Two-thirds of pregnant women with major depression are not receiving
treatment, and others with milder depression or at risk for depression lack
adequate care, according to a report from researchers at the University of
Michigan Depression Center.
The report appeared in the July-August General Hospital
Using DSM-IV criteria, Heather Flynn, Ph.D., and Sheila Marcus,
M.D., interviewed 276 women identified through standard depression
questionnaires as being at high risk for depression among 1,837 women in
waiting rooms of five obstetrics clinics.
Of the 276 women, 17 percent had major depression, and 23 percent had a
history of intermittent major depression needing monitoring and treatment.
Only 20 percent of the entire group were receiving treatment. Moreover, of the
women who had major depression, only 33 percent were receiving treatment.
The researchers further found that only 43 percent of the women taking
medication alone or in combination with talk therapy had been taking
antidepressant medication at the recommended dose for at least six weeks.
Flynn, who led the study, called the findings 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 said.
While she conceded that it may not be feasible to monitor closely every
pregnant woman at risk in the way this study did, she said it certainly makes
sense to ensure that women with depression get the help they need.
No significant depression or depression-treatment differences were found
among pregnant women of different races and ethnicities, employment
situations, education levels, and marital or parental situations. The only
factors found to increase a woman's chance of getting treatment were severe
symptoms at the time of the study, a history of major depression, and a
history of psychiatric treatment. Flynn said this suggests that women 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 clinician.
Flynn said 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 said. "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 lack of awareness
among doctors treating pregnant women, but such awareness has increased in
recent years, noted Flynn. Still, many women are never screened for depression
or treated to prevent a recurrence of past depression.
More information on depression during pregnancy, is posted at<www.med.umich.edu/depression/pregnancy.htm>."
Rates and Predictors of Depression Treatment Among Pregnant Women in
Hospital-Affiliated Obstetrics Practices" can be accessed at<www.sciencedirect.com>
by clicking on "G," "General Hospital Psychiatry,""
Volume 28, Issue 4," and the title of the article.▪