Prevalence of Self-Reported Postpartum Depressive Symptoms Ranges From 11.7% to 20.4%

Laurie Barclay, MD

April 11, 2008

April 11, 2008 — The prevalence of self-reported postpartum depressive symptoms (PDS) ranged from 11.7% to 20.4%, according to the results of a Centers for Disease Control and Prevention (CDC) analysis of data from the Pregnancy Risk Assessment Monitoring System (PRAMS) for 2004 to 2005, as reported in the April 11 issue of Morbidity and Mortality Weekly Report.

"Postpartum depression (PPD) affects 10% – 15% of mothers within the first year after giving birth," write K. Brett, PhD, from the National Center for Health Statistics, Hyattsville, Maryland, and colleagues. "Younger mothers and those experiencing partner-related stress or physical abuse might be more likely to develop PPD."

The purpose of this analysis was to determine the prevalence of self-reported PDS among mothers by selected demographic characteristics and other possible risk factors for PDS and to identify factors predicting development of PPD. The CDC therefore analyzed data from 2004 to 2005 — the most recent data available — in PRAMS, which is an ongoing, state-specific, population-based surveillance project collecting self-reported information on maternal attitudes and experiences before, during, and after delivery of a live infant.

Maternal factors analyzed included age at delivery, race/ethnicity, education, marital status, and receipt of Medicaid for delivery. Possible risk factors for PDS that were also analyzed were low infant birth weight (<2500 g), admission to a neonatal intensive-care unit, number of previous live births, tobacco use during the last 3 months of pregnancy, history of physical abuse before or during pregnancy, and reported stress during the 12 months preceding delivery (emotional, financial, partner related, or traumatic).

In 17 states, the prevalence of self-reported PDS ranged from 11.7% in Maine to 20.4% in New Mexico during 2004 to 2005. Women who were more likely to report PDS were younger, had lower educational attainment, and received Medicaid benefits for their delivery.

"State and local health departments should evaluate the effectiveness of targeting mental health services to these mothers and incorporating messages about PPD into existing programs (e.g., domestic violence services) for women at higher risk," the authors write.

In all 17 states, demographic characteristics that were significantly associated with PDS were maternal age, marital status, maternal education, and Medicaid coverage for delivery. In 13 of 16 states with available data, there was a significant association between race/ethnicity and PDS. Compared with women of other racial/ethnic groups, non-Hispanic white women had a lower prevalence of PDS.

An accompanying editorial notes that limitations of this study include data based on self-report and not confirmed by physician diagnosis, low specificity of the screening questions used in the survey, varying duration of time about which symptoms are reported, inability to analyze alcohol or illicit drug use, and inability to identify women with preexisting depression who might or might not also have reported PDS.

"The American College of Obstetricians and Gynecologists includes screening for PPD among the essential parts of a woman's 4 – 6 week postpartum visit," the editorial concludes. "Postpartum women also can be screened for PPD by pediatricians at their infants' well-child visits. Women who are considered to have self-reported PDS based on these screenings should be administered a full diagnostic interview because they are most likely to develop PPD."

MMWR Morb Mortal Wkly Rep. 2008;57(14);361–366.

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