BMJ 2001;323:257-260 ( 4 August )

Papers

Cohort study of depressed mood during pregnancy and after childbirth

Jonathan Evans, consultant senior lecturer a, Jon Heron, research assistant b, Helen Francomb, midwife c, Sarah Oke, consultant psychiatrist d, Jean Golding, professor of paediatric epidemiology b,  on behalf of the Avon Longitudinal Study of Parents and Children Study Team.

a Division of Psychiatry, University of Bristol, Bristol BS2 8DZ, b Unit of Paediatric and Perinatal Epidemiology, Division of Child Health, University of Bristol, Bristol BS8 1TQ, c Department of Women's Health and Care of the Newborn, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, d Mother and Baby Unit, Barrow Hospital, Barrow Gurney, Bristol BS48 3SG

Correspondence to: J Evans j.evans{at}bristol.ac.uk


    Abstract
Top
Abstract
Introduction
Participants and methods
Results
Discussion
References

Objective: To follow mothers' mood through pregnancy and after childbirth and compare reported symptoms of depression at each stage.
Design: Longitudinal cohort study.
Setting: Avon.
Participants: Pregnant women resident within Avon with an expected date of delivery between 1 April 1991 and 31 December 1992.
Main outcome measures: Symptom scores from the Edinburgh postnatal depression scale at 18 and 32 weeks of pregnancy and 8 weeks and 8 months postpartum. Proportion of women above a threshold indicating probable depressive disorder.
Results: Depression scores were higher at 32 weeks of pregnancy than 8 weeks postpartum (difference in means 0.88, 95% confidence interval 0.79 to 0.97). There was no difference in the distribution of total scores or scores for individual items at the four time points. 1222 (13.5%) women scored above threshold for probable depression at 32 weeks of pregnancy, 821 (9.1%) at 8 weeks postpartum, and 147 (1.6%) throughout. More mothers moved above the threshold for depression between 18 weeks and 32 weeks of pregnancy than between 32 weeks of pregnancy and 8 weeks postpartum.
Conclusions: Symptoms of depression are not more common or severe after childbirth than during pregnancy. Research and clinical efforts need to be moved towards understanding, recognising, and treating antenatal depression.


    Introduction
Top
Abstract
Introduction
Participants and methods
Results
Discussion
References

Women are more vulnerable to psychiatric illness during the postnatal period. The rate of psychiatric admission is increased postnatally, mostly because of the raised risk of psychosis in the first month after childbirth.1 In 1968, Pitt described a syndrome of "atypical depression following childbirth,"2 although there is now no evidence that there is a categorical difference between depression after childbirth and depression at other times. The prevalence of non-psychotic depressive illness in the postnatal period is similar to that in the general population. 3 4

Nevertheless, postnatal depression has become a focus of concern. General practitioners, health visitors, and others are exhorted to recognise and treat this condition. The consequences of postnatal depression to the child, mother, and family may include neglect of the child, family breakdown, self harm, and suicide. However, the more common consequences include emotional and behavioural problems, and cognitive delay in the children of depressed mothers. 5 6

In contrast, depression during pregnancy has been relatively neglected. Indeed, pregnancy was thought to protect women against depression. Studies of antenatal psychopathology have mostly examined antenatal mood as a predictor of postnatal depression.7-10 Watson et al found that in 23% of those who had postnatal depression this had started during pregnancy.11 Depressed mood during pregnancy has also been associated with poor attendance at antenatal clinics, substance misuse, low birth weight, and preterm delivery. 12 13 Psychopathological symptoms during pregnancy have physiological consequences for the fetus, which may explain some of these effects.14

We studied mood through pregnancy and after childbirth using prospectively gathered data from a cohort of 14 000 women. We compared depressive symptom score, the pattern of reported symptoms, and the proportion of mothers above a threshold indicating probable depressive disorder at each stage.


    Participants and methods
Top
Abstract
Introduction
Participants and methods
Results
Discussion
References

The Avon longitudinal study of parents and children enrolled women resident in Avon who were in the early stages of pregnancy with an expected date of delivery between 1 April 1991 and 31 December 1992. We recruited 14 541 women, of whom 13 799 had offspring surviving to 12 months old. Further details of the study aims and design are available (www.ich.bris.ac.uk/alspacext/). Ethical approval was obtained from the study's ethics committee and local ethics committees.

Women completed the Edinburgh postnatal depression scale15 and the Crown Crisp experiential index16 as part of a series of postal questionnaires. We present here data for questionnaires completed at 18 weeks and 32 weeks of pregnancy and at 8 weeks and 8 months postpartum. The Edinburgh postnatal depression scale focuses on the cognitive and affective features of depression rather than somatic symptoms. It is the only self report scale that has been validated for use postnatally and during pregnancy. 17 18 The scale cannot in itself confirm a diagnosis of depression; however, a score above 12 is widely used to indicate probable depressive disorder. Validation of the scale showed that all those found to have definite major depression when interviewed, had scored above 12 on the scale. Use of this threshold gave an overall sensitivity of 86% and specificity of 78% for all forms of depression.15

Statistical methods
We calculated mean Edinburgh postnatal depression scale scores for all responders and those responding at all four time points. Although the scores were negatively skewed, the differences in scores were symmetric and normal enough for analysis with paired t tests. The 95% confidence intervals for the differences in the mean values were corrected for multiple (six) comparisons. We plotted frequency histograms of total scores for each period and compared changes in symptom score between 18 weeks and 32 weeks of pregnancy with changes between 32 weeks of pregnancy and 8 weeks postpartum using a paired t test. Mean scores for each item of the Edinburgh postnatal depression scales at each time point were plotted to compare the frequency with which each symptom was reported. We repeated the analyses on the data from the Crown Crisp experiential index depression subscale to investigate whether a different scale produced any substantial differences in results.

We divided the cohort between probable cases of depression and probable non-cases at each time point using a threshold of 12/13 on the Edinburgh postnatal depression scale. We then compared changes across this threshold from 18 weeks to 32 weeks of pregnancy and 32 weeks of pregnancy to 8 weeks postpartum. We made a simplifying assumption that the two groups were independent, although some of the women would have been common to both groups. Under this assumption, using a normal approximation to the binomial distribution, we derived a confidence interval for the difference in the proportion of women rising above the threshold for probable depression between each time point.


    Results
Top
Abstract
Introduction
Participants and methods
Results
Discussion
References

Of the 13 799 eligible mothers, 12 059 (87%) completed at least one of the four questionnaires and 9028 (65%) completed all four. Table 1 shows the mean Edinburgh postnatal depression scale scores for each period. Mean scores were higher in pregnancy than postnatally, with a peak at 32 weeks of pregnancy of 6.72 (SD 4.94) and a lowest value at 8 months postpartum (5.25 (4.61)). The mean change in depression score from that at 18 weeks of pregnancy was -0.097 (95% confidence interval -0.18 to -0.01, P=0.025) at 32 weeks of pregnancy, 0.78 (0.69 to 0.88, P<0.001) at 8 weeks postpartum, and 1.37 (1.27 to 1.46, P<0.001) at 8 months postpartum. Mean change in score was 0.88 (0.79 to 0.97, P<0.001) between 32 weeks of pregnancy and 8 weeks postpartum, 1.46 (1.37 to 1.56, P<0.001) between 32 weeks of pregnancy and 8 months postpartum, and -0.58 (-0.50 to -0.67, P<0.001) between 8 weeks and 8 months postpartum. Women who did not complete all four questionnaires had higher depression symptom scores than women who completed all four. The mean depression scores were therefore higher when partial responders were included (table 1).


                              
View this table:
[in this window]
[in a new window]
 

Table 1. Edinburgh postnatal depression score during pregnancy and after childbirth

There was a small rise in depression symptom score during pregnancy (mean change 0.10; SE 0.043) and a small drop after childbirth (-0.88; 0.047). These changes were significantly different (difference 0.98, 95% confidence interval 0.83 to 1.13; P<0.001).

Table 2 shows the cumulative frequency of women with increasing Edinburgh postnatal depression scores at the four time points. The distribution did not differ between the time points.


                              
View this table:
[in this window]
[in a new window]
 

Table 2. Cumulative number (percentage) of women with various Edinburgh postnatal depression scores at each time point.

Table 3 gives the scores for each item in the questionnaire. A similar pattern was seen at all four time points, but question 3 (I have blamed myself unnecessarily when things went wrong) was rated higher at 18 weeks of pregnancy that at other times and question 6 (things have been getting on top of me) was rated lower at 8 months postpartum than at other times.


                              
View this table:
[in this window]
[in a new window]
 

Table 3. Mean score for Edinburgh postnatal depression scale items at each time point among 9028 women with complete data. (Maximum score for each question is 3)

When we repeated the above analyses using the Crown Crisp experiential index depression subscale there was no substantial differences in the findings.

The proportion of women with probable depression (Edinburgh postnatal depression score >= 13) was 11.8% at 18 weeks of pregnancy, 13.5% at 32 weeks of pregnancy, 9.1 % at 8 weeks postpartum, and 8.1% at 8 months postpartum (table 1). In all, 147 (1.6%) women had probable depression at all four time points and 6771 (75%) scored below the threshold at all time points; 436 (4.8%) had probable depression at 32 weeks of pregnancy only and 240 (2.7%) at 8 weeks postpartum only.

Of the 7966 women who were below the threshold for probable depression at 18 weeks of pregnancy, 673 (8.4%) were above the threshold at 32 weeks of pregnancy. Of the 7806 below the threshold for probable depression at 32 weeks of pregnancy, 410 (5.3%) were above the threshold at 8 weeks postpartum. There were 253 (3.2%) fewer women newly rising above the threshold for probable depression after childbirth than during pregnancy (95% confidence interval 2.4% to 4.0%).


    Discussion
Top
Abstract
Introduction
Participants and methods
Results
Discussion
References

We found that mothers have higher scores on the Edinburgh postnatal depression scale in pregnancy than postnatally and that the distribution of total scores and individual symptoms did not differ before and after childbirth. These data suggest that depression is no more likely after childbirth than it is after events during pregnancy.

Validity of instrument
Self report instruments do not provide a clinical diagnosis of depression. Some mothers scoring above the threshold will not have a depressive illness and some below the threshold will. However, a validation study found that a score of >= 13 gave the best estimate of prevalence of depression.15 This threshold may overestimate depression during pregnancy.17 However, even if we used a higher threshold in pregnancy than postnatally, depression was still common during pregnancy. Furthermore, the proportion of women rating themselves as severely depressed was similar before and after childbirth. We found no evidence that the question asking whether the woman feared she might harm herself was misinterpreted or overrated during pregnancy, despite suggestions that this could happen.19

Patterns of depression
We found no evidence to support the existence of a subgroup of women with a specific type or severity of symptoms. It has been suggested that a small subgroup of women with postnatal depression have abnormal thyroid function leading to depressed mood.20 Women who did not respond at all time points had higher depression scores, and the non-responders probably included some of the most depressed women. Our results may therefore be biased by selective non-response among women with severe postnatal depression. Another explanation for our lower postnatal scores is that incidence of depression may peak at a time not measured in this study. Our data support research suggesting that there is no difference in the pattern of symptoms of depression during pregnancy or postnatally. Thus, postnatal depression does not seem to be a distinct syndrome.

The scales that we used were developed using only the core symptoms of depression because they are applicable to different contexts. Women's experience of depression during pregnancy and after childbirth, however, may be very different. Childbirth is an important biological, social, and psychological event.

Although caution is needed when equating self report data with a clinical diagnosis of depression, our data suggest that childbirth is less likely than the events of pregnancy to be followed by depression in women who are not depressed, and more likely to be followed by improvement in women who are depressed. The fall in probable cases of depression after childbirth has been reported in a study using this dataset and examining change and stability in depression using latent variable modelling.21 However, there is some evidence that childbirth may be a non-specific stressor for depression in most women and a specific stressor in a subgroup of women.22 We will be able to test this hypothesis by following mothers through to their next pregnancy.

Implications
The consequences of antenatal depression are not well understood. Psychopathology during pregnancy may have an important effect on the uterine environment,14 and research is urgently needed into the consequences for the child of antenatal depression.

It is also important to study the potential benefits of screening for, and treating, depression during pregnancy. Although there are concerns about the widespread use of antidepressants during pregnancy, the benefits may outweigh the risks for women with severe depression. Non-pharmacological interventions that have been found effective in mild to moderate depression23 could be evaluated for treating depression during pregnancy.24 Our results show depression during pregnancy is more common than postnatal depression. Offering treatment may be important for both the mother and the future wellbeing of the child and family.


What is known on this topic

Postnatal depression is common

Recognising and treating depression is emphasised in postnatal care

Depression is also common in pregnancy

What this study adds

Self reported symptom scores for depression are higher in pregnancy than postnatally

The severity and nature of depressed mood does not differ before and after childbirth

More mothers have scores that rise above a threshold for probable depression during pregnancy than after childbirth



    Acknowledgments

We thank the mothers and fathers who took part and the midwives for their cooperation and help in recruitment. The study team comprises interviewers, computer technicians, laboratory technicians, clerical workers, research scientists, volunteers, and managers, who continue to make the study possible.

Contributors: JE wrote the paper and planned the data analyses, JH analysed the data, and HF planned the analyses and commented on the final draft of the paper. SO contributed to writing the paper and commented on the final draft. JG designed the study, advised on data analysis, and commented on the final draft. The ALSPAC study team designed the study and collected and entered the data. JE will act as guarantor.

    Footnotes

Funding: Medical Research Council, Wellcome Trust, Department of Health, Department of the Environment, and various charitable organisations and commercial companies. The ALSPAC study is part of the WHO initiated European longitudinal study of pregnancy and childhood.

Competing interests: None declared.


    References
Top
Abstract
Introduction
Participants and methods
Results
Discussion
References

1. Kendall RE, Wainwright S, Hailey A, Shannon B. The influence of childbirth on psychiatric morbidity. Psychol Med 1976; 6: 297-302[Medline].
2. Pitt B. Atypical depression following childbirth. Br J Psychiatry 1968; 114: 1325-1335[Abstract/Free Full Text].
3. Cooper PJ, Campbell EA, Day A, Kennerley H, Bond A. Non-psychotic psychiatric disorder after childbirth: a prospective study of prevalence, incidence, course and nature. Br J Psychiatry 1988; 152: 799-806[Abstract/Free Full Text].
4. O'Hara MW, Zekoski EM, Phillips LH, Wright EJ. Controlled prospective study of postpartum mood disorders: comparison of childbearing and non-childbearing women. J Abnormal Psychol 1990; 99: 3-15[CrossRef][Medline]
5. Sinclair D, Murray L. Effects of postnatal depression on children's adjustment to school. Br J Psychiatry 1998; 172: 58-63[Abstract/Free Full Text].
6. Murray L, Sinclair D, Cooper P, Ducournau P, Turner P. The socioemotional development of 5 year olds with postnatally depressed mothers. J Child Psychol Psychiatry 1999; 40: 1259-1271[CrossRef][Medline].
7. O'Hara MW, Neunaber DJ, Zekoski EM. Prospective study of postpartum depression: prevalence, course and predictive factors. J Abnormal Psychol 1984; 93: 158-171[CrossRef][Medline].
8. Green MJ. Who is unhappy after childbirth? Antenatal and intrapartum correlates from a prospective study. J Reprod Infant Psychol 1990; 8: 175-183.
9. Hobfoll SE, Ritter C, Lavin J, Hulsizer MR, Cameron RP. Depression prevalence and incidence among inner-city pregnant and postpartum women. J Consult Clin Psychol 1995; 65: 445-453.
10. Cox JL, Connor Y, Kendell RE. Prospective study of the psychiatric disorders of childbirth. Br J Psychiatry 1982; 140: 111-117[Abstract/Free Full Text].
11. Watson JP, Elliott SA, Rugg AJ, Brough DI. Psychiatric disorder in pregnancy and the first postnatal year. Br J Psychiatry 1984; 144: 453-462[Abstract/Free Full Text].
12. Pagel MD, Smilkstein G, Regen H, Montano D. Psychosocial influences on new born outcome: a controlled prospective study. Soc Sci Med 1990; 30: 597-604.
13. Hedegaard M, Henriksen TB, Sabroe S, Secher NJ. Psychological distress in pregnancy and preterm delivery. BMJ 1993; 307: 234-239.
14. Teixeira JMA, Fisk NM, Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ 1999; 318: 153-157[Abstract/Free Full Text].
15. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 1987; 150: 782-786[Abstract/Free Full Text].
16. Crown S, Crisp AH. Manual of the Crown-Crisp experiential index. London: Hodder and Stoughton, 1979.
17. Murray D, Cox JL. Screening for depression during pregnancy with the Edinburgh depression scale (EPDS). J Reprod Infant Psychol 1990; 8: 99-107.
18. Thorpe K. A study of the Edinburgh postnatal depression scale for use with parent groups outside the postpartum period. J Reprod Infant Psychol 1993; 11: 119-125.
19. Green JM, Snowdon C, Statham H. EPDS by post. Br J Psychiatry 1991; 158: 865.
20. Harris B, Othman S, Davies JA, Weppner GJ, Richards CJ, Newcombe RG, et al. Association between postpartum thyroid antibodies and depression. BMJ 1992; 305: 152-156.
21. Fergusson D, Horwood J, Thorpe K, ALSPAC Study Team. Changes in depression during and following pregnancy. Paediatric Perinatal Epidemiol 1996; 10: 279-293[Medline].
22. Cooper PJ, Murray L. Course and recurrence of postnatal depression. evidence for the specificity of the diagnostic concept. Br J Psychiatry 1995; 166: 191-195[Abstract/Free Full Text].
23. Mynors-Wallis LM, Gath DH, Day A, Baker F. Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care. BMJ 2000; 320: 26-23[Abstract/Free Full Text].
24. Spinelli MG. Interpersonal psychotherapy for depressed antepartum women: a pilot study. Am J Psychiatry 1997; 154: 1028-1030[Abstract].

(Accepted 19 April 2001)

© BMJ 2001
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

Related Articles

Depression during pregnancy
Veronica O'Keane and Michael S Marsh
BMJ 2007 334: 1003-1005. [Extract] [Full Text] [PDF]

Depressed mood during pregnancy and after childbirth
Julia Lappin, J Sheehan, F M Crotty, M R Oates, A Lee, Jonathan Evans, Jon Heron, Jean Golding, Helen Francomb, and Sarah Oke
BMJ 2001 323: 1367. [Extract] [Full Text]

Depression is more common during pregnancy than after childbirth
BMJ 2001 323: 0. [Full Text]

This article has been cited by other articles:

  • Hammarberg, K., Fisher, J.R.W., Wynter, K.H. (2008). Psychological and social aspects of pregnancy, childbirth and early parenting after assisted conception: a systematic review. Hum Reprod Update 0: dmn030v1-20 [Abstract] [Full text]  
  • Escribe-Aguir, V, Gonzalez-Galarzo, M C, Barona-Vilar, C, Artazcoz, L (2008). Factors related to depression during pregnancy: are there gender differences?. J. Epidemiol. Community Health 62: 410-414 [Abstract] [Full text]  
  • Rich-Edwards, J. W., Mohllajee, A. P., Kleinman, K., Hacker, M. R., Majzoub, J., Wright, R. J., Gillman, M. W. (2008). Elevated Midpregnancy Corticotropin-Releasing Hormone Is Associated with Prenatal, But Not Postpartum, Maternal Depression. J. Clin. Endocrinol. Metab. 93: 1946-1951 [Abstract] [Full text]  
  • Oberlander, T. F., Warburton, W., Misri, S., Aghajanian, J., Hertzman, C. (2008). Effects of timing and duration of gestational exposure to serotonin reuptake inhibitor antidepressants: population-based study. Br. J. Psychiatry 192: 338-343 [Abstract] [Full text]  
  • Lee, A. M., Lam, S. K., Sze Mun Lau, S. M., Chong, C. S. Y., Chui, H. W., Fong, D. Y. T. (2007). Prevalence, Course, and Risk Factors for Antenatal Anxiety and Depression. Obstet Gynecol 110: 1102-1112 [Abstract] [Full text]  
  • Freeman, M. P. (2007). Antenatal Depression: Navigating the Treatment Dilemmas. Am. J. Psychiatry 164: 1162-1165 [Full text]  
  • Suri, R., Altshuler, L., Hellemann, G., Burt, V. K., Aquino, A., Mintz, J. (2007). Effects of Antenatal Depression and Antidepressant Treatment on Gestational Age at Birth and Risk of Preterm Birth. Am. J. Psychiatry 164: 1206-1213 [Abstract] [Full text]  
  • O'Keane, V., Marsh, M. S (2007). Depression during pregnancy. BMJ 334: 1003-1005 [Full text]  
  • Ammerman, R. T., Bodley, A. L., Putnam, F. W., Lopez, W. L., Holleb, L. J., Stevens, J., Van Ginkel, J. B. (2007). In-Home Cognitive Behavior Therapy for a Depressed Mother in a Home Visitation Program. Clinical Case Studies 6: 161-180 [Abstract]  
  • Heneghan, A. M., Chaudron, L. H., Storfer-Isser, A., Park, E. R., Kelleher, K. J., Stein, R. E. K., Hoagwood, K. E., O'Connor, K. G., Horwitz, S. M. (2007). Factors Associated With Identification and Management of Maternal Depression by Pediatricians. Pediatrics 119: 444-454 [Abstract] [Full text]  
  • Oberlander, T. F., Reebye, P., Misri, S., Papsdorf, M., Kim, J., Grunau, R. E. (2007). Externalizing and Attentional Behaviors in Children of Depressed Mothers Treated With a Selective Serotonin Reuptake Inhibitor Antidepressant During Pregnancy. Arch Pediatr Adolesc Med 161: 22-29 [Abstract] [Full text]  
  • Dayan, J., Creveuil, C., Marks, M. N., Conroy, S., Herlicoviez, M., Dreyfus, M., Tordjman, S. (2006). Prenatal Depression, Prenatal Anxiety, and Spontaneous Preterm Birth: A Prospective Cohort Study Among Women With Early and Regular Care. Psychosom. Med. 68: 938-946 [Abstract] [Full text]  
  • Oberlander, T. F., Warburton, W., Misri, S., Aghajanian, J., Hertzman, C. (2006). Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data.. Arch Gen Psychiatry 63: 898-906 [Abstract] [Full text]  
  • Poikkeus, P., Saisto, T., Unkila-Kallio, L., Punamaki, R.-L., Repokari, L., Vilska, S., Tiitinen, A., Tulppala, M. (2006). Fear of Childbirth and Pregnancy-Related Anxiety in Women Conceiving With Assisted Reproduction.. Obstet Gynecol 108: 70-76 [Abstract] [Full text]  
  • Misri, S., Reebye, P., Kendrick, K., Carter, D., Ryan, D., Grunau, R. E., Oberlander, T. F. (2006). Internalizing Behaviors in 4-Year-Old Children Exposed in Utero to Psychotropic Medications. Am. J. Psychiatry 163: 1026-1032 [Abstract] [Full text]  
  • Rochat, T. J., Richter, L. M., Doll, H. A., Buthelezi, N. P., Tomkins, A., Stein, A. (2006). Depression Among Pregnant Rural South African Women Undergoing HIV Testing. JAMA 295: 1376-1378 [Full text]  
  • Rich-Edwards, J. W, Kleinman, K., Abrams, A., Harlow, B. L, McLaughlin, T. J, Joffe, H., Gillman, M. W (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice.. J. Epidemiol. Community Health 60: 221-227 [Abstract] [Full text]  
  • Bledsoe, S. E., Grote, N. K. (2006). Treating Depression During Pregnancy and the Postpartum: A Preliminary Meta-Analysis. Research on Social Work Practice 16: 109-120 [Abstract]  
  • McLearn, K. T., Minkovitz, C. S., Strobino, D. M., Marks, E., Hou, W. (2006). Maternal Depressive Symptoms at 2 to 4 Months Post Partum and Early Parenting Practices. Arch Pediatr Adolesc Med 160: 279-284 [Abstract] [Full text]  
  • Cohen, L. S., Altshuler, L. L., Harlow, B. L., Nonacs, R., Newport, D. J., Viguera, A. C., Suri, R., Burt, V. K., Hendrick, V., Reminick, A. M., Loughead, A., Vitonis, A. F., Stowe, Z. N. (2006). Relapse of Major Depression During Pregnancy in Women Who Maintain or Discontinue Antidepressant Treatment. JAMA 295: 499-507 [Abstract] [Full text]  
  • Gordon, T. E. J., Cardone, I. A., Kim, J. J., Gordon, S. M., Silver, R. K. (2006). Universal Perinatal Depression Screening in an Academic Medical Center. Obstet Gynecol 107: 342-347 [Abstract] [Full text]  
  • Jevitt, C., Zapata, L., Harrington, M., Berry, E. (2005). Screening for Perinatal Depression With Limited Psychiatric Resources. J Am Psychiatr Nurses Assoc 11: 359-363 [Abstract]  
  • Repokari, L., Punamaki, R.-L., Poikkeus, P., Vilska, S., Unkila-Kallio, L., Sinkkonen, J., Almqvist, F., Tiitinen, A., Tulppala, M. (2005). The impact of successful assisted reproduction treatment on female and male mental health during transition to parenthood: a prospective controlled study. Hum Reprod 20: 3238-3247 [Abstract] [Full text]  
  • Mallikarjun, P. K., Oyebode, F. (2005). Prevention of postnatal depression. The Journal of the Royal Society for the Promotion of Health 125: 221-226 [Abstract]  
  • Oluwatayo, O., Friedman, T. (2005). A survey of specialist perinatal mental health services in England. Psychiatr. Bull. 29: 177-179 [Abstract] [Full text]  
  • O'keane, V., Scott, J. (2005). From 'obstetric complications' to a maternal-foetal origin hypothesis of mood disorder. Br. J. Psychiatry 186: 367-368 [Full text]  
  • Fido, A., Zahid, M. A. (2004). Coping with Infertility among Kuwaiti Women: Cultural Perspectives. International Journal of Social Psychiatry 50: 294-300 [Abstract]  
  • Zelkowitz, P., Schinazi, J., Katofsky, L., Saucier, J. F., Valenzuela, M., Westreich, R., Dayan, J. (2004). Factors Associated with Depression in Pregnant Immigrant Women. Transcultural Psychiatry 41: 445-464 [Abstract]  
  • Masoli, M., Weatherall, M., Holt, S., Beasley, R. (2004). From the authors:. Eur Respir J 24: 513-514 [Full text]  
  • Larsson, C., Sydsjo, G., Josefsson, A. (2004). Health, Sociodemographic Data, and Pregnancy Outcome in Women With Antepartum Depressive Symptoms. Obstet Gynecol 104: 459-466 [Abstract] [Full text]  
  • Andersson, L., Sundstrom-Poromaa, I., Wulff, M., Astrom, M., Bixo, M. (2004). Implications of Antenatal Depression and Anxiety for Obstetric Outcome. Obstet Gynecol 104: 467-476 [Abstract] [Full text]  
  • Ahluwalia, I. B., Mack, K. A., Mokdad, A. (2004). Mental and Physical Distress and High-Risk Behaviors Among Reproductive-Age Women. Obstet Gynecol 104: 477-483 [Abstract] [Full text]  
  • Andersson, L., Sundstrom-Poromaa, I., Wulff, M., Astrom, M., Bixo, M. (2004). Neonatal Outcome following Maternal Antenatal Depression and Anxiety: A Population-based Study. Am J Epidemiol 159: 872-881 [Abstract] [Full text]  
  • Masoli, M., Holt, S., Weatherall, M., Beasley, R. (2004). Dose-response relationship of inhaled budesonide in adult asthma: a meta-analysis. Eur Respir J 23: 552-558 [Abstract] [Full text]  
  • Bennett, H. A., Einarson, A., Taddio, A., Koren, G., Einarson, T. R. (2004). Prevalence of Depression During Pregnancy: Systematic Review. Obstet Gynecol 103: 698-709 [Abstract] [Full text]  
  • Chaudron, L. H., Szilagyi, P. G., Kitzman, H. J., Wadkins, H. I.M., Conwell, Y. (2004). Detection of Postpartum Depressive Symptoms by Screening at Well-Child Visits. Pediatrics 113: 551-558 [Abstract] [Full text]  
  • Zeskind, P. S., Stephens, L. E. (2004). Maternal Selective Serotonin Reuptake Inhibitor Use During Pregnancy and Newborn Neurobehavior. Pediatrics 113: 368-375 [Abstract] [Full text]  
  • Morof, D., Barrett, G., Peacock, J., Victor, C. R., Manyonda, I. (2003). Postnatal Depression and Sexual Health After Childbirth. Obstet Gynecol 102: 1318-1325 [Abstract] [Full text]  
  • Martinez-Schallmoser, L., Telleen, S., Macmullen, N. J. (2003). The Effect of Social Support and Acculturation on Postpartum Depression in Mexican American Women. J Transcult Nurs 14: 329-338 [Abstract]  
  • Hofberg, K, Ward, M R (2003). Fear of pregnancy and childbirth. Postgrad. Med. J. 79: 505-510 [Abstract] [Full text]  
  • Spinelli, M. G., Endicott, J. (2003). Controlled Clinical Trial of Interpersonal Psychotherapy Versus Parenting Education Program for Depressed Pregnant Women. Am. J. Psychiatry 160: 555-562 [Abstract] [Full text]  
  • CHANDRAN, M., THARYAN, P., MULIYIL, J., ABRAHAM, S. (2002). Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India: Incidence and risk factors. Br. J. Psychiatry 181: 499-504 [Abstract] [Full text]  
  • Nulman, I., Rovet, J., Stewart, D. E., Wolpin, J., Pace-Asciak, P., Shuhaiber, S., Koren, G. (2002). Child Development Following Exposure to Tricyclic Antidepressants or Fluoxetine Throughout Fetal Life: A Prospective, Controlled Study. Am. J. Psychiatry 159: 1889-1895 [Abstract] [Full text]  
  • OATES, M. R. (2002). Adverse effects of maternal antenatal anxiety on children: causal effect or developmental continuum?. Br. J. Psychiatry 180: 478-479 [Full text]  
  • GLOVER, V., O'CONNOR, T. G. (2002). Effects of antenatal stress and anxiety: Implications for development and psychiatry. Br. J. Psychiatry 180: 389-391 [Full text]  
  • Miller, L. J. (2002). Postpartum Depression. JAMA 287: 762-765 [Full text]  
  • Lappin, J., Sheehan, J, Crotty, F M, Oates, M R, Lee, A, Evans, J., Heron, J., Golding, J., Francomb, H., Oke, S. (2001). Depressed mood during pregnancy and after childbirth. BMJ 323: 1367-1367 [Full text]  
  • (2001). Depression During Pregnancy: As Common As Postpartum Depression?. JWatch Psychiatry 2001: 10-10 [Full text]  
  • (2001). Depression During Pregnancy - It's More Than Just a Postpartum Affliction!. JWatch Emergency Med. 2001: 5-5 [Full text]  
  • (2001). Depression During Pregnancy: As Common As Postpartum Depression?. JWatch General 2001: 3-3 [Full text]  

Rapid Responses:

Read all Rapid Responses

Higher levels of depressed mood in pregnancy is not news
Carol Henshaw
bmj.com, 3 Aug 2001 [Full text]
Depression during pregnancy
Lisa Valentine
bmj.com, 6 Aug 2001 [Full text]
Higher Rate of depression in pregnancy?
Narayana Reddy Murali Jagadisha, et al.
bmj.com, 9 Aug 2001 [Full text]
Caution about the difference in depressed mood between pregnancy and after childbirth
J L Onwude
bmj.com, 10 Aug 2001 [Full text]
Depressed mood during pregnancy and following childbirth
Nazar N Amso
bmj.com, 14 Aug 2001 [Full text]
Depressed mood during pregnancy is not new and is associated with pre-eclampsia
Katharina Dalton
bmj.com, 16 Aug 2001 [Full text]
Do higher scores for depressed mood in pregnancy mean more Depression in pregnancy?
Sandra A Elliott
bmj.com, 17 Aug 2001 [Full text]
Cohort study of depressed mood during pregnancy and after childbirth
M R Oates, et al.
bmj.com, 17 Aug 2001 [Full text]
Optimising Use of Perinatal Mood Assessments
Julia Lappin
bmj.com, 17 Aug 2001 [Full text]
Depressed mood during pregnancy
Dietmar Fuchs
bmj.com, 24 Aug 2001 [Full text]
Cohort study of depressed mood in pregnancy and childbirth
John Sheehan, et al.
bmj.com, 24 Aug 2001 [Full text]
Focusing on Ante-natal depression
Thomas Nichols
bmj.com, 24 Aug 2001 [Full text]
A question of specificity of The Edindurgh scale
Brian Harris, et al.
bmj.com, 31 Aug 2001 [Full text]
birth experience
Christina Hurst-Prager
bmj.com, 2 Oct 2001 [Full text]
Profile of Antenatal Depression
Sue Lamerton
bmj.com, 18 Dec 2001 [Full text]
dead link
Thorsten Schumann
bmj.com, 31 Aug 2004 [Full text]
Re: dead link
Jonathan Evans
bmj.com, 31 Aug 2004 [Full text]

Student BMJ

Intimate examinations

Israeli students are refusing to perform intimate examinations on anaesthetised women without their informed consent.

www.student.bmj.com

Listen to the latest BMJ Interview