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Pregnant Women With Depressive Disorder, Panic Disorder or Post-Traumatic Stress Often Not Diagnosed During Prenatal Exams

Depressive disorders go undetected in low-income pregnant women in obstetric care settings more often than do panic disorders, a recent study reports.

Although practitioners once believed that pregnant women were at lower risk for mood and anxiety disorders than were non-pregnant women, recent research has found that between 10% and 20% of pregnant women experience depressive symptoms.

In this study, Megan V. Smith, MPH, Yale School of Medicine, New Haven, Connecticut, United States, and colleagues evaluated the rates of and detection of major and minor depressive disorder, panic disorder, and post-traumatic stress disorder (PTSD) among low-income women receiving prenatal care at public clinics in the United States.

They interviewed 387 pregnant women before a routine prenatal exam. Patients filled out the Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire, which measures major and minor depressive disorder and panic disorder. The PTSD module of the MINI International Neuropsychiatric Interview was added to assess PTSD. After their prenatal exam, patients were asked whether they had discussed mental health with their practitioner and if they had been referred for mental health treatment. Patient records outside of the prenatal visit were also reviewed for mental health diagnoses and treatments.

Twenty-three percent of women screened positive for depressive disorder, 2% screened positive for panic disorder, and 3% screened positive for PTSD. Of those who screened positive for depressive disorder, 2% were diagnosed by their practitioners during the prenatal visit. Detection was higher for panic disorder (11%), while none of the women with PTSD were diagnosed. Outside of the prenatal visit, 27% of women with depressive disorder, 50% of those with PTSD and 100% of those with panic disorder had been previously diagnosed by other healthcare providers.

"In our cohort, all but a minority of symptomatic depressed women remained undiagnosed and untreated, despite the fact that women were seen an average of 6 times in as many months by a health care professional." the authors conclude.

"Symptoms of depression during pregnancy may not raise clinicians' or patients' concerns given that several of these experiences--for example, disturbances in appetite, sleep, and energy levels--are normative for many pregnant women. Thus, it is critical that efforts be made to address these disorders and offer assistance to these less advantaged women," they write.

Psychiatr Serv 2004;55:407-414. "Screening for and Detection of Depression, Panic Disorder, and PTSD in Public-Sector Obstetric Clinics"