According to the report, roughly 1 in 20 American women who are pregnant or have given birth in the past 12 months are suffering from major depression. When episodes of major and minor depression are combined, as many as 13 percent of women experience depression. The report defines perinatal depression as occurring during pregnancy and up to 12 months after childbirth.

Major depression lasts 2 weeks or longer and is accompanied by five or more symptoms that substantially impair a person's ability to fully carry out normal, everyday activities. Minor depression is impairing but less severe than major depression and is accompanied by fewer symptoms.

"This report should serve as a wake-up call to health care providers as well as women and their family members," said AHRQ Director Carolyn M. Clancy, M.D. "The belief that depression is mostly a problem for women following childbirth is a myth stemming from the fact that postpartum depression has been studied more thoroughly. Enhanced detection of depression by primary care doctors and obstetrician-gynecologists can help improve women's quality of care."

The new AHRQ evidence report was requested by the Safe Motherhood Working Group, a coalition of HHS agencies that includes the Centers for Disease Control and Prevention, Health Resources and Services Administration, National Institute on Mental Health, Substance Abuse and Mental Health Services Administration, National Institute on Drug Abuse, HHS Office on Women's Health, NIH Office of Research on Women's Health, National Institute of Child Health and Human Development, Food and Drug

Administration's Office of Women's Health and Center for Drug Evaluation and Research, and AHRQ. The Safe Motherhood Working Group works to improve the health of women before, during, and after pregnancy by reducing illness and deaths.

Factors contributing to depression during or after pregnancy include personal or family history of depression or substance abuse, anxiety about the unborn child, problems with previous pregnancy or birth, and marital or financial problems. Additional factors contributing to depression after childbirth may include a sharp change in hormone levels, feeling tired and not getting enough sleep, doubts about being a good parent, and changes in work and home routines.

According to the report, evidence shows that psychotherapy and/or antidepressants can be effective treatments for women with perinatal depression. Currently there are only a small number of high-quality studies to support this treatment claim. The report suggests that women who are pregnant or breastfeeding talk with their doctors about the advantages and risks of taking antidepressants.

The evidence review also looked at the accuracy of screening instruments. Despite limited research on the topic, the available evidence suggests that screening instruments can identify perinatal depression but are more accurate at identifying major depression. These screening instruments detect depression in pregnant and postpartum women as well as the instruments used to detect depression in the general population in primary care settings. Whether used for major or minor depression, tests are relatively accurate in identifying women who do not have depression, but are less precise in identifying those who do.

Due to the small number of available studies, the report's authors were unable to determine whether screening ultimately improves patient outcomes. However, the available research suggests that providing psychosocial support to pregnant and postpartum women with depression may decrease symptoms.

"There is a lack of research in the area of perinatal depression," noted Wanda Jones, Dr.P.H., HHS Deputy Assistant Secretary for Health (Women's Health) and Chair of the Safe Motherhood Working Group. AHRQ and the Safe Motherhood Working Group plan to cofund additional research into the management of perinatal depression later this year.

This evidence review was conducted by AHRQ's RTI International-University of North Carolina Evidence-based Practice Center in Chapel Hill and Raleigh under the direction of Bradley N. Gaynes, M.D., an associate professor of psychiatry with the University of North Carolina School of Medicine, and Norma I. Gavin, Ph.D., a senior research economist with the Evidence-based Practice Center. The researchers called for future studies with larger sample sizes and more women from minority groups as well as more low-income women.

Details are in Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes. The summary is on AHRQ's Web site at http://www.ahrq.gov/clinic/epcsums/peridepsum.htm, and the full report is available at http://www.ahrq.gov/downloads/pub/evidence/pdf/peridepr/peridep.pdf. Print copies may be requested by calling AHRQ's Publications Clearinghouse at 1-800-358-9295 or sending an e-mail to ahrqpubs@ahrq.gov.

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