Research reportWhat does Chilean research tell us about postpartum depression (PPD)?
Introduction
Chile, a middle income country, with a population of 15 million inhabitants, is a so called emerging market-economy, characterized by rapid social and lifestyle changes. Increasing work demands and the gradual disappearance of the extended family, traditional sources of informal support, are increasing the pressures on families. Unsurprisingly, women are the most at risk of suffering mental disorders. Thus, studies using similar methodology have shown that while the prevalence of mental disorders in men is rather similar in Chile and Great Britain, there are marked differences in prevalence between women in the two countries (Rojas et al., 2005). As has been demonstrated in other countries depression is the leading cause of disease burden measured in disability-adjusted life years (DALYs) in Chilean adult women (Ministerio Servicio Nacional de la Mujer, 2002).
Furthermore, despite the country's economic growth, income disparity and economic inequality persist within the Chilean people and socioeconomic gaps may even widen. Correspondingly, the social distribution of mental illness shows that mental disorders are more common among the more socially disadvantaged, those poorest sectors of society that have the least access to mental-health specialists and are usually seen and treated in primary care. The often quoted WHO multicenter collaborative study on Psychological Symptoms in General Health care showed that women that attended primary care clinics in Santiago had nearly three times the average rate of depression found for women in the other 15 centers studied throughout the world (36.8% versus 12.5%) (Sartorius et al., 1993).
Understandably, within the Chilean sociocultural context of stress and rapid change, the birth of a child adds further to the pressures faced by women. Hence, the relevance of this review which will first describe the main epidemiological data derived from local studies regarding childbearing and affective disorders and then will raise some possible explanations to the surprising finding that in Chile the incidence of PPD does not appear to vary across different socioeconomic levels whereas prevalence does. Suggestions from recent research into potential treatment options for postpartum depression in women of lower socioeconomic status are also provided.
Section snippets
Methods
An extensive unrestricted search of MEDLINE (1985–2005) and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), 1982–2005, was conducted to obtain articles on postpartum depression carried out in Chile. The search terms used were depression, postpartum, postnatal, and puerperal. Data was also obtained from personal access of the main author to Chilean medical manuscripts and local journals as well as his own studies. The context has been augmented by the two coauthors.
Results
Figures of prevalence of depression in pregnant/postpartum women depend on how the disorder is conceptualized; if unspecific symptoms are included, rates will certainly be higher than if one restricts the definitions to clinical entities that fulfil strict diagnostic and operational criteria. In the following results, it will be demonstrated that Chilean data are in line with this premise.
Discussion
In Chile, as in many other countries, at least one out of ten mothers becomes depressed and may be diagnosed as having MDD, following parturition. Many more women experience depressive or other dysphoric symptoms during the perinatal period.
It should be emphasized that while Chilean investigators have not found differences in incidence of PPD in different socioeconomic groups, they have shown that prevalence does vary depending on SES. The idea that we would like to raise is that similarities
Acknowledgements
This work was supported by Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT), Proyect No 1040434.
No conflict of interest.
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