Majority of pregnant women with depression not receiving treatment

Aug 14 2006

The majority of pregnant women who have full-blown major depression aren't getting any treatment for the condition, and neither are most pregnant women who have signs of milder depression or depression risk, a new University of Michigan Depression Center study finds.

Even those who are receiving some form of treatment may not be getting enough, the researchers conclude in the current issue if General Hospital Psychiatry. Without adequate treatment -- medication, talk therapy, or both together -- prenatal and post-partum depression can seriously impact both women and their babies.

The findings come from a study of 1,837 pregnant women who were surveyed in the waiting rooms of five Michigan obstetrics clinics, using a standard questionnaire that detects signs of depression.

Of the women in the study, 276 met the criteria for being at risk of depression. All of these women had follow-up interviews with trained mental health workers who assessed them using the standard criteria used to diagnose depression, and asked them about their mental health and treatment history.

In all, 17 percent of the 276 women were found to be experiencing a serious depression. Another 23 percent had a history of major depression, which can come and go throughout life and needs regular monitoring and treatment. Of those who were experiencing major depression at the time of the study, only 33 percent were receiving any treatment for it. And of the 276 women with high depression risk, only 20 percent were receiving treatment, despite the fact that many had a history of depression.

When the researchers analyzed data on the at-risk and depressed women who were receiving treatment, they found that only 43 percent of those taking anti-depressant medications (alone or in combination with talk therapy) had been taking them at the recommended dose for at least six weeks. Such medications often must be taken for six to eight weeks before depression symptoms ease.

Heather Flynn, Ph.D., the U-M psychologist who led the study, calls the result very troubling. "These are women who meet the formal clinical criteria for the most severe form of depression. No one would argue that these women would benefit from some form of intervention, but only 33 percent of them were," she says. "It may be impossible to closely monitor every pregnant woman at risk in the way this study did, but it certainly makes sense to ensure that women with clear depression get the help they need."

Flynn and her colleague Sheila Marcus, M.D., have led an effort to screen pregnant women for depression in the waiting rooms of obstetric clinics at U-M and elsewhere in southern Michigan. They previously published results based on the waiting-room screening tests; the new study goes much further by performing a detailed psychological assessment using the criteria of the DSM-IV, the standard text for diagnosing mental health conditions.

Their results show no significant depression or depression-treatment differences among pregnant women of different races and ethnicities, employment situations, education levels, and marital or parental situations. The only factors that were found to increase a woman's chance of treatment were severe symptoms at the time of the study, a history of major depression and a history of any psychiatric treatment,

This suggests that women who are already accustomed to accessing the mental health system may be most likely to do so if they experience depressive symptoms during pregnancy, while other women may not recognize their symptoms - or may not know, or believe, that they can get help from a mental health provider.

Flynn, who treats patients as part of the Depression Center's clinical team, says she sees this phenomenon in her own work. "A lot of the women I see don't really appreciate that the way they've been feeling isn't normal, particularly during pregnancy," she says. "They attribute their fatigue, sleep and other problems to pregnancy, or don't believe that they could be suffering from depression. Others may suspect a problem but don't believe that treatment can work. But it can."

Another major barrier to depression treatment may be the lack of awareness among the doctors who treat women during pregnancy, but this seems to have improved in recent years, says Flynn. Many women, however, still are never screened for depression or treated to prevent a recurrence of past depression.

She and her colleagues are now preparing another paper that assesses the impact of screening pregnant women for depression, based on the results from the study group. "We're hoping to see if some of the approaches used in to help link people who have other health issues with needed treatments may help women work through the ambivalence or skepticism about treatment, help them engage in the treatment process," she says.

Pregnant women who are experiencing depression may think their symptoms are just a normal part of pregnancy. But in fact, the following signs may indicate depression: two or more weeks of depressed mood, decreased interest or pleasure in activities, change in appetite, change in sleep patterns, fatigue or loss of energy, difficulty concentrating, excessive feelings of worthlessness or guilt, thoughts of suicide, extreme restlessness and irritability.

Severe depression during pregnancy can interfere with women's ability to eat properly, get enough rest, or receive prenatal care -- all of which may contribute to premature and low birth-weight infants. Even mild depression during pregnancy can put a woman at risk of more severe post-partum depression, which can interfere with her ability to care for her newborn and herself. Pregnant women who are experiencing possible signs of depression, or who have a history of depression, should talk to their doctors or midwives immediately. Medications, talk therapy, stress reduction, exercise and other steps can help ease depression safely during pregnancy and beyond.