Fattori predittivi e di rischio di sviluppare un disturbo dell'umore in gravidanza e nel postpartum

Goals: In the frame of the wide subject related to pregnancy, delivery, puerperium, and the baby’s first year of life, which have been observed in the social economical and family environment, the problems of the post-partum depression have been emphasized. The aim of the present research is that: to identify those factors which, during pregnancy, could be predictive of behaviour disturbance – anxiety and/or depression – in post partum and in puerperium; to evaluate the incidence of the symptoms related to behaviour disturbance during pregnancy and post-partum; to train gynecologists facing the psychological and relational problems from the pre-conception checkup to puerperium while also give them the tools to distinguish the “baby blues” from depression and be able to single out those patients who are at risk to be affected by behaviour disturbance during puerperium; to identify therapeutic skills to prevent postpartum depression and other behaviour disturbance. Materials and methods: A series of tests to check the anxiety level (STAT1-state) and the depression status (Beck test) have been submitted to a sample of patients at the 22nd week of pregnancy or more, after having been informed about and have accepted to participate in the present research; seven days after delivery the same sample have been asked to be submitted to another series of tests and to two self-evaluation tests as the Edinburg postanatal Depression Scale (EDPS) (a self-evaluation test to screen those patients who present depressive symptoms after delivery) and the Multidimensional Scale of Perceived Support (MSPSS) which allows to evaluate the supportive capability of the social assistance, and in particuolar the efficacy of the perceived support from three sources: family, friends, other significant persons. The same tests have been repeated after one, three and six months after delivery; in addition the Parental Boding Instrument (PBI) has been submitted in order to measure the quality of the interiorized relations with parents during childhood; three months after delivery the SF 36 (a psycometric generic test) has been submitted in order to evaluate the activity and well being levels. All contacted women have accepted to be part of this research. The final sample have been made of 300 women, of average age of 33 years old (range 20-40), which 95% of Italian nationality, 49% with a high school degree, 45% with a university degree, 93% employed, most of them at the first pregnancy (98%) and married (65%) or anyhow involved in a stable relationship (35%). Results: According to examined sample, the 8% of the patients (24) older than 30 years old shows an alteration of the anxiety status (STAT1) greater than the reference cut-off of 2,5% of the patients (7) younger than 30 years old. For the same sample, the data obtained from the Beck test revealed a small to medium alteration of the depression level in the 25% of the women younger than 30 and in the 75% for those older than 30. According to the Beck test, in the most serious cases of depression this age difference disappears. This might suggest that the age is a critical factor only in light or medium behaviour disturbance. Seven days after delivery (270 women) the 24% (65 women) have accused a status anxiety, the 28 % (59) have perceived not to be enough supported by their family; one month after delivery, considering the sample of 270 women, the results of the three tests have not lowered as compared with the first tests submitted seven days after delivery. Three months after delivery, however, it has been shown a significant decrease in the status anxiety (7%) and in the depression symptoms accused by the 17% of the examined population, while a high percentage (25%) has perceived a lack in support. The SF-36 submitted at three months after delivery shows that the 8% of the population feels not to be in good health, while the 29% feels ok and the rest feels very good. Six months after delivery, only 5% of the population still accuses status anxiety, while the depression symptoms are the half as compared with the data found one month after delivery (from 77 to 34 women) while the perception of a lack of support is still high (25%, 67 women). Conclusions: The present research is based on the bio-psyco-social analysis of 300 pregnant women from pregnancy to the baby first year of life. Although only 57 have been observed until one year after delivery, and although most of them seems not to be comfortable in expressing their feelings and symptoms, the collected data seem to be significant in the aim to give to the doctors – and in particular – to gynecologists the tools to identify the patients at risk and to make an early diagnosis of behaviour disturbance. On the basis of the results, it should therefore be produced, at this stage, a series of Indications and recommendations and a Line up which can be used to identify, select and adopt the right behaviours both in clinic and in research.