ABSTRACT: It is estimated that the prevalence of depression among women seen at obstetrics and gynecology clinics ranges from 4% to 22%. Most women with depression do not present with depression symptoms. Because they often present with headache or other somatic symptoms, less than one third of these women are accurately diagnosed.
The aims of this study were to describe the presenting symptoms of women who screened positive for depression in obstetrics and gynecology clinics, to determine the frequency of a diagnosis of depression, and to investigate factors associated with the diagnosis of depression by an obstetrician-gynecologist (ob-gyn). Data were obtained from charts of women screening positive for depression enrolled in a randomized controlled clinical trial testing a collaborative care depression intervention delivered at 2 academic obstetrician and gynecology clinics. Participants were randomized either to intervention or to usual obstetric and gynecologic care. Patients screening positive for depression with the Patient Health Questionnaire received a complete psychiatric workup to confirm a diagnosis of depression. Bivariate and multivariable logistic regression models were used to estimate the odds ratios of having a diagnosis of depression by an ob-gyn and to examine patient factors associated with the diagnosis of depression by this specialist.
Only 11% of the patients with depression presented with a psychological chief complaint; an additional 30% reported an associated psychological symptom. All other patients had physical symptoms or presented for preventive care. Approximately 60% of patients with a depression diagnosis were not diagnosed by the ob-gyn. Depression severity was similar in women with and without an ob-gyn diagnosis of depression. Bivariate analyses identified 4 factors that were significantly associated with depression diagnosis: a psychological complaint either as a chief complaint or associated symptom (72% compared with 18.6%; P < 0.001), younger age (35.5 years compared with 40.8 years; P < 0.005), being within 12 months postpartum (13.9% compared with 2.8%; P < 0.005), and receiving primary rather than specialty care (72% compared with 30%; P < 0.001). Multivariable analysis showed the following variables to be significantly associated with a depression diagnosis: a psychological symptom either as the chief complaint or as an associated symptom (adjusted odds ratio [aOR], 8.90; 95% confidence interval [CI], 4.15–19.10; P < 0.001), receiving primary rather specialty care (aOR, 2.46; 95% CI, 1.14–5.29; P = 0.03), and each year of increasing age (aOR, 0.96; 95% CI, 0.93–0.96; P = 0.02).
These data show that the majority of women screening positive for depression in an obstetrics and gynecology setting presented with a physical, rather than a psychological, chief complaint. Depression in most of these women was not diagnosed by an ob-gyn. The severity of depression was similar in those with and without an ob-gyn diagnosis of 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, WA