Depressive Disorders During Pregnancy: Prevalence and Risk Factors in a Large Urban Sample

Melville, Jennifer L. MD, MPH; Gavin, Amelia PhD, MSW; Guo, Yuqing MSN; Fan, Ming-Yu PhD; Katon, Wayne J. MD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181f60b0a
Original Research
Abstract

OBJECTIVE: To estimate the prevalence of major and minor depression, panic disorder, and suicidal ideation during pregnancy while also identifying factors independently associated with antenatal depressive disorders.

METHODS: In this prospective study, participants were 1,888 women receiving ongoing prenatal care at a university obstetric clinic from January 2004 through January 2009. Prevalence of psychiatric disorders was measured using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria based on the Patient Health Questionnaire. Multiple logistic regression identified factors associated with probable major depressive disorder and any depressive disorder.

RESULTS: Antenatal depressive disorders were present in 9.9% with 5.1% (97) meeting criteria for probable major depression and 4.8% (90) meeting criteria for probable minor depression. Panic disorder was present in 3.2% (61), and current suicidal ideation was reported by 2.6% (49). Among patients with probable major depression, 29.5% (28) reported current suicidal ideation. Psychosocial stress (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.21–1.36), domestic violence (OR 3.45; 95% CI 1.46–8.12), chronic medical conditions (OR 3.05; 95% CI 1.63–5.69), and race (Asian: OR 5.81; 95% CI 2.55–13.23; or African American: OR 2.98; 95% CI 1.24–7.18) each significantly increased the odds of probable antepartum major depressive disorder, whereas older age (OR 0.92; 95% CI 0.88–0.97) decreased the odds. Factors associated with odds of any depression were similar overall except that Hispanic ethnicity (OR 2.50; 95% CI 1.09–5.72) also independently increased the odds of any depression.

CONCLUSION: Antenatal major and minor depressive disorders are common and significantly associated with clinically relevant and identifiable risk factors. By understanding the high point prevalence and associated factors, clinicians can potentially improve the diagnosis and treatment rates of serious depressive disorders in pregnant women.

LEVEL OF EVIDENCE: II

In Brief

Antenatal depressive disorders are common and significantly associated with clinically relevant and identifiable risk factors.

Author Information

From the Departments of Obstetrics and Gynecology and Psychiatry and Behavioral Sciences and the Schools of Social Work and Nursing, University of Washington School of Medicine, Seattle, Washington.

Supported in part by 1KL2RR025015-01 from the National Center for Research Resources of the National Institutes of Health.

Corresponding author: Jennifer L. Melville, MD, MPH, Assistant Professor, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA 98104-2499; e-mail: jmelvi@uw.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 The American College of Obstetricians and Gynecologists