Depression Common, Often Untreated in Young Women

Megan Brooks

March 13, 2018

One in 20 women of childbearing age suffer from major depression, but only about 1 in 3 are being treated with antidepressants, new research shows.

"Given that 54% of women with depression before pregnancy have depression during pregnancy, and that 50% of US pregnancies are unplanned, better diagnosis and treatment of nonpregnant women with depression may reduce the burden of perinatal mental illness," the researchers, led by Nan Guo, PhD, Stanford University School of Medicine in California, write.

The study was published online March 12 in Obstetrics and Gynecology.

Few studies have examined the prevalence of major depression in nonpregnant women of childbearing age, the researchers note.

To investigate, they combined data from the 2007-2014 data collection cycles of the National Health and Nutrition Examination Surveys for 3705 nonpregnant women of childbearing age. The surveys used the Patient Health Questionnaire 9 to assess for major and minor depression.

The prevalence of major depression was 4.8% (95% confidence interval [CI], 4.0 - 5.7%); for minor depression, the prevalence was 4.3% (95% CI, 3.5 - 5.2%). Yet only 32.4% (95% CI, 25.3 - 40.4%) of women with major depression and 20.0% (95% CI, 12.9 - 29.7%) of those with minor depression were receiving an antidepressant.

"These data suggest that a substantial proportion of women with severe depression are untreated or undertreated," the investigators write.

The most commonly used antidepressants in women with major depression were selective serotonin reuptake inhibitors (21.3%), phenylpiperazines (8.4%), and serotonin-norepinephrine reuptake inhibitors (7.2%). Selective serotonin reuptake inhibitors were the most common antidepressant used in women with minor depression (9.5%).

In the multivariable analysis, being a current smoker, having hypertension, and having government insurance were independently associated with major depression. Factors independently associated with minor depression were black race, other race, all education categories below college graduate level, being a smoker, and having asthma.

The factors most strongly associated with major depression were having government insurance (adjusted relative risk [RR] ratio, 2.49; 95% CI, 1.56 - 3.96) and hypertension (adjusted RR, 2.09; 95% CI, 1.25 - 3.50); for minor depression, these factors were education level less than high school (adjusted RR, 4.34; 95% CI, 2.09 - 9.01) or high school education (adjusted RR, 2.92; 95% CI, 1.35 - 6.31).

"Given these findings and the limited guidance for managing severely depressed women before pregnancy, there is unmet need for stakeholders in obstetrics, primary care, and psychiatry to coordinate approaches to optimize care and prepregnancy counseling for women with major depression," the investigators note.

They add that further study is needed to determine whether improved screening and treatment of severe depression in nonpregnant women of childbearing age can secondarily reduce the prevalence of perinatal and postpartum depression.

The study had no commercial funding. The authors have disclosed no relevant financial relationships.

Obstet Gynecol. Published online March 12, 2018. Abstract

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