlled trial with active comparison. BMC
Pregnancy Childbirth. 2017;17:140.
40. Bowen A, Baetz M, Schwartz L, Balbuena L, Muhajarine N.
Antenatal group therapy improves worry and depression
symptoms. Isr J Psychiatry Relat Sci. 2014;51(3):226-31.
41. Sacristan-Martin O, Santed MA, Garcia-Campayo J, Duncan
LG, Bardacke N, Fernandez-Alonso C, et al. A mindfulness and
compassion-based program applied to pregnant women and their
partners to decrease depression symptoms during pregnancy and
postpartum: study protocol for a randomized controlled trial.
Trials. 2019;20(1):654.
42. Dennis, C.-L., & Letourneau, N. Global and relationship-specific
perceptions of support and the development of postpartum
depressive symptomatology. Soc Psychiatry Psychiatr Epidemiol.
2007;42(5), 389–395.
43. Lin N, Ye X, Ensel WM. Social support and depressed mood: a
structural analysis. J Health Soc Behav. 1999;40:344-59.
44. Thoits PA. Social support as coping assistance. J Consult Clin
Psychol. 1986;54:416-23.
45. ACOG Committee Opinion No. 650: Physical Activity and
Exercise During Pregnancy and the Postpartum Period. Obstet
Gynecol. 2015;126(6), e135–e142.
46. Ersek JL, Brunner Huber LR. Physical Activity Prior to and
During Pregnancy and Risk of Postpartum Depressive Symptoms.
J Obstet Gynecol Neonatal Nurs. 2009;38(5):556–66.
47. Da Costa D, Rippen N, Dritsa M, Ring A. Self-reported leisuretime physical activity during pregnancy and relationship
to psychological well-being. J Psychosom Obstet Gynaecol.
2003;24(2),111–9.
48. Werner E, Miller M, Osborne LM, Kuzava S, Monk C. Preventing
postpartum depression: review and recommendations. Arch
Womens Ment Health. 2014;18(1),41–60.
49. Morrell CJ, Sutcliffe P, Booth A, Stevens J, Scope A, Stevenson M,
et al. A systematic review, evidence synthesis and meta-analysis
of quantitative and qualitative studies evaluating the clinical
effectiveness, the cost-effectiveness, safety and acceptability of
interventions to prevent postnatal depression. Health Technol
Assess. 2016;20(37):1-414.
50. Chabrol H, Teissedre F, Saint-Jean M, Teisseyre N, Rogé B,
Mullet E. Prevention and treatment of post-partum depression:
a controlled randomized study on women at risk. Psychol Med.
2002;32(6):1039-47.
51. Arango C, Díaz-Caneja CM, McGorry PD, Rapoport J, Sommer IE,
Vorstman JA, et al. Preventive strategies for mental health. Lancet
Psychiatry. 2018;5(7):591-604.
52. Bauer A, Knapp M, McDaid D. Assessing the Economic Pay‐off
of Low‐level Interventions in Reducing Postnatal Depression
[Internet]. LSE Health and Social Care; 2012 [citado 2021 mar 22].
Disponible en: http://www.lse.ac.uk/LSEHealthAndSocialCare/
pdf/DP2806.pdf
53. Frieder A, Fersh M, Hainline R, Deligiannidis KM.
Pharmacotherapy of postpartum depression: current approaches
and novel drug development. CNS Drugs. 2019;33(3):265–82.
54. Yasuma N, Narita Z, Sasaki N, Obikane E, Sekiya J, Inagawa
T, et al. Psychological intervention for universal prevention of
antenatal and postnatal depression among pregnant women:
protocol for a systematic review and meta-analysis. Syst Rev.
2019;8(1):297.
55. Dennis CL, Creedy DK. Psychosocial and psychological
interventions for preventing postpartum depression. Cochrane
Database Syst Rev. 2004;4:CD001134.
56. Dukhovny D, Dennis CL, Hodnett E, Weston J, Stewart D,
Mao W, et al. Prospective economic evaluation of a peer
support intervention for prevention of postpartum depression
among high-risk women in Ontario, Canada. Am J Perinatol.
2013;30(8):631–42
57. Nakku JE, Nakasi G, Mirembe F. Postpartum major depression
at six weeks in primary health care: prevalence and associated
factors. Afr Health Sci. 2006;6(4):207–214.
58. Pan WL, Chang CW, Chen SM, Gau ML. Assessing the
effectiveness of mindfulness-based programs on mental health
during pregnancy and early motherhood - A randomized control
trial. BMC Pregnancy Childbirth. 2019;19(1):1–8.
59. Tandon SD, Ward EA, Hamil JL, Jimenez C, Carter M. Perinatal
depression prevention through home visitation: a cluster
randomized trial of mothers and babies 1-on-1. J Behav Med.
2018;41(5):641-52.
60. Jiang L, Wang ZZ, Qiu LR, Wan GB, Lin Y, Wei Z. Psychological
intervention for postpartum depression J. Huazhong Univ. Sci.
Technol. [Med. Sci.] 2014;34(3):437-42.
61. Austin MP, Frilingos M, Lumley J, Hadzi-Pavlovic D, Roncolato
W, Acland S, et al. Brief antenatal cognitive behaviour therapy
group intervention for the prevention of postnatal depression
and anxiety: a randomised controlled trial. J Affect Disord.
2008;105(1-3):35-44.
62. Haga SM, Drozd F, Lisøy C, Wentzel-Larsen T, Slinning K.
Mamma Mia–A randomized controlled trial of an internetbased intervention for perinatal depression. Psychol Med.
2019;49(11):1850-8.
63. De Vargas C, Rodriguez M, Stein A, Gonçalves B, Garcia D, Pires
F, et al. Efficacy of Regular Exercise During Pregnancy on the
Prevention of Postpartum Depression: The PAMELA Randomized
Clinical Trial. JAMA Netw open. 2019;2(1):e186861.
64. Songøygard KM, Stafne SN, Evensen KAI, Salvesen KÅ, Vik T,
Mørkved S. Does exercise during pregnancy prevent postnatal
depression?: A randomized controlled trial. Acta Obstet Gynecol
Scand. 2012;91(1):62–7.
65. Dennis CL, Hodnett E, Kenton L, Weston J, Zupancic J, Stewart
DE, Kiss A. Effect of peer support on prevention of postnatal
depression among high risk women: multisite randomised
controlled trial. BMJ. 2009;338:a3064.
66. Fonseca A, Alves S, Monteiro F, Gorayeb R, Canavarro MC.
Be a Mom, a web-based intervention to prevent postpartum
depression: results from a pilot randomized controlled trial.
Behavior Therapy. 2020;51(4):616-33.
67. Lara MA, Navarro C, Navarrete L. Outcome results of a psychoeducational intervention in pregnancy to prevent PPD: A
randomized control trial. J Affect Disord. 2010;122(1-2):109-17.
68. Ngai FW, Wong PC, Chung KF, Chau PH, Hui PW. Effect of couple‐based cognitive behavioural intervention on prevention
of postnatal depression: multisite randomised controlled trial.
BJOG. 2020;127(4):500-7.
69. Vismara L, Sechi C, Lucarelli L. Reflective parenting home
visiting program: A longitudinal study on the effects upon
depression, anxiety and parenting stress in first-time mothers.
Heliyon. 2020;6(7):e04292.
70. Özkan SA, Kücükkelepce DS, Korkmaz B, Yılmaz G, Bozkurt
MA. The effectiveness of an exercise intervention in reducing
the severity of postpartum depression: A randomized controlled
trial. Perspect Psychiatr Care. 2020;56(4):844-50.
71. Sockol LE. A systematic review of the efficacy of cognitive
behavioral therapy for treating and preventing perinatal
depression. J Affect Disord. 2015;177:7-21.
72. Nagy E, Moore S. Social interventions: An effective approach to
reduce adult depression? J Affect Disord. 2017;218:131-152.
73. Horowitz JA, Murphy CA, Gregory K, Wojcik J, Pulcini J, Solon
L. Nurse home visits improve maternal/infant interaction and
decrease severity of postpartum depression. J Obstet Gynecol
Neonatal Nurs. 2013;42(3):287-300.
74. Nakamura A, van der Waerden J, Melchior M, Bolze C, El-Khoury
F, Pryor L. Physical activity during pregnancy and postpartum
depression: Systematic review and meta-analysis. J Affect
Disord. 2019;246:29–41.
75. Pritchett R V., Daley AJ, Jolly K. Does aerobic exercise reduce
postpartum depressive symptoms?: A systematic review and
meta-analysis. Br J Gen Pract. 2017;67(663):e684–91.
76. Daley AJ, Foster L, Long G, Palmer C, Robinson O, Walmsley H, et
al. The effectiveness of exercise for the prevention and treatment
of antenatal depression: Systematic review with meta-analysis.
BJOG. 2015;122(1):57–62.
77. Carter T, Bastounis A, Guo B, Morrell CJ. The effectiveness
of exercise-based interventions for preventing or treating
postpartum depression: a systematic review and meta-analysis.
Arch Womens Ment Health. 2019;22(1):37–53.
78. Fontein-Kuipers YJ, Nieuwenhuijze MJ, Ausems M, Budé L, De
Vries R. Antenatal interventions to reduce maternal distress: A
systematic review and meta-analysis of randomised trials. BJOG.
2014;121(4):389–97.
79. Campolong K, Jenkins S, Clark MM, Borowski K, Nelson N,
Moore KM, et al. The association of exercise during pregnancy
with trimester-specific and postpartum quality of life and
depressive symptoms in a cohort of healthy pregnant women.
Arch Womens Ment Health. 2018;21(2):215–24.
80. Shorey S, Ang L, Hon B, Yin C. A systematic mixed-studies
review on mindfulness- based childbirth education programs
and maternal outcomes. Nursing Outlook. 2019;67(6):696–706.
81. Sheffield KM, Woods-Giscombé CL. Efficacy, feasibility, and
acceptability of perinatal yoga on women’s mental health
and well-being: a systematic literature review. J Holist Nurs.
2016;34(1):64–79.
82. Taylor BL, Cavanagh K, Strauss C. The Effectiveness of MindfulnessBased Interventions in the Perinatal Period: A Systematic Review
and Meta-Analysis. PLoS One. 2016;11(5):1–29.
83. Smith CA, Shewamene Z, Galbally M, Schmied V, Dahlen H. The
effect of complementary medicines and therapies on maternal
anxiety and depression in pregnancy: A systematic review and
meta-analysis. J Affect Disord. 2019;245(1):428-39.
84. Gaston A, Cramp A. Exercise during pregnancy: A review of
patterns and determinants. J Sci Med Sport. 2011;14(4):299–305.
Publicado
2021-06-01
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