Salud mental, abuso de sustancias y trastornos duales en el embarazo: tasas de prevalencia y tratamiento en un país desarrollado

Rodrigo Carmona Camacho, Nayara López Carpintero, María Luisa Barrigón, Cristina Ruiz Nogales, Inés Menéndez, Montserrat Sánchez Alonso, Irene Caro Cañizares, Juan José Hernández Aguado, Benjamin Le Cook, Margarita Alegría, Ricardo Saviron Cornudella, Javier Plaza, Enrique Baca-García

Resumen


El tabaquismo y el consumo de sustancias durante el embarazo son importantes causas prevenibles de morbimortalidad, teniendo una relación bidireccional y deletérea con la salud mental de la madre y el niño.
Como parte de la iniciativa WOMAP (Woman Mental Health and Addictions on Pregnancy), se estudiaron 2014 embarazadas buscando describir la prevalencia de trastornos mentales y por uso de sustancias concurrentes, las tasas de tratamiento y los diagnósticos y la gravedad. Las participantes fueron evaluadas con la escala AC-OK y se les preguntó sobre sus hábitos tabáquicos y uso de servicios de salud mental/sustancias. De las participantes, 170 mujeres resultaron positivas para un trastorno mental y por uso de sustancias concurrentes (≥ 2 positivos a la subescala AC-OK-Salud Mental, ≥ 1 positivos a la subescala AC-OK-Sustancias y/o fumar más de una vez al mes y no estar en tratamiento) y fueron evaluadas en profundidad mediante una batería de escalas (Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Post-traumatic stress disorder Checklist [PCL-5], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST] y Fagerström).
 En el último año, 614 mujeres (30,5 %) fumaron tabaco (42,5 % diariamente) y el 9,8 % fueron positivas para problemas por uso de sustancias y salud mental según la AC-OK. Solo el 11,1 % había recibido tratamiento en los tres meses previos y solo un 13,6 % tenía una cita en el siguiente mes. De las 170 pacientes evaluadas secundariamente, 62(36,5 %) presentaron al menos depresión moderada, 35(20,6 %) al menos ansiedad moderada, 32(18,8 %) fueron positivas a la PCL-5, y 37 de las 88 que reconocieron uso de alcohol puntuaron por encima del umbral en AUDIT (≥ 3).
En conclusión, la combinación de una prevalencia significativa junto con bajas tasas de tratamiento, remarcan la necesidad de mecanismos de detección efectivos en la atención habitual, permitiendo una intervención temprana.

Palabras clave


Atención perinatal; Salud mental perinatal; Patología dual; Tabaquismo; Consumo de drogas; Cribado.

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Referencias


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DOI: https://doi.org/10.20882/adicciones.1568

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