Epidemiologic studies suggest that about 10% to 15% of women suffer from clinically significant depressive symptoms during pregnancy. Little is known, however, about the prevalence of depression among women with high risk pregnancies. A recent study published online in the Journal of Clinical Psychiatry suggests that this population may be at significant risk for antenatal depression.

129 women hospitalized for high risk pregnancies were assessed using a variety of instruments, including the Edinburgh Postnatal Depression Scale (EPDS) and the Dyadic Adjustment Scale (DAS). Obstetric complications were classified according to the Hobel Risk Assessment for Prematurity.

-44.2% of the women (57/129) had clinically significant depressive symptoms, with a score of 11 or greater on the EPDS.

-19.4% of the women (25/129) met the DSM-IV criteria for major depressive disorder.

-Mothers reporting strong attachment to the unborn child experienced less severe depressive symptoms.

-Women reporting relationship difficulties were more likely to experience more severe depressive symptoms.

-The severity of the obstetric complication did not appear to correlate with the severity of depressive symptoms; however, one type of complication – incompetent cervix – was more strongly associated with depressive symptoms.

These findings indicate that women with high risk pregnancies are at higher risk for depression than women with uncomplicated pregnancies and argue for more careful screening for depression in this population. Because depression during pregnancy is a predictor for postpartum depression, it should be noted that these women may continue to be at risk for depression after delivery. Furthermore, certain interventions, including psychotherapy and support groups, may help to prevent more severe psychological symptoms in this population at high risk for depression.

Ruta Nonacs, MD PhD

Brandon AR, Trivedi MH, Hyman LS, et al. Prenatal Depression in Women Hospitalized for Obstetric Risk. J Clin Psychiatry February 27, 2008: e1-e9.

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