The North Staffordshire Maternity Hospital prospective study of pregnancy-associated depression

The objective of the study was to establish the frequency of depression dur ing pregnancy and the puerperium, and its relationship to marital disharmon y and sociodemographic variables. A prospective longitudinal study was carr ied out in a district general hospital in the West Midlands, UK. The cohort consisted of 417 women booked for confinement at the hospital. Depression was measured as a proportion of high scores (> 14) on the Edinburgh Postnat al Depression Scale (EPDS) and marital disharmony was determined by the Spa nier Dyadic Adjustment Scale. Using recommended cut-offs, 41/417 (9.8%) of the women were depressed during pregnancy and 31/417 (7.4%) were depressed at 3 months postpartum. There was a significant association between antenat al and postnatal depression, seven of the 31 women who were depressed postp artum had also been depressed in the antenatal period. Only five of the 41 women with antenatal depression and eight of the 31 women with postnatal de pression were identified by their general practitioners as depressed. Marit al disharmony was sequentially associated with depression before and after delivery. We conclude that antenatal depression is more common than general ly thought, and that both antenatal and postnatal depression are frequently missed during routine consultation. Pregnancy-associated depression is mor e common where marital disharmony exists. More widespread use of the EPDS d uring pregnancy may help to highlight these often unidentified mental healt h problems.