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Onset and Persistence of Postpartum Depression in an Inner-City Maternal Health Clinic System

About Dr Sameera Bazli

Objective
Postpartum depressive disorders lead to maternal disability and disturbed mother-infant relationships, but information regarding the rates of major depressive disorder in minority women is noticeably lacking. The goal of this study was to determine whether the risk factors for and rate of postpartum major depressive disorder in a predominantly African American and Hispanic clinic population would be similar to those reported for Caucasian women.

Method
Investigators systematically screened all women scheduled for their first postpartum visit on selected days at four publicly funded inner-city community maternal health clinics in Dallas County (N=802). A multistage screening process included the Edinburgh Postnatal Depression Scale, the Inventory of Depressive Symptamatology, and the Structured Clinical Interview for DSM-IV for a maximum of three assessments during the initial 35-week postpartum period.

Results
The estimated rate of major depressive disorder during the postpartum period among women in this setting was between 6.5% and 8.5%. Only 50% of the depressed women reported onset following birth. Bottle-feeding and not living with one's spouse or significant other were associated with depression at the first evaluation; persistent depressive symptoms were linked with the presence of other young children at home. Greater severity of depressive symptoms at first contact predicted major depressive disorder several weeks later.

Conclusions
Rates of postpartum depression among Latina and African American postpartum women are similar to epidemiological rates for Caucasian postpartum and non-postpartum women.
As previously shown for Caucasian women, major depressive disorder in many Latina and African American postpartum women begins before delivery, revealing the need to screen pregnant women for depression.

Am J Psychiatry 158:1856-1863, November 2001.

Kimberly A. Yonkers, M.D., Susan M.Ramin, M.D., A.John Rush, M.D., Carlos A.Navarrete, M.A., Thomas Carmody, Ph.D., Dana March, B.A., Stephen F.Heartwell, Dr.P.H., and Kenneth J.Leveno M.D.