Acontecimientos vitales estresantes asociados a la sintomatología depresiva y postraumática en puérperas mexicanas expuestas a violencia extrema ambiental

Durante los ultimos anos el estudio de los Acontecimientos Vitales Estresantes (AVE´s) ha generado un gran interes en el campo de los trastornos psiquiatricos posnatales. Parte de este interes se relaciona con el reconocimiento de determinados factores de tipo biologico, psicosocial y ambiental, que interactuan entre si y pueden asociarse con una mayor vulnerabilidad al estres y mayor riesgo de Depresion Posparto (DPP) u otras psicopatologias posnatales. A partir de la inclusion de las muestras de los paises en vias de desarrollo con caracteristicas socio-demograficas, educativas y de salud especificas, ha sido posible observar tasas de prevalencia de DPP y otros trastornos muy superiores a las publicadas en las muestras de los paises desarrollados. Asimismo, se ha reconocido la presencia de nuevos factores de riesgo que dificilmente se presentan en las poblaciones desarrolladas. No obstante, continua siendo escasa la evidencia sobre la Psicopatologia Perinatal en los paises en vias de desarrollo. La presente investigacion estudia la relacion entre determinados AVE´s remotos y recientes y la sintomatologia depresiva y postraumatica en el posparto, en una muestra de mujeres Mexicanas que dio a luz en una ciudad con elevadas tasas de violencia extrema ambiental debido a la Guerra contra el narcotrafico. Para cumplir el objetivo principal, se desarrollaron dos estudios que evaluaron a 234 mujeres durante las primeras 24 horas del posparto y se les dio seguimiento a las a las 8-12 semanas (n=148). Cada uno con un diseno, metodologia, resultados y conclusiones propias. En el primero se determinaron tasas de prevalencia de sintomas depresivos, se evaluaron de forma simultanea, los AVE´s remotos y recientes y se identifico su asociacion con la sintomatologia depresiva en ambos periodos posnatales. Los resultados reportaron tasas de prevalencia superiores al 45% en ambos periodos y se observo que violencia extrema ambiental (OR: 4,04, 95% IC: 1,88-8,64; OR: 2,29, 95%IC: 0,97-5,37, respectivamente) y en la relacion de pareja (OR: 3,00, 95% IC: 1,34-6.37; OR: 2,46, 95% IC: 0,91-6,64, respectivamente) eran los AVE´s mas asociados a los sintomas depresivos durante las 8-12 semanas del posparto. El segundo estudio evaluo la prevalencia de sintomas postraumaticos, las formas de violencia extrema ambiental experimentadas en el perinato, su impacto subjetivo y su asociacion con la aparicion de sintomas postraumaticos durante las primeras 8-12 semanas del posparto. Cerca del 50% presentaba sintomas postraumaticos a las 24 horas y alrededor del 23% a las 8-12 semanas del posparto. El asesinato de una persona cercana durante el embarazo se asocio con la severidad de los sintomas postraumaticos en el posparto inmediato (? : 6,89, 95%IC: 1,22-12,56) y con sus sub-escalas (re-experimentacion: ? : 6,62 95% IC: 5,05-7,73; evitacion: ? : 0,72, 95%IC: -1,70-3,13; y aumento de la activacion: ? : 1,85, 95%IC: 0,28-3,57). Experimentar el asesinato de un familiar despues del parto fue el evento violento mas asociado con el incremento de los sintomas relacionados con la evitacion (? : 2,16, 95% IC: 0.37-10,89) a las 8-12 semanas del posparto. Estos eventos obtuvieron las puntuaciones con mayor impacto subjetivo. Se concluye que la violencia extrema ambiental y en la relacion de pareja son los AVE´s con mayor asociacion predictiva para los sintomas depresivos en el posparto. Las formas de violencia extrema ambiental mas asociadas a los sintomas postraumaticos fueron el asesinato de personas cercanas y/o familiares, que estan caracterizadas por su elevado impacto subjetivo. El presente trabajo es innovador, ya que brinda tasas de prevalencia y factores asociados a la sintomatologia depresiva y postraumatica en el posparto en una muestra con caracteristicas muy especificas que no habia sido estudiada anteriormente debido a su complejidad social. Este se suma a los reducidos estudios de factores de riesgo de psicopatologia perinatal en los paises en vias de desarrollo. During the last years the study of stressful life events (SLE) has generated great interest in the field of postnatal psychiatric disorders. Part of this interest is related to the recognition of certain biological, psychosocial and environmental factors that interact with each other and could be associated with high vulnerability to stress and also with the risk of Postpartum Depression (PPD) or other postnatal psychopathologies. From the inclusion of samples from developing countries with specific socio-demographic, educational and health characteristics, it has been possible to observe prevalence rates of DPP and other mental disorders far superior to those prevalence rates published in samples of developed countries. Likewise, it has also recognized the presence of new risk factors that hardly occur in developed populations. However, there is little evidence on Perinatal Psychopathology in populations of developing countries. So, this research studies the role of some remote and recent SLE on the development of depressive and post-traumatic symptoms in postpartum, in a sample of Mexican women who gave birth in a city with high rates of community violence due to “Military Mexican Drug War”. In order to fulfill the main goal, two prospective studies were conducted, which evaluated 234 women during the first 24 hours postpartum and were invited to participate in an 8-12 weeks follow-up study (n = 148). Each study had its own design, methodology, results and conclusions. In the first study, prevalence rates of depressive symptoms were determined, remote and recent SLE were evaluated simultaneously, and it also analyzed their association with postnatal depressive symptoms in both periods. The results of this study reported prevalence rates above 45% in both periods and determined that community violence (OR: 4.04, 95% CI: 1.88 to 8.64; OR: 2.29, 95% CI: 0.97 to 5.37, respectively) and intimate partner violence (OR: 3.00, 95% CI: 1.34-6.37; OR: 2.46, 95% CI: 0.91 to 6. 64, respectively) were the SLE most associated with depressive symptoms at the 8-12 weeks postpartum. The second study assessed the prevalence of post-traumatic symptoms, forms of community violence experienced during the perinatal period as well as its subjective impact and its association with the emergence of post-traumatic symptoms during the first 8-12 weeks postpartum. Almost 50% had post-traumatic symptoms at 24 hours and about 23% at 8-12 weeks postpartum. The murder of someone close during pregnancy was associated with the severity of posttraumatic symptoms at early postpartum period (? : 6.89, 95% CI: 1.22 to 12.56) and its subscales (Re-experiencing: ? : 6.62 95% CI: 5.05 to 7.73; avoidance: ? : 0.72, 95% CI: -1.70 to 3.13, and increased arousal: ? : 1.85, 95% CI: 0.28 to 3.57). The murder of a family member after childbirth was the violent event that increased avoidance symptoms at 8-12 weeks postpartum (? : 2.16, 95% CI: 0.37 to 10.89). These events obtained the greatest scores of subjective impact. It concludes that community and intimate partner violence are the SLF most related to postpartum depressive symptoms. Community violence forms more associated with post-traumatic symptoms in postpartum were the murder of someone close and/or relatives, which are characterized by their high subjective impact. This research is innovative because it provides prevalence rates of depressive symptoms and posttraumatic symptoms and their associated factors, in a sample of women with very specific characteristics that had not previously been studied due of their social complexity. This study adds to the small studies on risk factor for Perinatal Psychopathology in developing countries.