Influence of body posture on the association between postpartum depression and pain

Rita di Cássia de Oliveira Angelo; Denila Coelho da Silva; Carla Fonseca Zambaldi; Amaury Cantilino; Everton Botelho Sougey

doi:10.1590/2237-6089-2013-0029

Original Article

Influence of body posture on the association between postpartum depression and pain

Influência do tipo postural na associação entre depressão pós-parto e dor

Rita di Cássia de Oliveira Angelo; Denila Coelho da Silva; Carla Fonseca Zambaldi; Amaury Cantilino; Everton Botelho Sougey

http://dx.doi.org/10.1590/2237-6089-2013-0029 Trends Psychiatry Psychother, vol.36, n1, p.32-39, 2014

PDF

SciELO

Downloads: 0

Abstract

OBJECTIVE: To determine the association between postpartum depression (PPD), intensification of back pain and exacerbation of changes in postural alignment intrinsic to puerperium. METHODS: Eighty women at 2 to 30 weeks postpartum were included in the study according to the following criteria: literate mothers, gestation of 34 to 42 weeks, and healthy live-born infants. All mothers agreed to participate in the study. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Pain was assessed using a visual analogue scale (VAS) and the Nordic Musculoskeletal Questionnaire (NMQ), and posture, using real time naturalistic observation. RESULTS: There was a statistically significant association between PPD and pain intensity (p = 0.002). The upper back was the most frequent pain site among depressed women, both before (p = 0.04) and after delivery (p = 0.01). There were no associations between PPD and type of posture (p = 0.328). However, pain intensity was greater among depressed women in the swayback group (p < 0.001). CONCLUSION: The intensification of puerperal pain is closely associated with PPD. Our results suggest that back pain may be both a risk factor and a comorbidity of PPD among puerperal women and that pain and type of posture are interdependent.

Keywords

Depression, pain, posture, postpartum

Resumo

OBJETIVO: Verificar a associação entre depressão pós-parto (DPP), intensificação do quadro álgico na região posterior do tronco e exacerbação das alterações no alinhamento postural intrínsecas ao puerpério. MÉTODOS: Foram selecionadas 80 mulheres em pós-parto de 2 a 30 semanas, de acordo com os seguintes critérios: mães alfabetizadas; gestação entre 34 e 42 semanas; parição de bebê saudável e vivo. Todas as mães concordaram em participar da pesquisa. Os sintomas depressivos foram rastreados através da Escala de Depressão Pós-natal de Edimburgo (EDPE). A avaliação da dor ocorreu através de uma escala visual analógica (EVA) e do Questionário Nórdico de Sintomas Osteomusculares (QNSO). Para avaliação postural, empregou-se observação naturalística em tempo real. RESULTADOS: Foi verificada associação estatisticamente significativa entre DPP e maior intensidade de dor referida (p = 0,002). A região dorsal foi o sítio doloroso mais apontado pelas puérperas deprimidas, tanto no período pré-puerperal (p = 0,04), quanto no puerpério (p = 0,01). Não houve associação estatística entre DPP e tipo postural (p = 0,328). No entanto, a intensidade da dor foi maior entre as mulheres deprimidas no grupo com postura desleixada (swayback) (p < 0,001). CONCLUSÃO: A intensificação do quadro álgico puerperal associa-se fortemente à DPP. Nas puérperas deste estudo, a dor na região dorsal aparentemente se comportou tanto como um fator de risco quanto como uma comorbidade de DPP. Admite-se que existe uma relação de interdependência entre dor e tipo postural.

Palavras-chave

Depressão, dor, postura, pós-parto

References

Horak FB, MacPherson JM. Postural orientation and equilibrium. Handbook of physiology: a critical, comprehensive presentation of physiological knowledge and concepts. :255-92.

Ostgaard HC, Andersson GB. Postpartum low-back pain. Spine (Phila Pa 1976). ;17:53-5.

Borg-Stein J, Dugan SA. Musculoskeletal disorders of pregnancy, delivery and postpartum. Phys Med Rehabil Clin N Am. ;18:459-76.

To WW, Wong MW. Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy. Acta Obstet Gynecol Scand. ;82:1086-091.

Gaudet C. The association of acute and chronic postpartum pain with postpartum depression in a nationally representative sample of Canadian women [dissertation]. .

Webb DA, Bloch JR, Coyne JC, Chung EK, Bennett IM, Culhane JF. Postpartum physical symptoms in new mothers: their relationship to functional limitations and emotional well-being. Birth. ;35:179-87.

Gutke A, Josefsson A, Oberg B. Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms. Spine (Phila Pa 1976). ;32:1430-436.

McGovern P, Dowd B, Gjerdingen D, Gross CR, Kenney S, Ukestad L. Postpartum health of employed mothers 5 weeks after childbirth. Ann Fam Med. ;4:159-67.

Cooper PJ, Tomlinson M, Swartz L, Woolgar M, Murray L, Molteno C. Post-partum depression and the mother-infant relationship in a South African peri-urban settlement. Br J Psychiatry. ;175:554-58.

Moraes IG, Pinheiro RT, Silva RA, Horta BL, Sousa PL, Faria AD. [Prevalence of postpartum depression and associated factors]. Rev Saude Publica. ;40:65-70.

Cantilino A, Zambaldi CF, Albuquerque TLC, Paes JA, Montenegro ACP, Sougey EB. Postpartum depression in Recife - Brazil: prevalence and association with bio-socio-demographic factors. J Bras Psiquiatr. ;59:1-9.

Pawar G, Wetzker C, Gjerdingen D. Prevalence of depressive symptoms in the immediate postpartum period. J Am Board Fam Med. ;24:258-61.

Morari-Cassol EG. Amamentação e desconforto músculo-esquelético da mulher [tese]. .

Abou-Saleh MT, Ghubash R. The prevalence of early postpartum psychiatric morbidity in Dubai: a transcultural perspective. Acta Psychiatr Scand. ;95:428-32.

Lowen A. O corpo em depressão: as bases biológicas da fé e da realidade. .

Teixeira MJ. Dor: contexto interdisciplinar. .

Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med. ;341:1329-335.

Canales JZ, Cordás TA, Fiquer JT, Cavalcante AF, Moreno RA. Posture and body image in individuals with major depressive disorder: a controlled study. Rev Bras Psiquiatr. ;32:375-80.

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. ;150:782-86.

Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. ;18:233-37.

Huskisson EC. Measurement of pain. Lancet. ;2:1127-131.

Kendall FP, McCreary EK, Provance PG, Rod MM. Músculos: provas e funções. .

Jardri R, Maron M, Delion P, Thomas P. Pain as a confounding factor in postnatal depression screening. J Psychosom Obstet Gynaecol. ;31:252-55.

Kirmayer LJ, Robbins JM, Dworkind M, Yaffe MJ. Somatization and the recognition of depression and anxiety in primary care. Am J Psychiatry. ;150:734-41.

Rajala U, Keinänen-Kiukaanniemi S, Uusimäki A, Kivelä SL. Musculoskeletal pains and depression in a middle-aged Finnish population. Pain. ;61:451-57.

Breen TW, Ransil BJ, Groves PA, Oriol NE. Factors associated with back pain after childbirth. Anesthesiology. ;81:29-34.

Morari-Cassol EG, Campos D, Haeffner LSB. Musculoskeletal discomfort post-partum and breastfeeding. Fisioter Bras. ;9:9-16.

Gilleard WL, Crosbie J, Smith R. Static trunk posture in sitting and standing during pregnancy and early postpartum. Arch Phys Med Rehabil. ;83:1739-744.

Keleman S. Anatomia emocional. .

Influence of body posture on the association between postpartum depression and pain

Influência do tipo postural na associação entre depressão pós-parto e dor

Rita di Cássia de Oliveira Angelo; Denila Coelho da Silva; Carla Fonseca Zambaldi; Amaury Cantilino; Everton Botelho Sougey

Abstract

Keywords

Resumo

Palavras-chave

References

Links

Share

Trends Psychiatry Psychother