Transtornos mentais comuns maternos e fatores associados: estudo de uma série transversal no estado do Ceará, Nordeste do Brasil em 2023

Abstract

Introduction: Maternal Mental Health (MMH) is a public health imperative, especially in contexts of deep socioeconomic inequalities, such as Brazil. Maternal Common Mental Disorders (CMD), which include non-psychotic symptoms of depression and anxiety, impose a significant burden of morbidity. This study aimed to analyze the prevalence of Maternal CMD and its associated factors in the State of Ceará, Northeast Brazil, in 2023. Methods: A cross-sectional, observational, population-based survey was conducted using primary data from the Maternal and Child Health Survey in Ceará (PESMIC) carried out in 2023. The study population consisted of mothers of children up to three years of age. For Maternal CMD screening, the Self-Reporting Questionnaire (SRQ-20) was used, considering a score above 7 as a positive screen. The analysis of associated factors was structured using a Multidimensional Hierarchical Theoretical Model, with multivariate analysis using logistic regression. Written informed consent was obtained from the participating women. The VII PESMIC was submitted to the Research Ethics Committee and approved under protocol number 5.614.102. Results: The prevalence of Maternal CMD identified among the 1,768 mothers of young children in the State of Ceará was 28.1%, a figure that aligns with the high burden historically observed in vulnerable populations in Northeast Brazil. The hierarchical analysis identified that psychological distress is a multifaceted outcome, determined by the accumulation of risks at various levels. Distal factors (Macrosystem), such as Severe Food Insecurity (SFI), remained robust predictors, evidencing that MMH is inextricably linked to the deprivation of basic resources and the woman's socioeconomic condition. Proximal contextual factors (Microsystem), such as exposure to Domestic Violence (DV) and Unplanned Pregnancy, showed significant association, signaling the breakdown of the domestic environment as a protective space. Individual/intrinsic factors (such as alcoholism, body dissatisfaction, and severe pain during menstruation) and intermediate factors (Mesosystem), such as the occurrence of accidents among offspring (falls), were also associated with the outcome, reinforcing the cycle of stress in the mother-child dyad. Conclusion: Maternal CMD in Ceará emerges as a dramatic indicator of social inequity and chronic socioeconomic vulnerability. The magnitude and etiological complexity of the problem require that the public health response transcends the reactive biomedical approach. It is imperative to institutionalize universal screening for Maternal CMD in Primary Health Care (PHC), develop Psychological Prenatal Care programs, and expand Integrative Community Therapy (ICT) throughout the territory, articulated with structural policies that combat the social determinants of distress, such as SFI and DV, in order to transform vulnerability into dignity and suffering into effective care, ensuring full child development and the safety of future generations.