Impacto de um programa de intervenção psicossocial intergeracional na prevalência de sintomas depressivos maternos no primeiro ano após o parto

Abstract

Environment plays a role increasingly evident in child health and development. Adverse situations, such as maternal depression, can contribute to several negative outcomes in children. Objectives: To evaluate the impact of an intergenerational psychosocial intervention program on maternal depressive symptoms' prevalence in the first year after birth, to analyze associated factors with maternal depressive symptoms and to analyze intervention’s effect size for the most socioeconomic vulnerable subgroup. Methods: The sample was recruited at Sofia Feldman’s Hospital and at Hospital das Clínicas’s premature babies follow up clinic, both in Belo Horizonte. A quasi-experimental clinical trial with two arms (ReBEC RBR-6ct969) was carried out, applying an intergenerational psychosocial intervention, focusing on mothers and babies, during the first year after childbirth. Intervention was composed of three elements: application of the Newborn Behavioral Observation (NBO) at maternity and when babies were 2 months old, mothers’ group mediated by a health professional before discharge and at 2, 4, 6, 9 and 12 months and use of “Baby’s Book” as a guide for group discussions. Evaluation of depressive symptoms was done with Edinburgh Postnatal Depression Scale (EPDS) when babies were 2 and 9 months old. For preterm infants, corrected gestational age was considered at all evaluations. To assess the association between variables and the depressive symptoms was adjusted Logistic Marginal Models and the effect size of the intervention was calculated using Cohen's d. A significance level of 5% was adopted. Results: 494 dyads were divided into control (n = 349, 70.6%) and intervention (n = 145, 29.4%) groups. The sample consisted predominantly of premature (75.5%) and low birth weight babies (67.4%). Regarding mothers, 62.4% had a partner, and only one third (33.4%) came from Belo Horizonte. Most families (58.5%) were classified in classes C1/C2 according to ABEP, and 15% of the mothers were beneficiaries of the Bolsa Família program. The average maternal schooling was 9.71 years. A prevalence of 27.4% and 26.1% of maternal depressive symptoms were found at 2 and 9 months, respectively. Multivariate analysis showed an association between maternal schooling and depressive symptoms' prevalence (p = 0.000), and that for each year increased in mother's schooling the probability of presenting depressive symptoms decreased by 0.83 [0.76; 0.91] times. In the intervention group, there was no statistically significant reduction in the prevalence of maternal depressive symptoms at 9 months and the effect size was considered small (Cohen's d = 0.20). When the groups were adjusted by Bolsa Família, it was verified that intervention’s effect size in a subgroup of mothers receiving Bolsa Família was large (Cohen's d = 1.17), indicating a reduction of 2,13 times the chance of mothers being depressed at 9 months in this subgroup. Conclusion: Maternal depressive symptoms’s prevalence was compatible with other studies in Brazilian population. Low maternal schooling was a risk factor for depressive symptoms’s occurrence. Intervention’s effect was considered small, but for mothers who received Bolsa Família (the most socioeconomic vulnerable subgroup) a significant reduction of these symptoms was observed at 9 months.