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College of Nursing study helps to understand risk for depression in pregnancy

February 28, 2008

While pregnancy is usually a time for celebration, East Carolina University College of Nursing researchers found a third of rural, low income women in Pitt County surveyed were at risk for depression in pregnancy.

The results of the study led by Dr. Elizabeth Jesse and co-written by Dr. Melvin Swanson were recently published in Nursing Research. The $160,535 study was funded by the March of Dimes Birth Defect Foundation as part of a larger research project to understand risk factors for preterm birth.

Between 2004 and 2007, the research team interviewed 324 pregnant women in Pitt County prenatal clinics to determine the frequency of depressive symptoms and to investigate whether psychosocial and physiological factors were related to symptoms' occurrence.

The symptoms include sadness, tearfulness, sleep or appetite problems, nervousness, anxiety, irritability, weight changes, low energy, loss of interest or pleasure, guilt, poor concentration, hopelessness and thoughts of harming oneself. An estimated 11 percent to 50 percent of pregnant women experience these symptoms and 7 percent to 13 percent suffer major depression.

Forty-three percent of the women interviewed were African-American, 31 percent were white and 26 percent were Hispanic. All were low-income women. They found a third of the women, or 33 percent, were at risk for depression in pregnancy. The risk for depression was twice as great among African-American women as Hispanic or white women. All women at risk for depression were more likely to have suffered abuse, increased stress, low self-esteem, less spirituality, and lack of support from family or friends.

"Depression is treatable, but may not resolve without treatment which can lead to dire consequences," said Jesse, an associate professor in the ECU College of Nursing. "The results of the research also emphasize the need for universal screening of prenatal women for depression. Those at risk should be evaluated further and referred for treatment."

Jesse has worked with clinicians at prenatal clinics in the region to begin universal screening for depression. She also has been leading an interdisciplinary team to develop an effective cognitive behavioral intervention for women at risk for prenatal and postpartum depression that can be implemented in clinics and health departments.

About one in 20 American women who are pregnant or have given birth in the past year suffer from major depression, according to a 2005 report by the U.S. Health and Human Services' Agency for Healthcare Research and Quality.

About 25 percent of pregnant women with depressive symptoms subsequently developed postpartum depression, according to a study in the British Medical Journal. Because symptoms of depression are not equal to a clinical diagnosis of depression, it is important to include a clinical diagnosis in future studies, researchers said.

"Our study is only one small step in trying to puzzle out the complex relationship between depressive symptoms and other psychosocial domains of health," Jesse said. "The findings suggest the importance of screening and developing practice guidelines for depressive symptoms in pregnancy, to discover and help women who may be in an abusive relationship, to enhance stress-relieving activities, and to emphasize women's resources in pregnancy, such as social support and spirituality for those who value it."