%0 Journal Article %J Gen Hosp Psychiatry %D 2012 %T Depression in pregnancy is associated with preexisting but not pregnancy-induced hypertension. %A Katon, Wayne J %A Russo, Joan E %A Melville, Jennifer L %A Katon, Jodie G %A Gavin, Amelia R %K Adult %K Antidepressive Agents %K Depression %K Female %K Humans %K Hypertension %K Pregnancy %K Pregnancy Complications %K Prospective Studies %K Regression Analysis %K Surveys and Questionnaires %K Young Adult %X

BACKGROUND: The aim was to examine whether depression is associated with preexisting hypertension or pregnancy-induced hypertension in a large sample of women attending a university-based obstetrics clinic.

METHODS: In this prospective study, participants were 2398 women receiving ongoing prenatal care at a university-based obstetrics clinic from January 2004 through January 2009. Prevalence of depression was measured using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria based on the Patient Health Questionnaire-9 as well as the self-reported use of antidepressant medication. Evidence of preexisting hypertension, pregnancy-induced hypertension and preeclampsia/eclampsia was determined by obstetrician International Classification of Diseases, Ninth Revision codes. Logistic regression was used to quantify the association between hypertension in pregnancy and antenatal depression.

RESULTS: After adjusting for sociodemographic variables, chronic medical conditions, smoking and prior pregnancy complications, women with preexisting hypertension had an increased risk of any depression (minor, major, use of antidepressants) [odds ratio (OR)=1.55, 95% confidence interval (CI) 1.08-2.23) and major depression and/or use of antidepressants (OR=1.65, 95% CI 1.10-2.48) compared to women without hypertension. No differences were seen in risk of depression in women with pregnancy-induced hypertension or preeclampsia/eclampsia compared to those without hypertension.

CONCLUSION: Women with preexisting hypertension, but not pregnancy-induced hypertension, are more likely to meet criteria for an antenatal depressive disorder and/or to be treated with antidepressants and could be targeted by obstetricians for screening for depression and enhanced treatment.

%B Gen Hosp Psychiatry %V 34 %P 9-16 %8 2012 Jan-Feb %G eng %N 1 %R 10.1016/j.genhosppsych.2011.09.018 %0 Journal Article %J J Womens Health (Larchmt) %D 2011 %T Diabetes and depression in pregnancy: is there an association? %A Katon, Jodie G %A Russo, Joan %A Gavin, Amelia R %A Melville, Jennifer L %A Katon, Wayne J %K Adult %K Attitude to Health %K Cohort Studies %K Comorbidity %K Cross-Sectional Studies %K Depression %K Diabetes, Gestational %K Female %K Humans %K Pregnancy %K Pregnancy in Diabetics %K Prenatal Care %K Prevalence %K Prospective Studies %K Quality of Life %K Risk Factors %K United States %K Women's Health %K Young Adult %X

BACKGROUND: Prior studies have reported inconsistent findings regarding the association of antenatal depression with pregnancy-related diabetes. This study examined the association of diabetes and antenatal depression.

METHODS: We conducted a cross-sectional analysis of baseline data from a prospective cohort study of pregnant women receiving prenatal care at a single University of Washington Medical Center clinic between January 2004 and January 2009. The primary exposure was diabetes in pregnancy (no diabetes, preexisting diabetes, or gestational diabetes [GDM]). Antenatal depression was defined by the Patient Health Questionnaire-9 (PHQ-9) score or current use of antidepressants. Antenatal depression was coded as (1) any depression (probable major or minor depression by PHQ-9 or current antidepressant use) and (2) major depression (probable major depression by PHQ-9 or current antidepressant use). Logistic regression was used to quantify the association between diabetes in pregnancy and antenatal depression.

RESULTS: The prevalences of preexisting diabetes, GDM, any antenatal depression, and major antenatal depression were 9%, 18%, 13.6%, and 9.8%, respectively. In the unadjusted analysis, women with preexisting diabetes had 54% higher odds of any antenatal depression compared to those without diabetes (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.08-2.21). After adjusting for important covariates the association was attenuated (OR 1.16, 95% CI 0.79-1.71). Results were similar for antenatal major depression. GDM was not associated with increased odds for any antenatal depression or antenatal major depression.

CONCLUSIONS: Neither preexisting diabetes nor GDM was independently associated with increased risk of antenatal depression.

%B J Womens Health (Larchmt) %V 20 %P 983-9 %8 2011 Jul %G eng %N 7 %R 10.1089/jwh.2010.2662 %0 Journal Article %J Arch Womens Ment Health %D 2011 %T Prevalence and correlates of suicidal ideation during pregnancy. %A Gavin, Amelia R %A Tabb, Karen M %A Melville, Jennifer L %A Guo, Yuqing %A Katon, Wayne %K Adult %K Attitude to Health %K Comorbidity %K Confidence Intervals %K Cross-Sectional Studies %K Depression %K Ethnic Groups %K Female %K Humans %K Logistic Models %K Odds Ratio %K Pregnancy %K Pregnancy Complications %K Prenatal Care %K Prevalence %K Quality of Life %K Risk Factors %K Suicidal Ideation %K United States %K Young Adult %X

Data are scarce regarding the prevalence and risk factors for antenatal suicidal ideation because systematic screening for suicidal ideation during pregnancy is rare. This study reports the prevalence and correlates of suicidal ideation during pregnancy. We performed cross-sectional analysis of data from an ongoing registry. Study participants were 2,159 women receiving prenatal care at a university obstetric clinic from January 2004 through March 2010. Multiple logistic regression identified factors associated with antenatal suicidal ideation as measured by the Patient Health Questionnaire. Overall, 2.7% of the sample reported antenatal suicidal ideation. Over 50% of women who reported antenatal suicidal ideation also reported major depression. In the fully adjusted model antenatal major depression (OR = 11.50; 95% CI 5.40, 24.48) and antenatal psychosocial stress (OR = 3.19; 95% CI 1.44, 7.05) were positively associated with an increased risk of antenatal suicidal ideation. We found that being non-Hispanic White was associated with a decreased risk of antenatal suicidal ideation (OR = 0.51; 95% CI 0.26-0.99). The prevalence of antenatal suicidal ideation in the present study was similar to rates reported in nationally representative non-pregnant samples. In other words, pregnancy is not a protective factor against suicidal ideation. Given the high comorbidity of antenatal suicidal ideation with major depression, efforts should be made to identify those women at risk for antenatal suicidal ideation through universal screening.

%B Arch Womens Ment Health %V 14 %P 239-46 %8 2011 Jun %G eng %N 3 %R 10.1007/s00737-011-0207-5 %0 Journal Article %J Gen Hosp Psychiatry %D 2011 %T Racial differences in the prevalence of antenatal depression. %A Gavin, Amelia R %A Melville, Jennifer L %A Rue, Tessa %A Guo, Yuqing %A Dina, Karen Tabb %A Katon, Wayne J %K Adult %K Depression %K Female %K Health Status Disparities %K Humans %K Logistic Models %K Pregnancy %K Prenatal Care %K Surveys and Questionnaires %K United States %K Young Adult %X

OBJECTIVE: This study examined whether there were racial/ethnic differences in the prevalence of antenatal depression based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria in a community-based sample of pregnant women.

METHOD: Data were drawn from an ongoing registry of pregnant women receiving prenatal care at a university obstetric clinic from January 2004 through March 2010 (N =1997). Logistic regression models adjusting for sociodemographic, psychiatric, behavioral and clinical characteristics were used to examine racial/ethnic differences in antenatal depression as measured by the Patient Health Questionnaire.

RESULTS: Overall, 5.1% of the sample reported antenatal depression. Blacks and Asian/Pacific Islanders were at increased risk for antenatal depression compared to non-Hispanic White women. This increased risk of antenatal depression among Blacks and Asian/Pacific Islanders remained after adjustment for a variety of risk factors.

CONCLUSION: Results suggest the importance of race/ethnicity as a risk factor for antenatal depression. Prevention and treatment strategies geared toward the mental health needs of Black and Asian/Pacific Islander women are needed to reduce the racial/ethnic disparities in antenatal depression.

%B Gen Hosp Psychiatry %V 33 %P 87-93 %8 2011 Mar-Apr %G eng %N 2 %R 10.1016/j.genhosppsych.2010.11.012 %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 Arch Gen Psychiatry %D 2010 %T A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. %A Grote, Nancy K %A Bridge, Jeffrey A %A Gavin, Amelia R %A Melville, Jennifer L %A Iyengar, Satish %A Katon, Wayne J %K Cross-Cultural Comparison %K Depressive Disorder %K Female %K Fetal Growth Retardation %K Humans %K Infant, Low Birth Weight %K Infant, Newborn %K Mass Screening %K Obstetric Labor, Premature %K Pregnancy %K Pregnancy Complications %K Prospective Studies %K Risk %K Socioeconomic Factors %X

CONTEXT: Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR).

OBJECTIVE: To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression.

DATA SOURCES AND STUDY SELECTION: We searched for English-language and non-English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB (<37 weeks' gestation), LBW (<2500 g), or IUGR (<10th percentile for gestational age). Of 862 reviewed studies, 29 US-published and non-US-published studies met the selection criteria.

DATA EXTRACTION: Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error.

DATA SYNTHESIS: Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval] = 1.39 [1.19-1.61], 1.49 [1.25-1.77], and 1.45 [1.05-2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00-1.06], 1.04 [0.99-1.09], and 1.02 [1.00-1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR = 2.05; 95% confidence interval, 1.43-2.93) compared with the United States (RR = 1.10; 95% confidence interval, 1.01-1.21) or European social democracies (RR = 1.16; 95% confidence interval, 0.92-1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States.

CONCLUSIONS: Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.

%B Arch Gen Psychiatry %V 67 %P 1012-24 %8 2010 Oct %G eng %N 10 %R 10.1001/archgenpsychiatry.2010.111 %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