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      Sintomatología depresiva materna en México: prevalencia nacional, atención y perfiles poblacionales de riesgo Translated title: Maternal depressive symptomatology in México: National prevalence, care, and population risk profiles

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          Abstract

          Objetivo. Estimar la prevalencia de sintomatología depresiva (SD) en madres de menores de cinco años, tasas de detección y atención y probabilidades de presentar SD de acuerdo con perfiles de riesgo específicos. Material y métodos. Muestra de 7 187 mujeres con hijos menores de cinco años, proveniente de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012. Resultados. La prevalencia de SD es de 19.91%, lo que implica que 4.6 millones de menores viven con madres que podrán sufrir depresión moderada o grave. Hay bajas tasas de detección (17.06%) y atención (15.19%) de depresión. La SD se asocia con violencia (OR=2.34; IC95% 1.06-5.15), tener más de cuatro hijos, sexo femenino del menor, mayor edad del último hijo, bajo peso al nacer, inseguridad alimentaria y haber iniciado vida sexual antes de los 15 años (p<0.01). La probabilidad acumulada de SD, si se consideran todos los factores de riesgo, es de 69.76%; se podría reducir a 13.21% con medidas preventivas enfocadas en eliminar la violencia, la inseguridad alimentaria, las valoraciones inequitativas de género y el bajo peso al nacer. Conclusiones. La SD es un problema relevante de salud pública en México; está asociada con un conjunto bien determinado de factores de riesgo que ameritan prevención, así como detección y atención oportuna en los distintos niveles de atención.

          Translated abstract

          Objective. This study estimates the prevalence of depressive symptomatology (DS) in women with children younger than five years of age, examines detection and care rates and probabilities of developing DS based on specific risk profiles. Materials and methods. The sample consists of 7 187 women with children younger than five drawn from the Ensanut 2012. Results. DS prevalence is 19.91%, which means at least 4.6 million children live with mothers who experience depressive symptoms indicative of moderate to severe depression. Rates of detection (17.06%) and care (15.19%) for depression are low. DS is associated with violence (OR=2.34; IC95% 1.06-5.15), having ≥4 children, having a female baby, older age of the last child, low birth weight, food insecurity, and sexual debut <15 years old (p<0.01). Accumulated probability of DS, taking into consideration all risk factors measured, is 69.76%. It could be reduced to 13.21% through prevention efforts focused on eliminating violence, food insecurity, bias against having a female baby, and low birth weight. Conclusions. DS is a compelling public health problem in Mexico associated with a well-defined set of risk factors that warrant attention and timely detection at various levels of care.

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          Children of depressed parents: an integrative review.

          This article reviews the various literatures on the adjustment of children of depressed parents, difficulties in parenting and parent-child interaction in these families, and contextual factors that may play a role in child adjustment and parent depression. First, issues arising from the recurrent, episodic, heterogeneous nature of depression are discussed. Second, studies on the adjustment of children with a depressed parent are summarized. Early studies that used depressed parents as controls for schizophrenic parents found equivalent risk for child disturbance. Subsequent studies using better-defined samples of depressed parents found that these children were at risk for a full range of adjustment problems and at specific risk for clinical depression. Third, the parenting difficulties of depressed parents are described and explanatory models of child adjustment problems are outlined. Contextual factors, particularly marital distress, remain viable alternative explanations for both child and parenting problems. Fourth, important gaps in the literature are identified, and a consistent, if unintentional, "mother-bashing" quality in the existing literature is noted. Given the limitations in knowledge, large-scale, long-term, longitudinal studies would be premature at this time.
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            The costs of depression.

            The data reported herein show clearly that major depression is a commonly occurring and burdensome disorder. The high prevalence, early age of onset, and high persistence of MDD in the many different countries where epidemiologic surveys have been administered confirm the high worldwide importance of depression. Although evidence is not definitive that MDD plays a causal role in its associations with the many adverse outcomes reviewed here, there is clear evidence that depression has causal effects on a number of important mediators, making it difficult to assume anything other than that depression has strong causal effects on many dimensions of burden. These results have been used to argue for the likely cost -effectiveness of expanded depression treatment from a societal perspective. Two separate, large-scale, randomized, workplace depression treatment effectiveness trials have been carried out in the United States to evaluate the cost effectiveness of expanded treatment from an employer perspective. Both trials had positive returns on investment to employers. A substantial expansion of worksite depression care management programs has occurred in the United States subsequent to the publication of these trials. However, the proportion of people with depression who receive treatment remains low in the United States and even lower in other parts of the world. A recent US study found that only about half of workers with MDD received treatment in the year of interview and that fewer than half of treated workers received treatment consistent with published treatment guidelines. Although the treatment rate was higher for more severe cases, even some with severe MDD often failed to receive treatment. The WMH surveys show that treatment rates are even lower in many other developed countries and consistently much lower in developing countries. Less information is available on rates of depression treatment among patients with chronic physical disorders, but available evidence suggests that expanded treatment could be of considerable value. Randomized, controlled trials are needed to expand our understanding of the effects of detection and treatment of depression among people in treatment for chronic physical disorders. In addition, controlled effectiveness trials with long-term follow-ups are needed to increase our understanding of the effects of early MDD treatment interventions on changes in life course role trajectories, role performance, and onset of secondary physical disorders.
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              Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: a systematic review and meta-analysis.

              To date, few systematic reviews of observational studies have been conducted to comprehensively evaluate the co-morbidity of intimate partner violence (IPV) and specific depression outcomes in women. In this systematic review and meta-analysis, we summarize the extant literature and estimate the magnitude of the association between IPV and key depressive outcomes (elevated depressive symptoms, diagnosed major depressive disorder and postpartum depression). PubMed (January 1, 1980-December 31, 2010) searches of English-language observational studies were conducted. Most of the selected 37 studies had cross-sectional population-based designs, focused on elevated depressive symptoms and were conducted in the United States. Most studies suggested moderate or strong positive associations between IPV and depression. Our meta-analysis suggested two to three-fold increased risk of major depressive disorder and 1.5-2-fold increased risk of elevated depressive symptoms and postpartum depression among women exposed to intimate partner violence relative to non-exposed women. A sizable proportion (9%-28%) of major depressive disorder, elevated depressive symptoms, and postpartum depression can be attributed to lifetime exposure to IPV. In an effort to reduce the burden of depression, continued research is recommended for evaluating IPV preventive strategies. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                spm
                Salud Pública de México
                Salud pública Méx
                Instituto Nacional de Salud Pública (Cuernavaca )
                0036-3634
                April 2015
                : 57
                : 2
                : 144-154
                Affiliations
                [1 ] Instituto Nacional de Salud Pública México
                [2 ] Ball State University Estados Unidos de América
                Article
                S0036-36342015000200009
                b978145f-b333-4078-a091-4710ac2078ba

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Mexico

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0036-3634&lng=en
                Categories
                Health Policy & Services

                Public health
                depression,depresive symptomatology,risk factors,detection,care,Mexico,depresión,sintomatología depresiva,factores de riesgo,detección,atención,México

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