Depresia post-natala - Depresia post-partum

Scala Edinburgh de depresie post-natala (Edinburgh Postnatal Depression Scale - EPDS)

Depresia post-partum este cea mai comuna complicatie de dupa nastere si se intalneste la aproximativ 13% dintre femeile care au nascut64. Daca nu este corect identificata si tratata, depresia post-partum are cele mai mari sanse sa evolueze cronic.

Cea mai frecventa cauza incriminata in aparitia depresiei post-partum este declinul rapid al hormonilor gonadici de dupa nastere. Alaturi de aceste modificari hormonale, evenimentele stresante, discordia familiala si istoria familiala de tulburari afective sunt factori care cresc probabilitatea aparitiei depresiei post-partum65.

Un studiu recent care a cuprins un lot de 5.262 de femei a conturat si alti factori de risc precum istoria familiala de tulburari psihiatrice, nivelul crescut de stres in ultimul trimestru de sarcina si izolarea sociale66.

Scala Edinburgh de depresie post-natala (Edinburgh Postnatal Depression Scale - EPDS) a fost dezvoltata de Cox si colab. (1987)67 pentru a ajuta medicii de medicina generala sa detecteze femeile suferind de depresie post-partum. Scala a fost conceputa si testata in centrele de sanatate din Livingston si Edinburg si consta in 10 intrebari prin care femeia testata trebuie sa aleaga un raspuns din patru eventualitati furnizate de scala referitor la felul cum s-a simtit in ultima saptamana. Scorul maxim este de 30, iar un scor peste 10 tradeaza o posibila depresie; un scor peste 13 sugereaza o depresie de severitate moderat spre sever. Evaluatorul este invitat sa se uite totdeauna la intrebarea nr. 10 despre gandurile suicidare pentru a decela din timp un posibil risc. Studiile de validitate arata ca scala identifica corect 92 % dintre femeile care sufera de depresie post-partum. Scala reuseste sa discearna aceste cazuri de cele cu tulburari anxioase, fobice sau cu tulburari de personalitate. Scala EPDS s-a dovedit un instrument foarte robust pentru decelarea femeilor cu risc de depresie post-partum si este folosita pe larg in activitatile de screening. Ea a fost folosita in diferite spatii culturale si a dovedit o buna senzitivitate (86%), specificitate (78%) si valoare predictiva (73% .

Totusi, ea nu se poate substitui unui examen clinic competent. Un studiu care compara trei scale de decelare timpurie ale depresiei post-partum, Scala Edinburgh, Inventarul de predictie a depresiei post-partum (Postpartum Depression Prediction Inventory) si Scala de screening al depresiei (Postpartum Depression Screening Scale) a aratat ca rezultatele la EPDS coreleaza semnificativ cu cele obtinute la inventarul de predictie a depresiei post-partum, un instrument mai recent si mai sofisticat69. In plus, Scala EPDS s-a dovedit a furniza rezultate stabile atunci cand evaluarile sunt repetate si prezinta trei factori de structura: factorul "depresie" cu intrebarile 1, 2 si 8, factorul "anxietate" cu intrebarile 3, 4 si 5 si factorul "suicid" cu intrebarea 1070.

Scala Edinburgh de depresie post-natala este prezentata in anexa 13.

Anexele pot fi consultate si descarcate la adresa: www.vrasti.org.

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