Depression in Pregnancy and the Postpartum Period

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DESCRIPTION (provided by applicant): Perinatal depression is thought to affect a considerable portion of pregnant and postpartum women, creating a public health event with a large population at risk. Untreated, it can have long-term, negative consequences for the woman, her child, and family. Much past research on the prevalence and incidence of perinatal depression and its risk factors has two important limitations: (a) it is largely based on narrowly defined, homogeneous samples; and (b) it has relied on screening tools to assess perinatal depression without confirming the diagnosis. This makes past results vulnerable to dispute. The proposed research provides a cost-effective approach to overcoming the limitations. We will provide more accurate incidence and prevalence estimates than have previously been available for a diverse group of women, better identify risk factors for perinatal depression, and for the first time examine how characteristics of a woman's place of residence are related to her perinatal depression risks. Specifically, we will: (1) Estimate the prevalence and incidence of major and minor depressive episodes at the beginning of the third trimester of pregnancy, and at two weeks and six months postpartum, including estimates by age, race, education, income, marital status, and parity. (2) Estimate, net of other characteristics, the relationships between psychosocial characteristics, including personal and family history of mood disorders and family stressors, and the likelihood of experiencing major and/or minor depression symptoms at each of the three points in time. (3) Estimate, the net effect of pregnancy intention, delivery method and complications on the likelihood of experiencing depression at the three points in time. (4) Estimate the relationships between community characteristics of women's place of residence (e.g., types and availability of health care resources and providers, social, economic, and demographic composition of the community, and the normative environment governing health care seeking behaviors) and the likelihood of experiencing depression at each of the three points in time. We propose to collect data from a larger and more diverse sample of women than in prior U.S. studies of perinatal depression, and to validate a diagnosis of depression at each point in time with the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) for the women who score above an established level on the Edinburgh Postnatal Depression Scale. We will use these data to estimate incidence and prevalence to address Specific Aim 1 and to estimate multivariate models to address Specific Aims 2-4.