CLINICAL ARTICLE Effectiveness of psychological intervention for treating symptoms of anxiety and depression among pregnant women diagnosed with fetal malformation Renata P. Gorayeb a, ⁎, Ricardo Gorayeb a , Aderson T. Berezowski b , Geraldo Duarte b a Department of Neurosciences and Behavioral Sciences, School of Medicine at Ribeirão Preto, University of São Paulo, São Paulo, Brazil b Department of Gynecology and Obstetrics, School of Medicine at Ribeirão Preto, University of São Paulo, São Paulo, Brazil abstract article info Article history: Received 2 August 2012 Received in revised form 10 December 2012 Accepted 25 January 2013 Keywords: Anxiety Depression, Fetal malformation Intervention Pregnancy Psychology Objective: To determine the effectiveness of a psychological intervention targeting pregnant women with fetal malformation. Methods: A clinical study was conducted that enrolled 65 pregnant women attending Clinics Hospital at Ribeirão Preto, University of São Paulo, Brazil, between February 2004 and May 2008. Participants were allocated to 1 of 4 groups: normal pregnancy (NP), fetal malformation (FM), fetal or neonatal death (FD), and control (CG). Psychological intervention—including support, empathy, education, and desensitization— was provided to the NP, FM, and FD groups. Women in CG did not receive the intervention and were assessed in the postnatal period only. Anxiety was measured using the Hospital Anxiety and Depression (HAD) scale. Depression was measured by HAD and the Edinburgh Postnatal Depression Scale. Results: Significant reduc- tions from baseline were observed in anxiety and depression scores after psychological intervention in the NP and FM groups. Symptom scores in the postnatal period were also significantly reduced among these groups (P b 0.001). Conclusion: Psychological intervention was effective in relieving symptoms of anxiety and depression experienced by pregnant women with fetal malformation. © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction Pregnancy, birth, and the postnatal phases are periods of life often experienced in a positive manner by parents and their close relatives. Complicated pregnancies or intrauterine impaired fetal development can negatively alter these feelings and sometimes cause psychological manifestations that require specialized intervention [1]. Fetal developmental disturbances or malformations increase the risk of maternal depression [2–4]. Mothers of children with congeni- tal heart disease are appreciably more likely than mothers of healthy children to have puerperal and post-puerperal depression and anxi- ety, and the magnitude of fetal disease is associated with the severity of depression [2]. Fetal and neonatal deaths are also associated with negative reactions, such as depression, difficulty in sleeping, irritabil- ity, eating disorders, and delusional symptoms [5]. A study conducted in Niger found that all women who had experienced spontaneous abortions exhibited depressive symptoms, and approximately 14% of them experienced symptoms of severe depression [1]. Such effects, however, tend to be minimized over the first 2 years following loss of the fetus. A study by Leon indicated that bereaved parents gradually resume their daily activities and are eventually able to experience pleasure in life again [3]. Despite this recovery, the experience of spontaneous abortion completely alters the manner in which an indi- vidual regards life, relationships, and the future; this observation suggests that spontaneous abortion is an experience with important psychological impact [3]. Studies have also focused on the association between mental health and adverse responses to events occurring during pregnancy or in the puerperium [6,7]. Illnesses such as depression, anxiety, schizophrenia, and suicidal ideation seem to be risk factors for impaired fetal develop- ment and death [7]. Another important aspect for pregnant women with fetal malfor- mation is the strong psychological effect of the decision to either pro- ceed with the pregnancy or abort it. Many international studies have investigated the emotions involved in making this difficult decision [8–10]. Aune and Möller noted that numerous elements are involved in the process a woman goes through before she is able to choose whether or not to end the pregnancy [10]. These elements include the emotional connection with the fetus, social pressures, feelings of guilt, and a perceived lack of control over the situation. The necessity to make choices about her own future and that of her fetus can cause a pregnant woman to experience a variety of feelings and an emotional crisis, which Summerseth and Sundby have termed a "continuous state of chaos" [8]. In Brazil, issues surrounding the decision to undergo induced abor- tion affect only a small portion of the population because laws, which International Journal of Gynecology and Obstetrics 121 (2013) 123–126 ⁎ Corresponding author at: Departamento de Neurociências e Ciências do Comportamento da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo 14.049 000, Brazil. Tel.: +55 16 3602 2320; fax: +55 16 3602 2385. E-mail address: renatagorayeb@gmail.com (R.P. Gorayeb). 0020-7292/$ – see front matter © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijgo.2012.12.013 Contents lists available at SciVerse ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo