Depressive Symptoms among Pregnant Women Screened in Obstetrics Settings

Abstract

Objectives: This study aimed to describe the prevalence of depressive symptomatology during pregnancy when seen in obstetric settings, the extent of treatment in this population, and specific risk factors associated with mood symptoms in pregnancy.Methods: A total of 3472 pregnant women age 18 and older were screened while waiting for their prenatal care visits in 10 obstetrics clinics using a brief (10 minute) screening questionnaire. This screen measured demographics, tobacco and alcohol (TWEAK problem alcohol use screening measure), and depression measures, including the Center for Epidemiological Studies-Depression scale (CES-D), use of antidepressant medications, past history of depression, and current treatment (i.e., medications, psychotherapy, or counseling) for depression.Results: Of women screened, 20% (n 5 689) scored above the cutoff score on the CES-D, and only 13.8% of those women reported receiving any formal treatment for depression. Past history of depression, poorer overall health, greater alcohol use consequences, smoking, being unmarried, unemployment, and lower educational attainment were significantly associated with symptoms of depression during pregnancy.Conclusions: These data show that a substantial number of pregnant women screened in obstetrics settings have significant symptoms of depression, and most of them are not being monitored in treatment during this vulnerable time. This information may be used to justify and streamline systematic screening for depression in clinical encounters with pregnant women as a first step in determining which women may require further treatment for their mood symptoms. As elevations in depressive symptomatology have been associated with adverse maternal and infant outcomes, further study of the impact of psychiatric treatment in gravid women is essential. 373

Depression during pregnancy: prevalence and risk factors among women attending a public health clinic in Rio de Janeiro, Brazil

“…Consistent with the extant literature, we found an association between antenatal major depression and a previous history of depression 5,6,7,14,18,19,27 as well as previous psychiatric treatment 10, 23,24 . Since major depressive disorder is often a recurrent condition, it is not surprising that a prior depressive episode is a significant risk factor for depression during pregnancy.…”

“…The lower prevalence in these countries might have resulted from high quality antenatal care, better nutrition during pregnancy, and less stressful life events such as financial difficulties 58,59 . Some studies in developed countries show rates in excess of 20% 6,9,15,20,23,24,60,61,62 . These findings could be explained by the use of screening questionnaires rather than diagnostic interviews.…”

“…Thus, prevalence rates of depression during pregnancy were significantly higher in low-income countries. The main risk factors associated with these differences are past history of psychiatric disorders, poor antenatal care, poor nutrition, stressful life events, economic deprivation and gender based violence, which are more prevalent in developing countries 4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29 .…”

Omega-3 fatty acids and supportive psychotherapy for perinatal depression: A randomized placebo-controlled study

“…MDD affects between 10-20% of perinatal women (Marcus et al, 2003;Evans et al, 2001). Untreated depression increases the risk of negative pregnancy outcomes (Wadhwa et al, 1993;Wisner et al, 2000;Istvan, 1986).…”

Racial and Ethnic Disparities in Postpartum Depression Care Among Low-Income Women

“…Effective screening tools and treatment strategies for combating postpartum depression have been developed (4,5). However, detection and treatment rates for this condition are low (6–8), particularly among high-risk women (9). Untreated postpartum depression can have severe impacts on the health and well-being of the affected woman and her family, including long-term consequences for the cognitive, emotional, and behavioral development of her child (10–13).…”