Prevalence of Perinatal Depression Significantly Underestimated?

Pauline Anderson

May 23, 2019

SAN FRANCISCO — Women completing a screen for depression through a novel mobile app report much higher rates of perinatal depression than current estimates, a new study shows.

Investigators found more than half of the 164,237 women who used a free pregnancy and parenting mobile application and completed the Edinburgh Postnatal Depression Scale (EPDS) reported symptoms of depression up to a year after the birth of their baby.

About one third were at risk for depression soon after the birth.

The Centers for Disease Control and Prevention (CDC) estimates 11% of women in the US suffer postpartum depression.

Christina Cobb

"My message to doctors is that probably more of your pregnant patients are depressed than you think, and so we need to increase screening," study investigator Christina Cobb, BS, clinical affairs associate, Ovia Health, the company behind this and related apps, told Medscape Medical News.

 

The findings were presented here at the American Psychiatric Association (APA) 2019 annual meeting.

Specialist Disconnect

The 10-item EPDS queries users about the frequency of symptoms and whether they have considered harming themselves or their baby.

A score of less than 10 on the EPDS suggests patients are not at risk; a score of 10–12 indicates patients are at risk; and a score of 13 or higher indicates probable depression. A score of 15 or higher flags suicidal thoughts or attempts.

The study results showed patterns of depression among app users completing the EPDS at least once over the course of pregnancy and beyond.

In the first half of pregnancy, 45.4% of respondents were at risk and 27.4% had probable depression. In the second half of pregnancy, 47.3% were at risk and 29% had probable depression.

At 0 to 3 months perinatal, 37.8% fell into the at-risk category and 21.7% into the probable depression category. At 3 to 6 months perinatal. 47.1% were at risk and 28% had probable depression. These percentages at 6 to 12 months were 52.2% and 34.6%, respectively

"In the EPDS, we found that women are showing the lowest rates of depression during the 3 months perinatal. We typically screen for perinatal depression at about 8 weeks perinatal, yet that's when there's the lowest incidence rate," said Cobb.

These results highlight the need for more screening — before, during, and after pregnancy, said Cobb. In her home state of Massachusetts, health experts are pushing for screening to be available and funded for up to a year perinatal.

Users of the free Ovia Health app who have high EPDS scores are offered perinatal educational materials and are connected to local mental health resources.

Cobb believes there's a "disconnect" between the specialists involved in caring for pregnant women who may be depressed — the obstetrician, the psychiatrist, and the pediatrician.

"The obstetrician knows all about the mother and baby but not the mind," said Cobb. "The psychiatrist knows all about mind but not what's going on with mom and baby. And once the baby is born and the pediatrician gets involved, they know about baby but not the pregnancy."

What's needed is a "cohesive way for these three different parties to communicate with each other" when it comes to depression screening, said Cobb.

Too Soon for Conclusions

Commenting on the study for Medscape Medical News, Maureen Van Niel, MD, a reproductive psychiatrist in Cambridge, Massachusetts, and president of APA women's caucus, said the survey findings seem to run "counter" to what current science reveals.

"It's too preliminary to make conclusions" based on this one app, said Van Niel, who noted that a number of other depression screening apps are under development.

"We will have to ascertain the evidence basis for the claims that come with these new apps, but if the evidence basis can be aligned with our clinical practice, then it would be a very helpful," said Van Neil, who was not involved with the current study.

She agreed, however, that screening is important and is not being done often enough. "A lot of women don't know they have a perinatal mood or anxiety disorder, so it goes unnoticed and undiagnosed. Women also sometimes feel ashamed that they're not feeling happy and excited about having a child," said Van Niel.

Only about half of the women with a perinatal mood or anxiety disorder are diagnosed, and of those who are diagnosed, only half complete treatment, she noted. Experts are starting to recognize that women can have such a disorder during pregnancy as well as postpartum.

"We're learning from the new science that there's an overlap and it's a continuum where some women have actually started early in the pregnancy to have these symptoms," said Van Niel.

APA Panel Recommendations

An APA panel of experts in reproductive psychiatry has developed recommendations for screening and treatment of perinatal depression.

The panel recommends that women get screened twice during pregnancy — once at the beginning "because you want to detect any underlying untreated depression to begin with" and again at the end of the pregnancy, said Van Niel.

Perinatal women should be screened at the regular well-baby visits, she said. "The panel found that pediatricians are almost in the best position to do this because once you've had the 6-week visit, you're done with the obstetrician."

Van Niel stressed the importance of treating depression during and after pregnancy.

"People often worry too much about giving medication during pregnancy or in the perinatal period," she said, "but actually, the results of an untreated depression can be equally damaging to the woman and the baby as using certain medications."

New research shows that untreated depression in pregnancy can increase the risk of developmental delays in the child, as well as behavioral and emotional problems well into adolescence, said Van Niel.

She added that untreated depression can even be "life threatening." Suicide is the second leading cause of death in women following birth and that "every year in this country there are at least 200 infanticides," she said.

Cobb is a clinical affairs associate for Ovia Health. Van Neil has disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2019: Abstract 1 (Session 8). Presented May 21, 2019.

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