Psychiatric Disorders in Pregnant and Postpartum Women in the United States

Overview

Journal Arch Gen Psychiatry

Specialty Psychiatry

Date 2008 Jul 9

PMID 18606953

Citations 349

Authors

Oriana Vesga-Lopez

Carlos Blanco

Katherine Keyes

Mark Olfson

Bridget F Grant

Deborah S Hasin

Affiliations

Soon will be listed here.

Abstract

Context: Psychiatric disorders and substance use during pregnancy are associated with adverse outcomes for mothers and their offspring. Information about the epidemiology of these conditions in this population is lacking.

Objective: To examine sociodemographic correlates, rates of DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking among past-year pregnant and postpartum women in the United States.

Design: National survey.

Setting: Face-to-face interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions.

Participants: A total of 43 093 respondents were interviewed, of whom 14 549 were women 18 to 50 years old with known past-year pregnancy status.

Main Outcome Measures: Prevalence of 12-month DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking.

Results: Past-year pregnant and postpartum women had significantly lower rates of alcohol use disorders and any substance use, except illicit drug use, than nonpregnant women. In addition, currently pregnant women had a lower risk of having any mood disorder than nonpregnant women. The only exception was the significantly higher prevalence of major depressive disorder in postpartum than in nonpregnant women. Age, marital status, health status, stressful life events, and history of traumatic experiences were all significantly associated with higher risk of psychiatric disorders in pregnant and postpartum women. Lifetime and past-year treatment-seeking rates for any psychiatric disorder were significantly lower among past-year pregnant than nonpregnant women with psychiatric disorders. Most women with a current psychiatric disorder did not receive any mental health care in the 12 months prior to the survey regardless of pregnancy status.

Conclusions: Pregnancy per se is not associated with increased risk of the most prevalent mental disorders, although the risk of major depressive disorder may be increased during the postpartum period. Groups of pregnant women with particularly high prevalence of psychiatric disorders were identified. Low rates of maternal mental health care underscore the need to improve recognition and delivery of treatment for mental disorders occurring during pregnancy and the postpartum period.

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Schwarze C, Lerche V, Wallwiener S, Pauen S BMC Pregnancy Childbirth. 2024; 24(1):664.

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References

Oren D, Wisner K, Spinelli M, Epperson C, Peindl K, Jiuan Su Terman . An open trial of morning light therapy for treatment of antepartum depression. Am J Psychiatry. 2002; 159(4):666-9. DOI: 10.1176/appi.ajp.159.4.666. View

Spinelli M . Interpersonal psychotherapy for depressed antepartum women: a pilot study. Am J Psychiatry. 1997; 154(7):1028-30. DOI: 10.1176/ajp.154.7.1028. View

Kelly R, Danielsen B, Golding J, Anders T, Gilbert W, Zatzick D . Adequacy of prenatal care among women with psychiatric diagnoses giving birth in California in 1994 and 1995. Psychiatr Serv. 1999; 50(12):1584-90. DOI: 10.1176/ps.50.12.1584. View

Regmi S, Sligl W, Carter D, Grut W, Seear M . A controlled study of postpartum depression among Nepalese women: validation of the Edinburgh Postpartum Depression Scale in Kathmandu. Trop Med Int Health. 2002; 7(4):378-82. DOI: 10.1046/j.1365-3156.2002.00866.x. View

Munk-Olsen T, Laursen T, Pedersen C, Mors O, Mortensen P . New parents and mental disorders: a population-based register study. JAMA. 2006; 296(21):2582-9. DOI: 10.1001/jama.296.21.2582. View

OConnor T, Heron J, Golding J, Glover V . Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis. J Child Psychol Psychiatry. 2003; 44(7):1025-36. DOI: 10.1111/1469-7610.00187. View

OConnor T, Heron J, Glover V . Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry. 2002; 41(12):1470-7. DOI: 10.1097/00004583-200212000-00019. View

Rahman A, Bunn J, Lovel H, Creed F . Maternal depression increases infant risk of diarrhoeal illness: --a cohort study. Arch Dis Child. 2006; 92(1):24-8. PMC: 2083137. DOI: 10.1136/adc.2005.086579. View

Martin S, English K, Clark K, Cilenti D, Kupper L . Violence and substance use among North Carolina pregnant women. Am J Public Health. 1996; 86(7):991-8. PMC: 1380441. DOI: 10.2105/ajph.86.7.991. View

10.

Kelly R, Russo J, Holt V, Danielsen B, Zatzick D, Walker E . Psychiatric and substance use disorders as risk factors for low birth weight and preterm delivery. Obstet Gynecol. 2002; 100(2):297-304. DOI: 10.1016/s0029-7844(02)02014-8. View

11.

Kelly R, Danielson B, Zatzick D, Haan M, Anders T, Gilbert W . Chart-recorded psychiatric diagnoses in women giving birth in California in 1992. Am J Psychiatry. 1999; 156(6):955-7. DOI: 10.1176/ajp.156.6.955. View

12.

Kendell R, Chalmers J, PLATZ C . Epidemiology of puerperal psychoses. Br J Psychiatry. 1987; 150:662-73. DOI: 10.1192/bjp.150.5.662. View

13.

Howard M, Battle C, Pearlstein T, Rosene-Montella K . A psychiatric mother-baby day hospital for pregnant and postpartum women. Arch Womens Ment Health. 2006; 9(4):213-8. DOI: 10.1007/s00737-006-0135-y. View

14.

Holmes T, RAHE R . The Social Readjustment Rating Scale. J Psychosom Res. 1967; 11(2):213-8. DOI: 10.1016/0022-3999(67)90010-4. View

15.

Adewuya A, Ola B, Aloba O, Dada A, Fasoto O . Prevalence and correlates of depression in late pregnancy among Nigerian women. Depress Anxiety. 2006; 24(1):15-21. DOI: 10.1002/da.20221. View

16.

Kelly R, Zatzick D, Anders T . The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics. Am J Psychiatry. 2001; 158(2):213-9. DOI: 10.1176/appi.ajp.158.2.213. View

17.

Battle C, Zlotnick C, Miller I, Pearlstein T, Howard M . Clinical characteristics of perinatal psychiatric patients: a chart review study. J Nerv Ment Dis. 2006; 194(5):369-77. DOI: 10.1097/01.nmd.0000217833.49686.c0. View

18.

Ruan W, Goldstein R, Chou S, Smith S, Saha T, Pickering R . The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug Alcohol Depend. 2007; 92(1-3):27-36. PMC: 2246381. DOI: 10.1016/j.drugalcdep.2007.06.001. View

19.

Stowe Z, Nemeroff C . Women at risk for postpartum-onset major depression. Am J Obstet Gynecol. 1995; 173(2):639-45. DOI: 10.1016/0002-9378(95)90296-1. View

20.

Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R . Impact of maternal depression on infant nutritional status and illness: a cohort study. Arch Gen Psychiatry. 2004; 61(9):946-52. DOI: 10.1001/archpsyc.61.9.946. View