Estratégias para o cuidado e acompanhamento de gestantes com transtorno mental: revisão integrativa
DOI:
https://doi.org/10.21527/2176-7114.2025.50.16391Palavras-chave:
Saúde da mulher, Saúde mental, Cuidado pré-natal, Transtornos mentaisResumo
Objetivo: Analisar as evidências disponíveis na literatura sobre as estratégias de abordagem e os desafios na atenção pré-natal de gestantes com transtornos mentais. Metodologia: Trata-se de uma revisão integrativa da literatura publicada entre 2013 e 2023, as bases de dados consultadas foram BVS, MEDLINE®, Scopus e Web of Science. Resultados e discussão: Foram selecionados 21 artigos e, após a análise crítica, emergiram três categorias para discussão: percepções e relatos de mulheres com transtorno mental sobre o cuidado pré-natal; experiências e conhecimento dos profissionais sobre a saúde mental durante a gestação; e estratégias e intervenções voltadas para a saúde mental durante o pré-natal. Conclusão: Os resultados demonstraram a importância de promover discussões sobre o cuidado pré-natal de mulheres com transtornos mentais. Observou-se a necessidade de incluir e ouvir essas mulheres nos debates sobre as práticas de cuidados. Destacou-se também a importância de uma abordagem colaborativa multiprofissional, qualificada e inclusiva para a promoção de um suporte efetivo e integral.
Referências
Homonchuk O, Barlow J. Specialist Health Visitors in Perinatal and Infant Mental Health. Vol. 1. Oxford: University of Oxford; 2022. 49 p.
2. NICE. National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance. London: National Institute for Health and Care Excellence (NICE); 2020. 57 p.
3. Williams CJ, Turner KM, Burns A, Evans, J, Bennert K. Midwives and women׳s views on using UK recommended depression case finding questions in antenatal care. Midwifery. 2016;35:39–46.
4. Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 4: Obstetrics & Gynecology. 2023;141(6):1232–61.
5. Australian Living Evidence Collaboration. Australian pregnancy care guidelines [Internet]. 2nd ed. 2024. 472 p. Available from: https://leappguidelines.org/
6. Wickberg B, Bendix M, Wetterholm MB, Skalkidou A. Perinatal mental health around the world: priorities for research and service development in Sweden. BJPsych Int. 2020;17(1):6–8.
7. Howard LM, Thornicroft G, Salmon M, Appleby L. Predictors of parenting outcome in women with psychotic disorders discharged from mother and baby units. Acta Psychiatr Scand. 2004;110(5):347–55.
8. Ranning A, Laursen TM, Thorup A, Hjorthøj C, Nordentoft M. Serious Mental Illness and Disrupted Caregiving for Children: A Nationwide, Register-Based Cohort Study. J Clin Psychiatry. 2015;76(08):e1006–14.
9. WHO. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016. 152 p.
10. WHO. World Health Organization. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme (mhGAP) [Internet]. version 2.0. Geneva: World Health Organization; 2016. 174 p. Available from: https://iris.who.int/handle/10665/250239
11. WHO. World Healht Organization. Guide for Integration of Perinatal Mental Health in Maternal and Child Health Services. 1st ed. Geneva: World Health Organization; 2022. 66 p.
12. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–858.
13. Ferrari AJ, Santomauro DF, Aali A, Abate YH, Abbafati C, Abbastabar H, et al. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. 2024;403(10440):2133–61.
14. Soares CB, Hoga LAK, Peduzzi M, Sangaleti C, Yonekura T, Silva DRAD. Integrative Review: Concepts And Methods Used In Nursing. Rev esc enferm USP. 2014;48(2):335–45.
15. Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546–53.
16. Karino ME, Felli VEA. Enfermagem baseada em evidências: avanços e inovações em revisões sistemáticas. Cienc Cuid Saúde. 2012;11(5):011–5.
17. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.
18. Khamseh F, Parandeh A, Hajiamini Z, Tadrissi SD, Najjar M. Effectiveness of applying problem-solving training on depression in Iranian pregnant women: Randomized clinical trial. J Educ Health Promot. 2019;8(1).
19. Noorbala AA, Afzali HM, Abedinia N, Akhbari M, Moravveji SA, Shariat M. Investigation of the effectiveness of psychiatric interventions on the mental health of pregnant women in Kashan City - Iran: A clinical trial study. Asian J Psychiatr. 2019;46:79–86.
20. Adjorlolo S, Aziato L, Akorli VV. Promoting maternal mental health in Ghana: An examination of the involvement and professional development needs of nurses and midwives. Nurse Educ Pract. 2019;39:105–10.
21. Marcus S, Malas N, Dopp R, Quigley J, Kramer AC, Tengelitsch E, et al. The Michigan child collaborative care program: Building a telepsychiatry consultation service. Psychiatr Serv. 2019;70(9):849–52.
22. Anke TMS, Slinning K, Skjelstad DV. ‘What if I get ill?’ perinatal concerns and preparations in primi- and multiparous women with bipolar disorder. Int J Bipolar Disord. 2019;7:7.
23. Darwin Z, McGowan L, Edozien LC. Antenatal mental health referrals: Review of local clinical practice and pregnant women’s experiences in England. Midwifery. 2015;31(3):E17–22.
24. Phillips L. Assessing the knowledge of perinatal mental illness among student midwives. Nurse Educ Pract. 2015;15(6):463–9.
25. Kingston D, Austin MP, Heaman M, McDonald S, Lasiuk G, Sword W, et al. Barriers and facilitators of mental health screening in pregnancy. J Affect Disord. 2015;186:350–7.
26. Phillips L, Thomas D. The first antenatal appointment: An exploratory study of the experiences of women with a diagnosis of mental illness. Midwifery. 2015;31(8):756–64.
27. Van Ravesteyn LM, Kamperman AM, Schneider TAJ, Raats ME, Steegers EAP, Tiemeier H, et al. Group-based multicomponent treatment to reduce depressive symptoms in women with co-morbid psychiatric and psychosocial problems during pregnancy: A randomized controlled trial. J Affect Disord. 2018;226:36–44.
28. Lee-Carbon L, Nath S, Trevillion K, Byford S, Howard LM, Challacombe FL, et al. Mental health service use among pregnant and early postpartum women. Soc Psychiatry Psychiatr Epidemiol. 2022;57(11):2229–40.
29. Rollans M, Schmied V, Kemp L, Meade T. ‘We just ask some questions…’ the process of antenatal psychosocial assessment by midwives. Midwifery. 2013;29(8):935–42.
30. Viveiros CJ, Darling EK. Barriers and facilitators of accessing perinatal mental health services: The perspectives of women receiving continuity of care midwifery. Midwifery. 2018;65:8–15.
31. Baker N, Gillman L, Coxon K. Assessing mental health during pregnancy: An exploratory qualitative study of midwives’ perceptions. Midwifery. 2020;86:102690.
32. Shah N, Donaldson L, Giridhar R. Completing the cycle: The use of audit to develop a mental health service in times of austerity. Obstet Med. 2013;6(4):165–8.
33. Bayrampour H, McNeil DA, Benzies K, Salmon C, Gelb K, Tough S. A qualitative inquiry on pregnant women’s preferences for mental health screening. BMC pregnancy and childbirth. 2017;17(1):339.
34. Corscadden L, Callander EJ, Topp SM, Watson DE. Experiences of maternity care in New South Wales among women with mental health conditions. BMC pregnancy and childbirth. 2020;20(1):286.
35. Doering JJ, Wichman CL, Laszewski A, Kuehn S, Ke W. Perinatal psychiatric practitioner consultation program delivers rapid response to OB/GYN practitioners. Birth-Issue Perinat Care. 2023;50(4):764–72.
36. Alderdice F. What’s so special about perinatal mental health? J Reprod Infant Psychol. 2020;38(2):111–2.
37. Gagnon R, Orellana PL. Humanization of birth, women’s empowerment, and midwives’ actions and knowledge: experiences from Quebec and Chile. Saúde debate. 2022;46(135):987–98.
38. Mutahi J, Larsen A, Cuijpers P, Peterson SS, Unutzer J, McKay M, et al. Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa: A systematic review. eClinicalMedicine. 2022;44:101289.
39. Willey SM, Blackmore RP, Gibson-Helm ME, Ali R, Boyd LM, McBride J, et al. “If you don’t ask … you don’t tell”: Refugee women’s perspectives on perinatal mental health screening. Women and Birth. 2020;33(5):e429–37.
40. Xiao M, Huang S, Liu Y, Tang G, Hu Y, Fu B, et al. Stigma and its influencing factors for seeking professional psychological help among pregnant women: A cross-sectional study. Midwifery. 2024;132:103973.
41. Patabendige M, Athulathmudali SR, Chandrasinghe SK. Mental Health Problems during Pregnancy and the Postpartum Period: A Multicenter Knowledge Assessment Survey among Healthcare Providers. J Pregnancy. 2020;2020:4926702.
42. Rubin-Miller L, Henrich N, Peahl A, Moss C, Shah N, Jahnke HR. Utilization of digital prenatal services and management of depression and anxiety during pregnancy: A retrospective observational study. Front Digit Health. 2023;5:1152525.
43. Tsuji S, Fujii K, Ando M, Katsura D, Yoneoka Y, Amano T, et al. Impact of a Psychiatric Nurse Specialist as a Liaison for Pregnant Women with Mental Disorders. Tohoku J Exp Med. 2021;253(2):95–9.
44. Kuipers Y, Jomeen J, Dilles T, Van Rompaey B. The general health questionnaire as a measure of emotional wellbeing in pregnant women. J Ment Health Train Educ Pract. 2019;14(6):447–56.
45. Kim DR, Hantsoo L, Thase ME, Sammel M, Epperson CN. Computer-assisted cognitive behavioral therapy for pregnant women with major depressive disorder. J Womens Health (Larchmt). 2014;23(10):842–8.
46. Pandi-Perumal SR, Narasimhan M, Seeman MV, Jahrami H. Artificial intelligence is set to transform mental health services. CNS Spectr. 2024;29(3):155–7.
47. Webb R, Uddin N, Constantinou G, Ford E, Easter A, Shakespeare J, et al. Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare. BMJ Open. 2023;13(7):e066703.
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