Depression Rate Climbs After Childbirth But Is Related To Earlier Episodes, New AJP Study Shows

Main Category: Pregnancy / Obstetrics
Also Included In: Depression;  Psychology / Psychiatry
Article Date: 30 Sep 2007 - 1:00 PDT

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A large observational study that tracked women from nine months prior to pregnancy through nine months after delivery has revealed that the number of women diagnosed with depression actually decreases slightly during pregnancy, then rises after delivery. The study also confirmed that many women who experience depression during pregnancy or the postpartum period have a history of earlier depression.

Rates of depression among 4,398 pregnant women enrolled in a large health maintenance organization are reported in the October 2007 issue of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association (APA). The pregnancies occurred between 1998 and 2001.

The percentage of women with depression fell from 9 percent during the 39 weeks before pregnancy to 7 percent during pregnancy. It then rose to 10 percent during the 39 weeks after delivery. Patricia Dietz, Dr.P.H., M.P.H., Selvi Williams, M.D., M.P.H., Evelyn Whitlock, M.D., M.P.H., and colleagues at the Centers for Disease Control and Prevention, and at Kaiser Permanente Northwest Center for Health Research reported these findings in the AJP article, "Clinically Identified Maternal Depression Before, During, and After Pregnancies Ending in Live Births."

Dietz and her colleagues found that postpartum depression was preceded by depression during pregnancy or the pre-pregnancy period in more than half of the women. Also, more than half of those who were depressed before pregnancy also experienced depression during pregnancy. Other characteristics associated with depression were Caucasian, being unmarried, already having three or more children, receiving Medicaid, and smoking. However, none of these was a strong risk factor.

AJP editor-in-chief Robert Freedman, M.D., stated, "The severe consequences of postpartum and antepartum depression for the welfare of child and mother led us to publish this first comprehensive study of the prevalence of depression during this period of women's lives."

Depression can have devastating effects on the mother, infant, and other family members. Most of the women in this study were treated for their depression. However, the proportion who took antidepressant medications was lower during pregnancy (67 percent) than prior to pregnancy (77 percent) or after delivery (82 percent). Psychosocial treatments did not appear to be used as an alternative, as the proportion of depressed women who had "mental health visits" remained steady over the three intervals at approximately 50 percent.

The authors note that 4 percent of all the pregnant women in this study received selective serotonin reuptake inhibitors (SSRIs) during pregnancy. The data were collected before current concerns were publicized regarding these medications and a possible link to persistent pulmonary hypertension or cardiovascular malformations in newborn babies.

The frequency of previous episodes among these depressed women suggests that depression history should be part of the medical record for pregnant and postpartum women. Most cases of depression in this study were identified by primary care or mental health care providers; and continuity of care can be a challenge for women as they encounter multiple specialists.

"We found approximately one in seven women was diagnosed with depression during the entire study period, and most received treatment. This suggests depression is common and not necessarily confined to the postpartum period. Women should be screened for it as part of routine care, as well as prenatal and postpartum care," said lead author Patricia Dietz, Dr.P.H., M.P.H.

The study was funded by a contract from the Centers for Disease Control and Prevention. The contract was administered by America's Health Insurance Plans. Additional funding disclosures appear at the end of the article itself.
(Am J Psychiatry 2007; 164:1515-1520)

About the American Journal of Psychiatry

The American Journal of Psychiatry, the official journal of the American Psychiatric Association, publishes a monthly issue with scientific articles submitted by psychiatrists and other scientists worldwide. The peer review and editing process is conducted independently of any other American Psychiatric Association components. Therefore, statements in this press release or the articles in the Journal are not official policy statements of the American Psychiatric Association. The Journal's editorial policies conform to the Uniform Requirements of the International Committee of Medical Journal Editors, of which it is a member. For further information about the Journal visit http://www.ajp.psychiatryonline.org.

About the American Psychiatric Association

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at http://www.psych.org and http://www.HealthyMinds.org.