Underserved Treatment for Pregnant and Depressed

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 of General Hospital Psychiatry. Without adequate treatment — medication, talk therapy or both together — prenatal and postpartum depression can seriously affect 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. of M. psychologist who led the study, 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 the university 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.

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.


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