PSYCHOSOCIAL RISK FACTORS FOR POSTPARTUM DEPRESSION: AN INTEGRATIVE REVIEW
SUMMARY
Introduction: Postpartum depression (PPD) is one of the most recurrent non-obstetric complications associated with pregnancy, described by DSM-V as a specifier of major depressive disorder. Unlike maternity blue, which is a common, non-harmful and with spontaneous remission reaction, PPD is a more severe and persistent condition and, therefore, it has a negative impact on the maternal-infant relationship and increases the likelihood of self and heteroaggressions occurring. Although its etiopathology is not yet well defined, this condition is recognized as an important cause of maternal morbidity, which makes it a significant problem in the public health area. Objective: To identify, in the scientific literature, psychosocial risk factors for postpartum depression in women in this period. Methodology: This is an integrative review of the literature that collected data using the PubMed, SciELO and LILACS databases. The descriptors were correlated through the boolean operators AND and OR: "risk factors", "postpartum period", "postpartum" and "depressive disorder", according to the MeSH terms; "depression", "postpartum depression", "puerperal depression", "postnatal depression" and "risk factors", according to the DeCS; as well as the free term "postpartum". Results: We selected 11 articles published between 2010 and 2019, which were analyzed according to their objectives and main results. Thus, the risk factors for the development of PPD were identified, which include, among others, the lower maternal age and the lower participation in decisions concerning the child, aspects that are often associated. Moreover, regarding interpersonal relationships, are considered as predisposing factors: the frequent marital conflicts; the instability of consensual union; the lack of support offered by the partner and the other people with whom the parturient maintains a relationship; the presence of anguish and restlessness in the family; being a single mother; and the sexual problems in the postnatal period. Inadequate housing, financial difficulties, less than 12 weeks of maternity leave and lower schooling are social factors that increase the likelihood of developing this disturbance. Similarly, the late onset of breastfeeding; the use of infant formulae; transpelvic delivery and multiple pregnancies are also issues involved in this problem, as well as the medical complications linked to the mother and baby; the low weight of the baby at birth and at four weeks of life; hypertensive disorders in pregnancy; postpartum dysphoria; prematurity; and perinatal death. Furthermore, the history of adverse physical and/or sexual experiences in childhood; of spontaneous abortions; of depression; and of domestic violence have a negative impact on the lives of mothers, making them more susceptible to PPD. Finally, aspects associated with personality and behavioral patterns, consisting of somatic or psychic traumatic anxiety; distrust; neuroticism; mother’s frequent exposure to the cell phone; and depressive or anxious manifestations in the premenstrual period or pregnancy are other psychosocial risk issues. Conclusion: The predisposing factors to postpartum depression should be considered so that health professionals can plan and carry out actions aimed at promoting mental well-being, as well as prevention and early diagnosis of this disorder. As a result, an appropriate environment would be built to combat PPD in order to avoid the harmful consequences of this pathology.
Keywords: Postpartum depression, postpartum period, risk factors.
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