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Salud mental

versão impressa ISSN 0185-3325


LARA, Ma. Asunción; NAVARRO, Claudia; NAVARRETE, Laura  e  LE, Huynh-Nhu. Retention rates and potential predictors in a longitudinal randomized control trial to prevent postpartum depression. Salud Ment [online]. 2010, vol.33, n.5, pp.429-436. ISSN 0185-3325.

Perinatal depression is increasingly recognized as a significant public mental health problem; consequently, there is a major interest in developing strategies to prevent postpartum depression that may help reduce its detrimental consequences. However, the unique experiences associated with the perinatal period make it more difficult to recruit participants at this stage and to retain them over time when assessing prevention interventions. The aim of the study is to examine retention rates and predictors of retention in a longitudinal, randomized controlled trial (RCT) to prevent postnatal depression. Method Participants: Pregnant women (N = 377) at risk of depression were randomized to intervention or usual care condition and assessed during pregnancy and at 6 weeks and 4-6 months postpartum. Intervention: The intervention was designed by modifying a previously evaluated one and includes information on normal pregnancy and the postpartum period, from psychoanalytic and risk factors perspectives. It attempts to reduce depression levels by increasing positive thinking and pleasant activities, improving self-esteem, increasing self-care, learning skills to strengthen social support, and exploring unrealistic expectations about pregnancy and motherhood. It is delivered in eight two-hour weekly group sessions during pregnancy. Measures: Depressive symptoms were measured using the second edition of the Beck Depression Inventory (BDI-II); anxiety symptoms with the corresponding subscale of the Hopkins Symptoms Checklist (SCL-90) and social support with the Social Support Apgar (SSA). A short form of 12 items representing potential stressors was used as a measurement of stressful life events and the Abbreviated Version of the Dyadic Adjustment Scale (A-DAS) measured partner relationship. Results Retention rates -defined in three ways- were: (1) Total retention (percentage of participants completing the 4-6 month postpartum interview) was 41.7% (31.2% intervention and 61.4% control); (2) Retention from randomization to (a) completion of initial evaluation and attendance of > 1 intervention sessions was 42.4%; and (b) completion of initial evaluation (control) was 82.2%; and (3) Follow-up retention: (a) intervention participants attending > 1 sessions that completed the intervention as well as the 4-6 months postpartum interview was 73.5%; and (b) control participants assesses in this period was 66.6%. For those who came to at least one intervention session 83% completed the intervention. The predictors of total retention were: being single, more educated, and poor partner relationship quality. For the intervention condition, predictors of (a) retention from randomization to attendance to > 1 sessions were anxiety and stressful life events, and (b) for follow-up retention was being employed. Conclusions In the present study, retention of participants was even lower than what has been found in similar interventions. However, attendance rates of the course, once the participants had attended one session, were very good. In terms of predictors of retention, women at high risk of depression (single, with poor partner quality relationship, more stressful life events and high anxiety) were more committed to participating in the study. Consequently, in order to increase retention rates, future interventions should target women that present such risk factors. Nevertheless, those with low educational attainment and homemakers, who are a vulnerable group, were difficult to retain and thus remain a challenge in postpartum depression prevention studies. We conclude that rates and predictors of retention differed depending on points of measurement, suggesting different strategies to optimize participation.

Palavras-chave : Postnatal depression; prevention; retention; psycho-educational interventions.

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