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Prenatal Depression in Women Hospitalized for Obstetric Risk

Anna R. Brandon, Ph.D.; Madhukar H. Trivedi, M.D.; Linda S. Hynan, Ph.D.; Paula D. Miltenberger, Ph.D.; Dana Broussard Labat, Ph.D.; Jamie B. Rifkin, Ph.D.; and C. Allen Stringer, M.D.

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;69:635-643. Online Ahead of Print February 27, 2008.)

Received May 17, 2007; accepted Sept. 14, 2007. From the University of Texas Southwestern Medical Center at Dallas (Drs. Brandon, Trivedi, Hynan, Miltenberger, Labat, and Rifkin); and Baylor University Medical Center (Dr. Stringer), Dallas, Tex.

Statistical analyses and Dr. Brandon's time were supported in part by National Institutes of Health grant K12 RR023251.

Acknowledgments and financial disclosure are listed at the end of the article.

Corresponding author and reprints: Anna R. Brandon, Ph.D., UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9066 (e-mail: