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Presenting Symptoms of Women With Depression in an Obstetrics and Gynecology Setting

Cerimele, Joseph M. MD; Vanderlip, Erik R. MD; Croicu, Carmen A. MD; Melville, Jennifer L. MD, MPH; Russo, Joan PhD; Reed, Susan D. MD, MPH; Katon, Wayne MD

doi: 10.1097/AOG.0b013e31829999ee
Original Research

OBJECTIVE: To describe the presenting symptoms of women with depression in two obstetrics and gynecology clinics, determine depression diagnosis frequency, and examine factors associated with depression diagnosis.

METHODS: Data were extracted from charts of women screening positive for depression in a clinical trial testing a collaborative care depression intervention. Bivariate and multivariable analyses examined patient factors associated with the diagnosis of depression by an obstetrician–gynecologist (ob-gyn).

RESULTS: Eleven percent of women with depression presented with a psychologic chief complaint but another 30% mentioned psychologic distress. All others noted physical symptoms only or presented for preventive care. Ob-gyns did not identify 60% of women with a depression diagnosis. Depression severity was similar in women who were or were not diagnosed by their ob-gyns. Bivariate analyses showed four factors significantly associated with depression diagnosis: reporting a psychologic symptom as the chief complaint or associated symptom (72% compared with 18.6%, P<.001), younger age (35.5 years compared with 40.8 years, P<.005), being within 12 months postpartum (13.9% compared with 2.8%, P<.005), and a primary care-oriented visit (72% compared with 30%, P<.001). Multivariable analysis showed that reporting a psychologic symptom (adjusted odds ratio [OR] 8.90, 95% confidence interval [CI] 4.15–19.10, P<.001), a primary care oriented visit (adjusted OR 2.46, 95% CI 1.14–5.29, P=.03), and each year of increasing age (adjusted OR 0.96, 95% CI 0.93–0.96, P=.02) were significantly associated with a depression diagnosis.

CONCLUSION: The majority of women with depression presented with physical symptoms; most women with depression were not diagnosed by their ob-gyn, and depression severity was similar in those diagnosed and those not diagnosed.

LEVEL OF EVIDENCE: III

In obstetrics and gynecology clinics, women with depression generally present with physical rather than depressive symptoms; few women with depression are recognized as having depression.

Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, the Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Harborview Medical Center, and Northwest Women's Healthcare, Seattle, Washington.

Corresponding author: Joseph M. Cerimele, MD, Senior Fellow/Acting Instructor, University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560; e-mail: cerimele@uw.edu.

Supported by grants from the National Institute of Mental Health (R01-MH085668 and 5T32-MH020021-15).

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

The authors thank Erin McCoy, MPH, for figure preparation.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.