Abstract
To determine the prevalence of diagnosed and/or treated postpartum depression and anxiety, records were extracted for 1 year after delivery from databases of outpatient diagnoses and prescriptions, for women in a health maintenance organization who had delivered a child from July 1997 through June 1998. For comparison, telephone interviews were conducted 5 to 9 months after delivery with random samples of women who delivered at 2 facilities from June 1998 through January 1999. Of the women interviewed, 11% met criteria for major depression during the first 4 months postpartum, and an additional 13% met criteria for probable depression at 5 to 9 months postpartum. In contrast 7.0% of the large cohort had a visit or prescription for depression. The 1-year prevalence rate for diagnosed and/or treated anxiety without depression was 3.8%; the rate at time of interview was 14.7%. Overall, less than 33% of women with substantial depression or anxiety symptoms were detected.
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Llewellyn AM, Stowe ZN, Nemeroff CB. Depression during pregnancy and the puerperium.Journal of Clinical Psychiatry. 1997;58(suppl 15):26–32.
Epperson CN. Postpartum major depression: detection and treatment.American Family Physician. April 15, 1999;59:2247–2260.
Nonacs R, Cohen LS. Postpartum mood disorders: diagnosis and treatment guidelines.Journal of Clinical Psychiatry. 1998;59(suppl 2):34–40.
Pariser SF, Nasrallah HA, Gardner DK. Postpartum mood disorders: clinical perspectives.Journal of Women's Health. 1997;6(4):421–434.
Susman JL. Postpartum depressive disorders.Journal of Family Practice. 1996;43(6, suppl):S17-S24.
Pitt B. “Atypical” depression following childbirth.British Journal of Psychiatry. 1968;114:1325–1335.
Kumar R, Robson KM. A prospective study of emotional disorders in childbearing women.British Journal of Psychiatry. 1984;144:35–47.
Cox JL, Connor YM, Henderson I, et al. Prospective study of the psychiatric disorders of childbirth by self report questionnaire.Journal of Affective Disorders. 1983;5(1):1–7.
O'Hara MW. Social support, life events, and depression during pregnancy and the puerperium.Archives of General Psychiatry. 1986;43(6):569–573.
Campbell SB, Cohn JF. Prevalence and correlates of postpartum depression in first-time mothers.Journal of Abnormal Psychology. 1991;100(4):594–599.
Evans J, Heron J, Francomb H, et al. Cohort study of depressed mood during pregnancy and after childbirth.British Medical Journal. 2001;323(7307):257–260.
Cox JL, Murray D, Chapman G. A controlled study of the onset, duration and prevalence of postnatal depression.British Journal of Psychiatry. 1993;163:27–31.
Troutman BR, Cutrona CE. Nonpsychotic postpartum depression among adolescent mothers.Journal of Abnormal Psychology. 1990;99(1):69–78.
Schaper AM, Rooney BL, Kay NR, et al. Use of the Edinburgh Postnatal Depression Scale to identify postpartum depression in a clinical setting.Journal of Reproductive Medicine. 1994;39(8):620–624.
Stamp GE, Crowther CA. Postnatal depression: a South Australian prospective survey.The Australian and New Zealand Journal of Obstetrics and Gynaecology. 1994;34(2):164–167.
Cooper PJ, Campbell EA, Day A, et al. Non-psychotic psychiatric disorder after childbirth. A prospective study of prevalence, incidence, course and nature [comments].British Journal of Psychiatry. 1988;152:799–806.
Deal LW, Holt VL. Young maternal age and depressive symptoms: results from the 1988 National Maternal and Infant Health Survey.American Journal of Public Health. 1998;88(2):266–270.
Hobfoll SE, Ritter C, Lavin J, et al. Depression prevalence and incidence among inner-city pregnant and postpartum women.Journal of Consulting and Clinical Psychology. 1995;63(3):445–453.
Barnet B, Joffe A, Duggan AK, et al. Depressive symptoms, stress, and social support in pregnant and postpartum adolescents.Archives of Pediatrics and Adolescent Medicine. 1996;150(1):64–69.
Steiner M. Perinatal mood disorders: position paper.Psychopharmacology Bulletin. 1998;34(3):301–306.
O'Hara MW, Zekoski EM, Philipps LH, et al. Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women.Journal of Abnormal Psychology. 1990;99(1):3–15.
Cooper PJ, Murray L. Prediction, detection, and treatment of postnatal depression.Archives of Disease in Childhood. 1997;77:97–101.
Affonso DD, Lovett S, Paul S, et al. Dysphoric distress in childbearing women.Journal of Perinatology. 1992;12(4):325–332.
Stuart S, Couser G, Schilder K, et al. Postpartum anxiety and depression: onset and comorbidity in a community sample.The Journal of Nervous and Mental Disease. 1998;186(7):420–424.
Robinson S, Young J. Screening for depression and anxiety in the post-natal period: acceptance or rejection of a subsequent treatment offer.The Australian and New Zealand Journal of Psychiatry. 1982;16(2):47–51.
Najman JM, Morrison J, Williams G, et al. The mental health of women 6 months after they give birth to an unwanted baby: a longitudinal study.Social Science and Medicine. 1991;32:241–247.
Davidson JR, Meltzer-Brody SE. The underrecognition and undertreatment of depression: what is the breadth and depth of the problem?Journal of Clinical Psychiatry. 1999;60(suppl 7):4–9, discussion 10–11.
Hendrick V, Altshuler L, Strouse T, et al. Postpartum and nonpostpartum depression: differences in presentation and response to pharmacologic treatment.Depression and Anxiety. 2000;11(2):66–72.
Philipps LH, O'Hara MW. Prospective study of postpartum depression: 4 1/2-year follow-up of women and children.Journal of Abnormal Psychology. 1991;100(2):151–155.
Hirschfeld RM, Keller MB, Panico S, et al. The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression.Journal of the American Medical Association. 1997;277(4):333–340.
Leiferman J. The effect of maternal depressive symptomatology on maternal behaviors associated with child health.Health Education and Behavior. 2002;29(5):596–607.
Reighard FT, Evans ML. Use of the Edinburgh Postnatal Depression Scale in a southern, rural population in the United States.Progress in Neuro-psychopharmacology and Biological Psychiatry. 1995;19(7):1219–1224.
Maina G, Albert U, Bogetto F, et al. Recent life events and obsessive-compulsive disorder (OCD): the role of pregnancy/delivery.Psychiatry Research. 1999;89(1):49–58.
Wisner KL, Peindl KS, Hanusa BH. Effects of childbearing on the natural history of panic disorder with comorbid mood disorder.Journal of Affective Disorders. 1996;41:173–180.
Depression Guideline Panel.Depression in Primary Care. Rockville, Md: Agency for Healthcare Policy & Research; 1993. Detection and Diagnosis; Vol 1. Clinical Guideline Number 5. AHCPR Publication 93-0550.
Von Korff M, Unutzer J, Katon W, et al. Improving care for depression in organized health care systems.Journal of Family Practice. 2001;50(6):530–531.
Lin EHB, Katon W, Simon GE, et al. Achieving guidelines for the treatment of depression in primary care: is physician education enough?Medical Care. 1997;35:831–842.
Condon JT, Corkindale CJ. The assessment of depression in the postnatal period: a comparison of four self-report questionnaires.The Australian and New Zealand Journal of Psychiatry. 1997;31(3):353–359.
Muzik M, Klier CM, Rosenblum KL, et al. Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders?Acta Psychiatrica Scandinavica. 2000;102(1):71–73.
Beck CT, Gable RK. Comparative analysis of the performance of the Postpartum Depression Screening Scale with two other depression instruments.Nursing Research. 2001;50:242–250.
Weisberg RB, Paquette JA. Screening and treatment of anxiety disorders in pregnant and lactating women.Women's Health Issues. 2002;12:32–36.
Miller LJ, ed.Postpartum Mood Disorders. 1st ed. Washington, DC: American Psychiatric Press; 1999.
Dunnewold AL.Evaluation and Treatment of Postpartum Emotional Disorders (Practitioner's Resource Series). Sarasota, Fla: Professional Resource Press; 1997.
Bennett SS, Indman I.Beyond the Blues: Prenatal and Postpartum Depression, a Treatment Manual. San Jose, Calif: Moodswings Press; 2002.
Milgrom J, Martin PR, Negri LM.Treating Postnatal Depression: a Psychological Approach for Health Care Practitioners. Chichester, England: Wiley; 1999.
Hearn G, Iliff A, Jones I, et al. Postnatal depression in the community.British Journal of General Practice. 1998;48(428):1064–1066.
Bagedahl-Strindlund M, Monsen BK. Postnatal depression: a hidden illness.Acta Psychiatrica Scandinavica. 1998;98(4):272–275.
Evins GG, Theofrastous JP, Galvin SL. Postpartum depression: a comparison of screening and routine clinical evaluation.American Journal of Obstetrics and Gynecology. 2000;182(5):1080–1082.
Bryan TL, Georgiopoulos AM, Harms RW, et al. Incidence of postpartum depression in Olmsted County, Minnesota. A population-based, retrospective study.Journal of Reproductive Medicine. 1999;44(4):351–358.
Georgiopoulos AM, Bryan TL, Yawn BP, et al. Population-based screening for postpartum depression.Obstetrics and Gynecology. 1999;93(5, pt 1):653–657.
Johanson R, Chapman G, Murray D, et al. The North Staffordshire Maternity Hospital prospective study of pregnancy-associated depression.Journal of Psychosomatic Obstetrics and Gynaecology. 2000;21(2):93–97.
Georgiopoulos AM, Bryan TL, Wollan P, et al. Routine screening for postpartum depression.Journal of Family Practice. 2001;50:117–122.
Viinamaki H, Rastas S, Tukeva L, et al. Postpartum mental health.Journal of Psychosomatic Obstetrics and Gynaecology. 1994;15(3):141–146.
Whitton A, Warner R, Appleby L. The pathway to care in post-natal depression: women's attitudes to post-natal depression and its treatment.British Journal of General Practice. 1996;46(408):427–428.
Small R, Brown S, Lumley J, et al. Missing voices: what women say and do about depression after childbirth.Journal of Reproductive and Infant Psychology. 1994;12(2):89–103.
Hayes BA, Muller R, Bradley BS. Perinatal depression: a randomized controlled trial of an antenatal education intervention for primiparas.Birth. 2001;28(1):28–35.
Spinelli MG, Endicott J. Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women.American Journal of Psychiatry. 2003;160(3):555–562.
Straub H, Cross J, Curtis S, et al. Proactive nursing: the evolution of a task force to help women with postpartum depression.MCN: The American Journal of Maternal Child Nursing. 1998;23(5):262–265.
Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology.American Journal of Public Health. 1992;82(5):703–710.
International Classification of Diseases, 9th Revision, Clinical Modification. 4th ed. Los Angeles, Calif: Practice Management Information Corporation; 1994.
Radloff L. The CES-D Scale: a self-report depression scale for research in the general population.Applied Psychological Measurement. 1977;1(3):385–401.
Ilfeld FW. Further validation of a psychiatric symptom index in a normal population.Psychological Reports. 1976;39:1215–1228.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
Brantley P, Mehan D, Thomas J. The Beck Depression Inventory (BDI) and the Center for Epidemiologic Studies Depression Scale (CES-D). In: Maruish ME, ed.Handbook of Psychological Assessment in Primary Care Settings. Mahwah, NJ: Lawrence Erlbaum; 2000:391–421.
von Korff M, Katon W, Unutzer J, et al. Improving depression care: barriers, solutions, and research needs.Journal of Family Practice. 2001;50(6):E1.
Klinkman MS. Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care.General Hospital Psychiatry. 1997;19(2):98–111.
Goldberg D. Epidemiology of mental disorders in primary care settings.Epidemiologic Reviews. 1995;17(1):182–190.
Meredith LS, Rubenstein LV, Rost K, et al. Treating depression in staff-model versus network-model managed care organizations.Journal of General Internal Medicine. 1999;14(1):39–48.
Gallo JJ, Meredith LS, Gonzales J, et al. Do family physicians and internists differ in knowledge, attitudes, and self-reported approaches for depression?International Journal of Psychiatry in Medicine. 2002;32(1):1–20.
Docherty JP. Barriers to the diagnosis of depression in primary care.Journal of Clinical Psychiatry. 1997;58(suppl 1):5–10.
Gunn J, Lumley J, Young D. The role of the general practitioner in postnatal care: a survey from Australian general practice.British Journal of General Practice. 1998;48(434):1570–1574.
Dea RA. The integration of primary care and behavioral healthcare in northern California Kaiser-Permanente.Psychiatric Quarterly. 2000;71(1):17–29.
Small R, Johnston V, Orr A. Depression after childbirth: the views of medical students and women compared.Birth. 1997;24(2):109–115.
Misri S, Kostaras X. Benefits and risks to mother and infant of drug treatment for postnatal depression.Drug Safety. 2002;25(13):903–911.
Winans EA. Antidepressant use during lactation.Journal of Human Lactation. 2001;17(3):256–261.
Buist A. Treating mental illness in lactating women.Medscape Women's Health. 2001;6(2):3.
Chabrol H, Teissedre F, Santrisse K, et al. Acceptabilité des antidépresseurs et des psychothérapies dans les dépressions du post-partum: enquête chez 198 accouchées [Acceptability of antidepressants and psychotherapies in the depressions of the postpartum: inquiry to 198 delivered].Encephale. 2001;27(4):381–382.
Kessler D, Lloyd K, Lewis G, et al. Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care.British Medical Journal. 1999;318(7181):436–439.
Olfson M, Klerman GL. Depressive symptoms and mental health service utilization in a community sample.Social Psychiatry and Psychiatric Epidemiology. 1992;27(4):161–167.
Van Hook MP. Women's help-seeking patterns for depression.Social Work in Health Care. 1999;29(1):15–34.
Ying YW, Miller LS. Help-seeking behavior and attitude of Chinese Americans regarding psychological problems.American Journal of Community Psychology. 1992;20(4):549–556.
Vega WA, Kolody B, Aguilar-Gaxiola S, et al. Gaps in service utilization by Mexican Americans with mental health problems.American Journal of Psychiatry. 1999;156(6):928–934.
Horowitz JA, Damato E, Solon L, et al. Identification of symptoms of postpartum depression: linking research to practice.Journal of Perinatology. 1996;16(5):360–365.
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Coates, A.O., Schaefer, C.A. & Alexander, J.L. Detection of postpartum depression and anxiety in a large health plan. The Journal of Behavioral Health Services & Research 31, 117–133 (2004). https://doi.org/10.1007/BF02287376
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DOI: https://doi.org/10.1007/BF02287376