Anna R. Brandon, PhD; Madhukar H. Trivedi, MD; Linda S. Hynan, PhD; Paula D. Miltenberger, PhD; Dana Broussard Labat, PhD; Jamie B. Rifkin, PhD; and C. Allen Stringer, MD
Objective: Little is known about depression during pregnancy
in women with high maternal or fetal risk, as this population is often excluded
from research samples. The aim of this study was to evaluate depressive
symptoms and known risk factors for depression in a group of women hospitalized
with severe obstetric risk.
Method: In the antenatal unit, 129 inpatients completed the
Edinburgh Postnatal Depression Scale (EPDS), the Dyadic Adjustment Scale (DAS),
and the Maternal Antenatal Attachment Scale (MAAS) from October 2005 through
December 2006. A subset of women were administered the Mood Disorders module of
the Structured Clinical Interview for DSM-IV Axis I Disorders based on a score
of >= 11 on the EPDS. Obstetric complications were classified according to the
Hobel Risk Assessment for Prematurity.
Results: Fifty-seven of the 129 women (44.2%) scored 11 or
greater on the EPDS, and at least 25/129 (19.4%) met the DSM-IV criteria for
major depressive disorder. Mothers reporting high attachment to the fetus on
the MAAS reported lower severity of depressive symptoms (rho = -0.33, p <
.0001); those reporting interpersonal relationship dissatisfaction on the DAS
endorsed higher depressive severity (rho = -0.21, p = .02). Severity of
obstetric risk was unrelated to depression, but one complication, incompetent
cervix, was positively associated with level of depressive symptomatology.
Conclusion: Findings indicate a higher prevalence rate of
major depressive disorder in women with severe obstetric risk than that
reported in low-risk pregnancy samples, suggesting the need for routine
depression screening to identify those who need treatment. Fewer depressive
symptoms were reported by mothers reporting strong maternal fetal attachment
and greater relationship satisfaction.
J Clin Psychiatry 2008;69(4):635-643
© Copyright 2008 Physicians Postgraduate Press, Inc.