%0 Journal Article %J Obstet Gynecol %D 2010 %T Depressive disorders during pregnancy: prevalence and risk factors in a large urban sample. %A Melville, Jennifer L %A Gavin, Amelia %A Guo, Yuqing %A Fan, Ming-Yu %A Katon, Wayne J %K Adolescent %K Adult %K Depressive Disorder %K Female %K Humans %K Middle Aged %K Panic Disorder %K Pregnancy %K Pregnancy Complications %K Prevalence %K Risk Factors %K Spouse Abuse %K Stress, Psychological %K Suicide %K Urban Population %K Young Adult %X

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.

%B Obstet Gynecol %V 116 %P 1064-70 %8 2010 Nov %G eng %N 5 %R 10.1097/AOG.0b013e3181f60b0a %0 Journal Article %J Am J Obstet Gynecol %D 2010 %T Psychosocial stress during pregnancy. %A Woods, Sarah M %A Melville, Jennifer L %A Guo, Yuqing %A Fan, Ming-Yu %A Gavin, Amelia %K Adult %K Alcohol Drinking %K Cross-Sectional Studies %K Female %K Health Behavior %K Humans %K Logistic Models %K Pregnancy %K Pregnancy Outcome %K Risk Factors %K Stress, Psychological %K Substance-Related Disorders %X

OBJECTIVE: We sought to identify factors associated with high antenatal psychosocial stress and describe the course of psychosocial stress during pregnancy.

STUDY DESIGN: We performed a cross-sectional analysis of data from an ongoing registry. Study participants were 1522 women receiving prenatal care at a university obstetric clinic from January 2004 through March 2008. Multiple logistic regression identified factors associated with high stress as measured by the Prenatal Psychosocial Profile stress scale.

RESULTS: The majority of participants reported antenatal psychosocial stress (78% low-moderate, 6% high). Depression (odds ratios [OR], 9.6; 95% confidence interval [CI], 5.5-17.0), panic disorder (OR, 6.8; 95% CI, 2.9-16.2), drug use (OR, 3.8; 95% CI, 1.2-12.5), domestic violence (OR, 3.3; 95% CI, 1.4-8.3), and having > or =2 medical comorbidities (OR, 3.1; 95% CI, 1.8-5.5) were significantly associated with high psychosocial stress. For women who screened twice during pregnancy, mean stress scores declined during pregnancy (14.8 +/- 3.9 vs 14.2 +/- 3.8; P < .001).

CONCLUSION: Antenatal psychosocial stress is common, and high levels are associated with maternal factors known to contribute to poor pregnancy outcomes.

%B Am J Obstet Gynecol %V 202 %P 61.e1-7 %8 2010 Jan %G eng %N 1 %R 10.1016/j.ajog.2009.07.041