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Perinatal Depression: A Systematic Review of Prevalence and Incidence

Gavin, Norma I. PhD; Gaynes, Bradley N. MD, MPH; Lohr, Kathleen N. PhD; Meltzer-Brody, Samantha MD, MPH; Gartlehner, Gerald MD, MPH; Swinson, Tammeka

doi: 10.1097/01.AOG.0000183597.31630.db
Review

OBJECTIVE: We systematically review evidence on the prevalence and incidence of perinatal depression and compare these rates with those of depression in women at nonchildbearing times.

DATA SOURCES: We searched MEDLINE, CINAHL, PsycINFO, and Sociofile for English-language articles published from 1980 through March 2004, conducted hand searches of bibliographies, and consulted with experts.

METHODS OF STUDY SELECTION: We included cross-sectional, cohort, and case-control studies from developed countries that assessed women for depression during pregnancy or the first year postpartum with a structured clinical interview.

TABULATION, INTEGRATION, AND RESULTS: Of the 109 articles reviewed, 28 met our inclusion criteria. For major and minor depression (major depression alone), the combined point prevalence estimates from meta-analyses ranged from 6.5% to 12.9% (1.0-5.6%) at different trimesters of pregnancy and months in the first postpartum year. The combined period prevalence shows that as many as 19.2% (7.1%) of women have a depressive episode (major depressive episode) during the first 3 months postpartum; most of these episodes have onset following delivery. All estimates have wide 95% confidence intervals, showing significant uncertainty in their true levels. No conclusions could be made regarding the relative incidence of depression among pregnant and postpartum women compared with women at nonchildbearing times.

CONCLUSION: To better delineate periods of peak prevalence and incidence for perinatal depression and identify high risk subpopulations, we need studies with larger and more representative samples.

The evidence suggests that depression is a common complication of pregnancy and the postpartum period and is as frequent during childbearing as during nonchildbearing periods.

From 1RTI International, Research Triangle Park, North Carolina; 2Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill; 3University of North Carolina School of Public Health, Chapel Hill; and 4Cecil G. Sheps Center for Health Services Research, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

This research was funded through a contract from the Agency for Healthcare Research and Quality and the Safe Motherhood Group to the RTI International-University of North Carolina Evidence-Based Practice Center (contract no. 290–02–0016). Dr. Gaynes was supported in part by a National Institute of Mental Health K23 Career Development Award (MH01951–03).

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.

Corresponding author: Norma I. Gavin, PhD, RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194; e-mail: gavin@rti.org.

© 2005 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.