Marta Rondon | Universidade Nova de Lisboa (original) (raw)

Papers by Marta Rondon

The Lancet Psychiatry, Jun 1, 2022

Although IPV is endemic, it is not inevitable: evidence points to several targets for prevention ... more Although IPV is endemic, it is not inevitable: evidence points to several targets for prevention and intervention with individuals, families, communities, and societies. Some are stage-specific, such as parenting programmes to reduce child abuse and neglect, or schools-based programmes to address violence supportive norms and behaviours; others span several stages, or are relevant across the lifecourse, such as the prevention and treatment of substance misuse, and secondary or higher education for women.

Comprehensive Psychiatry, 2021

Archives of women's mental health, Sep 13, 2017

Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak dur... more Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSD during pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy.

Neuropsychopharmacology, Jan 11, 2020

Genome-wide approaches including polygenic risk scores (PRSs) are now widely used in medical rese... more Genome-wide approaches including polygenic risk scores (PRSs) are now widely used in medical research; however, few studies have been conducted in low-and middle-income countries (LMICs), especially in South America. This study was designed to test the transferability of psychiatric PRSs to individuals with different ancestral and cultural backgrounds and to provide genome-wide association study (GWAS) results for psychiatric outcomes in this sample. The PrOMIS cohort (N = 3308) was recruited from prenatal care clinics at the Instituto Nacional Materno Perinatal (INMP) in Lima, Peru. Three major psychiatric outcomes (depression, PTSD, and suicidal ideation and/or self-harm) were scored by interviewers using valid Spanish questionnaires. Illumina Multi-Ethnic Global chip was used for genotyping. Standard procedures for PRSs and GWAS were used along with extra steps to rule out confounding due to ancestry. Depression PRSs significantly predicted depression, PTSD, and suicidal ideation/self-harm and explained up to 0.6% of phenotypic variation (minimum p = 3.9 × 10 −6). The associations were robust to sensitivity analyses using more homogeneous subgroups of participants and alternative choices of principal components. Successful polygenic prediction of three psychiatric phenotypes in this Peruvian cohort suggests that genetic influences on depression, PTSD, and suicidal ideation/self-harm are at least partially shared across global populations. These PRS and GWAS results from this large Peruvian cohort advance genetic research (and the potential for improved treatments) for diverse global populations.

World Psychiatry, Oct 1, 2013

Sleep Medicine, Jun 1, 2020

Background:Physiological changes during pregnancy are often accompanied by reduced sleep quality,... more Background:Physiological changes during pregnancy are often accompanied by reduced sleep quality, sleep disruptions, and insomnia. Studies conducted among men and non-pregnant women have documented psychiatric disorders as common comorbidities of insomnia and other sleep disorders. However, no previous study has examined the association between stress-related sleep disturbances and psychiatric disorders among pregnant women.Methods:This cross-sectional study included a total of 2,051 pregnant women in Peru. The Spanish-language version of Ford Insomnia Response to Stress Test (FIRST-S) was used to assess sleep disruptions due to stressful situations. Symptoms of antepartum depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD) were examined using the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7 and PTSD Checklist – Civilian Version, respectively. High risk for psychosis was assessed using the Prodromal Questionnaire. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CI).Results:Stress-related sleep disturbance was reported by 33.2% of women. Of all women, 24.9% had antepartum depression, 32.2% had generalized anxiety disorder, 30.9% had PTSD, and 27.6% were assessed as having a high risk of psychosis. After adjusting for confounders, women with stress-related sleep disturbances were more likely to experience antepartum depression (OR=2.74; 95%CI: 2.22–3.38), generalized anxiety disorder (OR=2.48; 95%CI: 2.04–3.02), PTSD (OR=2.36; 95%CI: 1.93–2.88), and high risk for psychosis (OR=2.07; 95%CI: 1.69–2.54) as compared to women without stress-related sleep disturbances.Conclusions:Stress-related sleep disturbances during pregnancy are associated with increased odds of psychiatric disorders. Inquiring about stress related sleep disturbances during antenatal care may be beneficial for identifying and caring for women at high risk of psychiatric disorders.

Psychiatric Services, May 1, 2011

Objective: Gender disparities in mental health highlight the need to include gender equity measur... more Objective: Gender disparities in mental health highlight the need to include gender equity measures when planning, implementing, and evaluating mental health programs at national, state or provincial, and municipal levels. This study aimed to identify, select, and assess the feasibility of comparing gender-sensitive mental health indicators in a low-(Peru), middle-(Colombia), and high-(Canada) income country. Methods: The indicators were selected by a multidisciplinary group of experts who used criteria and a framework proposed by the World Health Organization. Data from national, population-based databases from each country were used to measure the indicators. Results: Seven indicators (12-month prevalence of the following: depression, psychological distress, generalized anxiety disorder, suicide attempts, alcohol dependence, mental health service use, and psychological impairment) were feasible for measurement in at least two countries. Only five indicators were comparable between two countries, and only one was comparable among all countries (suicide attempts). The indicators that showed the greatest inequities between men and women were depression, anxiety, suicide attempts, use of mental health services, and alcohol dependence. Female-to-male ratios for prevalence of mental illness ranged from .1 to 2.3, and ratios for service use ranged from 1.3 to 1.9. Significant trends were found when the indicators were considered by age, education, marital status, and income. Conclusions: Some of these indicators can be used to identify populations most vulnerable to gender inequities in mental health. The results from this study may provide useful information to program planners who aim to implement, improve, and monitor national mental health strategies that reduce gender inequities under different national conditions. (Psychiatric Services 62:516-524, 2011) M Ma ar rt ta a B B.. R Ro on nd do on n, , M M. .D D.. M Ma ar ri ie e D De es sM Me eu ul le es s, , M M. .S Sc c.. L Li in nd da a D Do or ra ad do o, , B B. .S Sc c.. Y Yo ol la an nd da a T To or rr re es s, , P Ph h. .D D.. D Do on nn na a E E.. S St te ew wa ar rt t, , M M. .D D. .

Annals of Epidemiology, Nov 1, 2017

Purpose-We sought to evaluate the extent to which childhood physical and/or sexual abuse history ... more Purpose-We sought to evaluate the extent to which childhood physical and/or sexual abuse history is associated with post-traumatic stress disorder (PTSD) during early pregnancy; and to explore the extent to which the childhood abuse-PTSD association is mediated through, or modified by, adult experiences of intimate partner violence (IPV). Methods-In-person interviews collected information regarding history of childhood abuse and IPV from 2,928 women age 18-49 years old prior to 16 weeks of gestation. PTSD was assessed using the PTSD Checklist-Civilian Version (PCL-C). Multivariate logistic regressions were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results-Compared to women with no childhood abuse, the odds of PTSD were increased 4.31fold for those who reported physical abuse only (95%CI: 2.18-8.49), 5.33-fold for sexual abuse only (95%CI 2.38-11.98) and 8.03-fold for those who reported physical and sexual abuse (95%CI 4.10-15.74). Mediation analysis showed 13% of the childhood abuse-PTSD association was mediated by IPV. Further, high odds of PTSD were noted among women with histories of childhood abuse and IPV compared with women who were not exposed to either (aOR=20.20; 95%CI 8.18-49.85). Conclusions-Childhood abuse is associated with increased odds of PTSD during early pregnancy. The odds of PTSD were particularly elevated among women with a history of childhood abuse and IPV. Efforts should be made to prevent childhood abuse and mitigate its effects on women's mental health.

Journal of Affective Disorders, Jun 1, 2014

Objective-We sought to evaluate the psychometric properties of two widely used screening scales: ... more Objective-We sought to evaluate the psychometric properties of two widely used screening scales: the Patient Health Questionnaire (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) among pregnant Peruvian women. Methods-This cross-sectional study included 1,517 women receiving prenatal care from February 2012 to March 2013. A structured interview was used to collect data using PHQ-9 and EPDS. We examined reliability, construct and concurrent validity between two scales using internal consistency indices, factor structures, correlations, and Cohen's kappa. Results-Both scales had good internal consistency (Cronbach's alpha > 0.8). Correlation between PHQ-9 and EPDS scores was fair (rho=0.52). Based on exploratory factor analysis

Journal of the Academy of Consultation-Liaison Psychiatry, May 1, 2022

The Lancet Psychiatry, Jun 1, 2017

Primary Care Update for Ob/gyns, Jul 1, 2003

The maternity blues are a group of symptoms of overemotionalism and overreactivity that appear ve... more The maternity blues are a group of symptoms of overemotionalism and overreactivity that appear very often in the early puerperium. The blues seem not to be part of a continuum with postpartum depression and puerperal psychosis. Causation is mostly biological, mainly the massive fluctuation of hormones in that period. There are no clear relationships with demographic or psychosocial factors. The clinical picture appears very similar in all the different settings in which it has been examined. As some women suffering from the blues will go on to develop postpartum depression, requiring medication and psychological interventions, it is very important to recognize the symptoms and to educate the patient and her partner, if there is one, so they will know what to expect and when to notify the obstetrician/gynecologist in case psychiatric referral is necessary. The time spent listening to the patient discuss her emotions and giving her pertinent education is very valuable, because the establishment of a good therapeutic alliance is crucial in the event that depression (a serious condition that puts both mother and child at risk) develops.

Headache, Mar 26, 2016

Background.-Suicide is a leading cause of maternal death globally, and suicide prevalence rates h... more Background.-Suicide is a leading cause of maternal death globally, and suicide prevalence rates have been shown to be increased in those with migraine. No previous study has examined the association between migraine and suicidal ideation during pregnancy. Objective.-To examine the association between migraine and suicidal ideation among a cohort of pregnant women. Methods.-A cross-sectional study was conducted among 3372 pregnant women attending prenatal care clinics in Lima, Peru. Suicidal ideation and depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) scale during early pregnancy. Migraine classification (including migraine and probable migraine) was based on International Classification of Headache Disorders-III beta criteria. Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (95%CI). Results.-Suicidal ideation was more common among those with migraine (25.6%) as compared to those with probable migraine (22.1%, P < .001) or non-migraineurs (12.3%, P < .001). After adjusting for confounders, including depression, those with migraine or probable migraine had a 78% increased odds of suicidal ideation (OR 5 1.78; 95% CI: 1.46-2.17), as compared with non-migraineurs. Women with both migraine and depression had a 4.14-fold increased odds of suicidal ideation (OR 5 4.14; 95% CI: 3.17-5.42) compared to those with neither condition. Conclusion.-Migraine is associated with increased odds of suicidal ideation in pregnant women even when controlling for depression. These findings support the consideration of screening women with comorbid migraine and depression for suicidal behavior during pregnancy.

Springer eBooks, 2019

A recent Royal College of Psychiatrists' statement concluded that current evidence on abortion an... more A recent Royal College of Psychiatrists' statement concluded that current evidence on abortion and mental health is inconclusive. This contribution examines the background to the Royal College of Psychiatrists' statement and the issues it raises. It is concluded that the best route to resolving such issues is through further and better research. Recently, the Royal College of Psychiatrists (2008) issued a statement (Appendix) on the relationship between induced abortion and women's mental health that reached the following conclusions:

Frontiers in Psychiatry, Mar 14, 2022

Background: Women in low-and middle-income countries (LMICs) are disproportionally affected by pe... more Background: Women in low-and middle-income countries (LMICs) are disproportionally affected by perinatal depression and anxiety and lack access to mental health care. Integrating perinatal mental health care into routine maternal care is recommended to address gaps in access to mental health care in such under-resourced settings. Understanding the effectiveness of interventions that integrate perinatal mental health care into routine maternal care in LMICs is critical to inform ongoing intervention development, implementation, and scale-up. This systematic review aims to assess the effectiveness of interventions that integrate perinatal mental health care into routine maternal care to improve maternal mental health and infant health outcomes in LMICs. Method: In accordance with the PRISMA guidelines, an electronic database search was conducted seeking publications of controlled trials examining interventions that aimed to integrate perinatal mental health care into routine maternal care in LMICs. Abstracts and full text articles were independently reviewed by two authors for inclusion utilizing Covidence Review Software. Data was extracted and narrative synthesis was conducted. Findings: Twenty studies met eligibility criteria from the initial search results of 2,382 unique citations. There was substantial heterogeneity between the study samples, intervention designs, and outcome assessments. Less than half of the studies focused on women with active depression or anxiety. Most studies (85%) implemented single intervention designs involving psychological, psychosocial, psychoeducational, or adjuvant emotion/stress management. There were few interventions utilizing multicomponent approaches, pharmacotherapy, or referral to mental health specialists. Outcome measures and assessment timing were highly variable. Eighteen studies demonstrated significantly greater improvement on depression and/or anxiety measures in the intervention group(s) as compared to control.

Archives of women's mental health, Nov 5, 2014

We sought to examine the concordance of two suicidal ideation items from the Patient Health Quest... more We sought to examine the concordance of two suicidal ideation items from the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS), to evaluate the prevalence of suicidal ideation among pregnant women, and to assess the co-occurrence of suicidal ideation with antepartum depressive symptoms. A cross-sectional study was conducted among 1,517 pregnant women attending prenatal care clinics in Lima, Peru. Item 9 of the PHQ-9 assesses suicidal ideation over the last 14 days while item 10 of the EPDS assesses suicidal ideation in the past 7 days. The two suicidal ideation items have a high concordance rate (84.2%) but a moderate agreement (the Cohen's kappa = 0.42). Based on the PHQ-9 and the EPDS, 15.8% and 8.8% of participants screened positive for suicidal ideation, respectively. Assessed by the PHQ-9, 51% of participants with suicidal ideation had probable depression. In prenatal care clinics, screening for suicidal ideation is needed for women with and without depressive symptoms. Future studies are needed to identify additional predictors of antepartum suicidality, determine the appropriate duration of reporting period for suicidal ideation screening, and assess the percentage of individuals with positive responses to the two suicidal ideation items at high risk of planning and attempting suicide.

PLOS ONE, Jan 30, 2015

Objective We examined associations of childhood physical and sexual abuse with risk of intimate p... more Objective We examined associations of childhood physical and sexual abuse with risk of intimate partner violence (IPV). We also evaluated the extent to which childhood abuse was associated with self-reported general health status and symptoms of antepartum depression in a cohort of pregnant Peruvian women. Methods In-person interviews were conducted to collect information regarding history of childhood abuse and IPV from 1,521 women during early pregnancy. Antepartum depressive symptomatology was evaluated using the Patient Health Questionnaire-9. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Results Any childhood abuse was associated with 2.2-fold increased odds of lifetime IPV (95%CI: 1.72-2.83). Compared with women who reported no childhood abuse, those who reported both, childhood physical and sexual abuse had a 7.14-fold lifetime risk of physical and sexual IPV (95%CI: 4.15-12.26). The odds of experiencing physical and sexual abuse by an intimate partner in the past year was 3.33-fold higher among women with a history of childhood physical and sexual abuse as compared to women who were not abused as children (95%CI 1.60-6.89).

The role of the health sector in the response 24 Objectives 31 Study design 31 Materials and meth... more The role of the health sector in the response 24 Objectives 31 Study design 31 Materials and methods 32 Outcomes 35 Discussion 59 Conclusions and recommendations 65 References 70 I acknowledge the support and friendship, and the very valuable expert advice from Professor Donna E Stewart and Professor Graça Cardoso. This thesis is dedicated to Silvia A.: friend, physician, mother and battered wife who committed suicide as a result of gender-based violence, may her death not be in vain.

The use of coercion in mental healthcare has long been subject to controversy, and the call for v... more The use of coercion in mental healthcare has long been subject to controversy, and the call for viable alternatives is growing both within the profession and among people with lived experience of coercion in mental healthcare. • This Discussion Paper outlines recent developments in practice, research and international human rights law concerning coercion in mental health settings with the aim of supporting psychiatrists and other mental health professionals in their work towards improving the quality and safety of mental health services and putting sound alternatives to coercion in placeVytauto Didžiojo universiteta