Depression in the Pregnant Patient
Providers caring for pregnant women are well versed in screening for and treating a variety of conditions known to affect maternal and child health. They routinely diagnose and counsel women about preterm labor, gestational diabetes, and hypertensive disorders of pregnancy. Yet even experienced clinicians are often at a loss when it comes to mental health issues. Despite the fact that it is the most common medical disease encountered in pregnancy, depression remains an under-recognized, inadequately discussed, and inadequately treated complication of pregnancy.
Depression during pregnancy affects ∼10% of women,1 and the prevalence of postpartum depression averages 11.5% in the United States, though it varies by state from a low of 8.0% in Georgia to a high of 20.1% in Arkansas.2 However, as few as 20% of affected pregnant women receive adequate treatment for their depressive symptoms.1 Barriers to treatment include the stigma attached to the diagnosis, inadequate training of providers in recognizing the problem, and providers’ lack of comfort with treatment or lack of resources for referral.
Considering the gravity and frequency of effects from depression, it is imperative that clinicians improve these statistics. The consequences of mental health issues in pregnancy and its aftermath are just as important as those of physical health issues. Depression can affect the mother’s health during pregnancy, the development of the fetus, the interaction with her child, and the dynamics of the entire family unit. The lack of attention to the mother’s mental health can have detrimental effects on any of these features.
This issue will review key facets of caring for women with depressive disorders in pregnancy. In order to accurately recognize mental health issues that require attention, clinicians must be aware of when and whom to screen for depressive symptoms. To counsel women effectively about treatment options, they need to know the types of pharmacological and nonpharmacological treatment available, as well as the risk of leaving the disease untreated. They should be familiar with resources that are available to help women who struggle with depression in pregnancy, and forge collaborations with other health care professionals to create the most efficient delivery of mental health services. They need to recognize when there are complicated, severe presentations that warrant immediate referral to mental health specialists. They also need to be aware of mental health conditions within the scope of normal and appropriate reaction to pregnancy, such as grief and bereavement.
The authors of articles in this issue address all of these aspects of care. Although the scope of mental health disorders is broad, the issue focuses on depression (in all of its forms), since a more complete discussion of psychiatric disorders would require a longer text. Hopefully the information contained within this issue will give obstetrical providers a resource to gain familiarity and comfort with managing this common and potentially devastating illness.
1. Vigod SN, Wilson CA, Howard LM. Depression in pregnancy. BMJ. 2016;352:i1547.
2. Ko JY, Rockhill KM, Tong VT, et al. Trends in postpartum depressive symptoms – 27 states, 2004, 2008, and 2012. Morb Mortal Wkly Rep. 2017;66:153–158.