Patterns of Depression and Treatment in Pregnant and Postpartum Women

Objective: To determine the course of depression and the effects of treatment during pregnancy and into the postpartum period. Method: This is a longitudinal study of a community sample of 649 pregnant women who were assessed in early pregnancy (17.4 +/- 4.9 weeks), late pregnancy (30.6 +/- 2.7 weeks), and postpartum (4.2 +/- 2.1 weeks) with the Edinburgh Postnatal Depression Scale (EPDS). Women who scored 12 or more on the EPDS were encouraged to seek assessment and treatment. We used generalized estimating equation modelling to determine the predicted mean depression scores, taking age, ethnicity, history of depression, and previous and present treatment status into account. Results: The unadjusted prevalence of depression (EPDS >= 12) was 14.1% (n = 91) in early pregnancy, 10.4% (n = 62) in late pregnancy, and 8.1% (n = 48) postpartum. Twelve per cent of women were engaged in treatment. The predicted mean EPDS score decreased over the course of the pregnancy into the postpartum period, most significantly when women were engaged in counselling or taking psychotropic medication. Counselling was the more common method of treatment during pregnancy and medication in the postpartum period. Women who were depressed and untreated were more likely to be younger, more stressed, have less support, have a history of depression, and use alcohol. Conclusions: We confirm that depressive symptoms improve over the course of the pregnancy into the postpartum period, particularly for women who receive treatment. Our study is unique as it takes the history of depression, present and past treatment status, and the longitudinal nature of the data into account.