Perinatal Depression

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• Perinatal Depression
• A Health Services Research Perpective

Susan F. Meikle, MD MSPH Agency for Healthcare
Research and Quality Center for Outcomes and
Evidence smeikle_at_ahrq.gov Tel [phone] Fax
301-427-1520
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Background on Perinatal Depression

• DSM diagnostic criteria only for post partum
• Data on large cohorts limited by
• Selection of comparison group
• Study size
• Racial-ethnic diversity
• Term definitions

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Healthcare Cost and Utilization Project (HCUP)

• 2000 Nationwide Inpatient Sample (NIS)
• Hospital inpatient stays
• Utilization, access, charges, quality, outcomes
• 28 states
• 1,000 hospitals
• 7 million hospital discharges
• http//www.ahrq.gov/data/hcup/hcupnis.htm

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Purpose

• To characterize pregnancy related
  hospitalizations that were also associated with
  depressive diagnoses

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Women Aged 12-50in 2000 NIS

• 4.6 million admissions associated with pregnancy,
  childbirth and the puerperium
• 4.3 million admissions for non-pregnant women of
  reproductive age
• 300K admissions associated with depression

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Safe Motherhood Interagency Working Group

• composed of Department of Health and Human
  Service Agencies
• established after World Health Day in 1998
• focus on womens health before , during and after
  pregnancy
• funded an evidence report on perinatal depression

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Evidence Based Practice Centers (EPC program)

• 13 centers selected competitively
• carry out systematic reviews of the literature
• provide summary statistics
• provide information on gaps in research
• used to develop practice guidelines

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Key questions from the EPC report

• Key question 1
• What is the incidence and prevalence of
  depression (major and minor) during pregnancy and
  during the post partum period?
• Is it increased during pregnancy and the post
  partum period compared to nonchildbearing
  periods?

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• Key question 2
• What is the accuracy of different screening tools
  for detecting depression during pregnancy and the
  post partum period?

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• Key question 3
• Does prenatal or early postnatal screening for
  depressive symptoms with subsequent intervention
  lead to improved outcomes?

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Conclusions

• Depression occurs throughout pregnancy
• this is probably the most important message
  because the current DSM manual only addresses
  post partum depression
• we hope this stimulates discussion of antepartum
  depression in the upcoming revised DSM

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Conclusions, continued

• Treatment in the perinatal period works
• there is an astounding lack of evidence in this
  area
• Research is indicated, especially in the
  different racial-ethnic and cultural groups in
  the United States
• the report highlights that the quality of
  research is only fair and many unanswered
  questions remain

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