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Implications of psychiatric disorders during pregnancy and the postpartum period - A population-based study
Umeå University, Faculty of Medicine, Clinical Sciences, Obstetrics and Gynaecology.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Depressive and anxiety disorders are common health problems, affecting women at least twice as often as men. Although some studies have been made on pregnant women or, especially, in the postpartum period, most of these studies have been performed on small samples, mainly specific risk groups such as teenage mothers, women of low socioeconomic status and certain ethnic groups. Also, there is a lack of studies on antenatal and postpartum depression and/or anxiety using diagnostic criteria adhering to the Diagnostic and Statistical Manual of Mental disorders, fourth edition (DSM-IV).

Aims and methods: The aims were to estimate the point prevalence of mood, anxiety and eating disorders, based on DSM-IV criteria, in an unselected population during the second trimester of pregnancy, and to assess the obstetric and neonatal outcome, as well as the health care consumption during pregnancy, delivery and the early postpartum period among women with a psychiatric disorder, compared to healthy subjects. Finally, we aimed to investigate depression and anxiety, and associated maternal characteristics and events through pregnancy and the postpartum period in the same group of women. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used for assessment of psychiatric disorders during the second trimester of pregnancy and three to six months after delivery. From October 2nd, 2000, to October 1st, 2001 all women attending the second trimester routine ultrasound-screening at two different hospitals in northern Sweden (at Umeå University Hospital and at Sunderby Central Hospital) were approached for participation in the study. After delivery, data were extracted from the medical records of the mothers and their offspring to evaluate obstetric and neonatal outcome. Three to six months after delivery, the women who had an antenatal depression and/or anxiety were contacted for an assessment using the PRIME-MD. The same procedure was made in a control group, consisting of 500 women, randomly selected among those who did not have any psychiatric diagnosis according to the PRIME-MD investigation during the second trimester of pregnancy.

Results and conclusions: Of the 1555 women in the study population, 220 (14.1%) had one or more PRIME-MD diagnoses. Living single, low socioeconomic status, smoking, multiparity and a body mass index of 30 or more were significantly associated with a psychiatric diagnosis in the second trimester of pregnancy. Women with antenatal depression and/or anxiety more often suffered from nausea and vomiting during pregnancy were more often on sick leave, and they visited their obstetrician more often than healthy subjects, specifically because of fear of childbirth and premature contractions. Also, they were more commonly delivered by elective caesarean section, had an increased use of epidural analgesia and reported a longer self-experienced duration of labor. Severe complications of pregnancy, delivery, and the early postpartum period were not affected by antenatal depression and/or anxiety. There was no significant difference in neonatal outcome depending on antenatal depressive or anxiety disorder. Fewer cases of depressive and/or anxiety disorders were prevalent postpartum, but there was a significant shift from a majority of sub-threshold diagnoses during pregnancy to full DSM-IV diagnoses during the postpartum period. Previous psychiatric disorder and living singly were significantly associated with both a new-onset and a postpartum continuation/recurrence of depression and/or anxiety. Postpartum continuation/recurrence of a psychiatric disorder was additionally associated with smoking, obesity, and adverse obstetric events.

Place, publisher, year, edition, pages
Umeå: Klinisk vetenskap , 2004. , 134 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 926
Keyword [en]
Obstetrics and gynaecology, Anxiety, Depression, Neonatal, Obstetric, Population-based, Postpartum, Pregnancy
Keyword [sv]
Obstetrik och kvinnosjukdomar
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:umu:diva-369ISBN: 91-7305-750-9 (print)OAI: oai:DiVA.org:umu-369DiVA: diva2:143275
Public defence
2004-12-10, Sal B, 9 tr, Tandläkarhögskolan, 90187, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2004-11-17 Created: 2004-11-17 Last updated: 2009-10-01Bibliographically approved
List of papers
1. Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study.
Open this publication in new window or tab >>Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study.
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2003 (English)In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 189, no 1, 148-154 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: This study was undertaken to determine the point prevalence of psychiatric disorders during the second trimester of pregnancy in a population-based sample of pregnant women. STUDY DESIGN: Participants were 1795 consecutive pregnant women attending routine ultrasound screening at two obstetric clinics in Northern Sweden during 1 year. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used for evaluating. RESULTS: Overall, 1734 (96.6%) of the women filled in the PRIME-MD patient questionnaire. Psychiatric disorders were present in 14.1% of the women. Major depression was prevalent in 3.3% of patients and minor depression in 6.9% of patients. Anxiety disorders were encountered in 6.6% of patients. Women with psychiatric disorders displayed significantly more somatic symptoms and more pronounced fear of childbirth. Among diagnosed patients, only 5.5% had some form of treatment. CONCLUSION: The prevalence of mood and anxiety disorders in this unselected population of pregnant women was high and the majority of the women were found to be undiagnosed and untreated.

Identifiers
urn:nbn:se:umu:diva-4256 (URN)10.1067/mob.2003.336 (DOI)12861154 (PubMedID)
Available from: 2004-11-17 Created: 2004-11-17 Last updated: 2017-12-14Bibliographically approved
2. Implications of antenatal depression and anxiety for obstetric outcome
Open this publication in new window or tab >>Implications of antenatal depression and anxiety for obstetric outcome
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2004 (English)In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 104, no 3, 467-476 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the obstetric outcome and health care consumption during pregnancy, delivery, and the early postpartum period in an unselected population-based sample of pregnant women diagnosed with antenatal depressive and/or anxiety disorders, compared with healthy subjects. METHODS: Participants were 1,495 women attending 2 obstetric clinics in Northern Sweden. The Primary Care Evaluation of Mental Disorders was used to evaluate depressive and anxiety disorders in the second trimester of pregnancy. To assess demographic characteristics, obstetric outcome, and complications, the medical records of the included women were reviewed. RESULTS: Significant associations were found between depression and/or anxiety and increased nausea and vomiting, prolonged sick leave during pregnancy and increased number of visits to the obstetrician, specifically, visits related to fear of childbirth and those related to contractions. Planned cesarean delivery and epidural analgesia during labor were also significantly more common in women with antenatal depression and/or anxiety. CONCLUSION: There is an association between antenatal depressive and/or anxiety disorders and increased health care use (including cesarean deliveries) during pregnancy and delivery.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2004
Keyword
Adult, Anxiety, Depression, Female, Humans, Pregnancy, Pregnancy Complications, Pregnancy Outcome
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-16442 (URN)10.1097/01.AOG.0000135277.04565.e9 (DOI)000225415200007 ()15339755 (PubMedID)
Available from: 2007-09-28 Created: 2007-09-28 Last updated: 2017-12-14Bibliographically approved
3. Neonatal outcome following maternal antenatal depression and anxiety: a population-based study.
Open this publication in new window or tab >>Neonatal outcome following maternal antenatal depression and anxiety: a population-based study.
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2004 (English)In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 159, no 9, 872-881 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to determine neonatal outcomes among women who had depressive and anxiety disorders during the second trimester of pregnancy in a population-based sample. Participants were 1,465 women and their neonates born at two obstetric clinics in Sweden. The inclusion period for the women was October 2, 2000-October 1, 2001. The Primary Care Evaluation of Mental Disorders (PRIME-MD) classification system was used to evaluate mental disorders in the second trimester of pregnancy. For assessment of demographic characteristics, birth statistics, and birth-related complications, the medical records of the included women and their offspring were reviewed after delivery. The study results revealed no differences in neonatal outcome between women with antenatal depressive disorders and/or anxiety disorders and healthy subjects. The authors conclude that neonatal outcome did not deteriorate despite the women's impaired mental health during pregnancy.

Keyword
Adult, Analysis of Variance, Anxiety Disorders/complications/diagnosis/epidemiology, Birth Weight, Case-Control Studies, Confounding Factors (Epidemiology), Depressive Disorder/complications/diagnosis/epidemiology, Female, Humans, Infant; Newborn, Infant; Small for Gestational Age, Logistic Models, Mental Health, Obstetric Labor; Premature/epidemiology/etiology, Population Surveillance, Pregnancy, Pregnancy Complications/diagnosis/epidemiology, Pregnancy Outcome/epidemiology, Pregnancy Trimester; Second, Prevalence, Psychiatric Status Rating Scales, Questionnaires, Risk Factors, Sweden/epidemiology, Women's Health
Identifiers
urn:nbn:se:umu:diva-16444 (URN)15105180 (PubMedID)
Available from: 2007-09-28 Created: 2007-09-28 Last updated: 2017-12-14Bibliographically approved
4. Depression and anxiety during pregnancy and six months postpartum: a follow-up study
Open this publication in new window or tab >>Depression and anxiety during pregnancy and six months postpartum: a follow-up study
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2006 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 8, 937-944 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: To investigate the relationship between antenatal and postpartum depression and anxiety and to explore associated maternal characteristics. METHODS: From a population-based sample of 1,555 women attending two obstetric clinics in Sweden, all women with an antenatal psychiatric diagnosis (n = 220) and a random selection of healthy women (n = 500) were contacted for a second assessment three to six months postpartum. The Primary Care Evaluation of Mental Disorders was used for evaluation on both occasions. RESULTS: Fewer cases of depressive and/or anxiety disorders were prevalent postpartum compared with the second trimester screening. Depression and/or anxiety were prevalent in 16.5% of postpartal women versus 29.2% of pregnant women. There was a significant shift from a majority of subthreshold diagnoses during pregnancy to full Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnoses during the postpartum period. A history of previous psychiatric disorder, living single, and obesity were significantly associated with a new-onset postpartum psychiatric disorder. The absence of a previous psychiatric disorder was significantly associated with a postpartum recovery of depression or anxiety. CONCLUSIONS: Depression and anxiety appear to be less common postpartum than during pregnancy.

Keyword
Adult, Anxiety Disorders/*epidemiology, Case-Control Studies, Depression; Postpartum/*epidemiology, Depressive Disorder/*epidemiology, Female, Follow-Up Studies, Humans, Pregnancy, Pregnancy Complications/*epidemiology, Prevalence, Sweden/epidemiology
Identifiers
urn:nbn:se:umu:diva-16438 (URN)10.1080/00016340600697652 (DOI)16862471 (PubMedID)
Available from: 2007-10-04 Created: 2007-10-04 Last updated: 2017-12-14Bibliographically approved

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