Mental illness constitutes a serious public health problem in our setting, with high morbidity, very high social health costs and a higher incidence in women. The gestational period and the puerperium stand as stressors capable of triggering or exacerbating pre-existing mental illness.
Mental illness constitutes a serious public health problem in our setting, with high morbidity and very high social and health costs. According to the 2006 Strategic Plan in Mental Health of the National Health System:
– 9% of the Spanish population currently suffers from a mental disorder and 15% will suffer from it throughout their lives.
– Spain is, behind Italy, the EU country with the lowest prevalence rates of mental illness.
– Psychiatric illness occurs more frequently in women, people without a partner, the unemployed, the elderly, and urban dwellers.
– Its incidence increases with age.
– Women go to the doctor more when perceiving these types of disorders than men and they are administered psychotropic drugs more frequently.
Regarding our daily work as obstetricians and the psychological adaptation of women to pregnancy, both the gestational period and the puerperium act as stressors that can trigger or exacerbate mental illness, and in fact, the prevalence of psychiatric disorders during pregnancy reaches 14% . The main concerns of pregnant women revolve around the health of the fetus, care of the newborn, change of lifestyle after childbirth and fear of labor pain, among others. Furthermore, the level of perceived stress is higher if the fetus has a high risk of congenital malformations or in pregnancies with medico-obstetric complications.
Consiste en la aparición de cambios bruscos en el estado de ánimo que experimentan el 15-85% de las puérperas en los primeros 10 días posparto, mostrando un pico de incidencia máxima en el .° día. Su aparición es más frecuente en mujeres con trastornos disfóricos menstruales previos o depresión pregestacional o gestacional, aunque no existe actualmente ninguna variable biológica que podamos utilizar como predictor de este trastorno. El cuadro sintomático de presentación se caracteriza por aparición de oscilaciones del humor (euforia seguida de ganas de llorar), irritabilidad, confusión y fatiga. A pesar de que se trata de un cuadro transitorio y de que no requiere de intervención terapéutica, su identificación por parte del obstetra es fundamental, pues constituye un factor de riesgo para el desarrollo ulterior de un cuadro de depresión puerperal.
It is defined as a major depressive episode that appears in the first 4 weeks after delivery and lasts at least 2 weeks, although, due to the peculiarity of this entity, the definition criteria are more lax in terms of the time period of appearance. It has an incidence of 10-15% and a recurrence rate in subsequent deliveries of up to 70% . As risk factors in the onset of this disease, a history of pre-pregnancy or gestational depression, previous menstrual dysphoric disorders, a history of hyperemesis gravidarum, young maternal age, lack of social or family support, the fact of being immigrant, lack of a partner, substance abuse disorders, postpartum blues in previous weeks as well as maternal and newborn sleep disorders.
The puerperium is a time of risk for the appearance of mental illness. For this reason, the obstetrician plays a fundamental role in its early detection and in its therapeutic orientation in an appropriate way. Postpartum depression is, both due to its high incidence and due to the adverse neonatal outcomes in the short and long term and due to the social and emotional imbalance that it causes in women and their environment, a picture that we must be aware of.