Onset and persistence of postpartum depression in an inner-city maternal health clinic system

Objective: Postpartum depressive disorders lead to maternal disability and disturbed mother-infant relationships, but information regarding the rates of major depressive disorder in minority women is noticeably lacking. The g oal of this study was to determine whether the risk factors for and rate of postpartum major depressive disorder in a predominantly African American a nd Hispanic clinic population would be similar to those reported for Caucas ian women. Method: Investigators systematically screened all women scheduled for their first postpartum visit on selected days at four publicly funded inner-city community maternal health clinics in Dallas County (N=802). A multistage s creening process included the Edinburgh Postnatal Depression Scale, the Inv entory of Depressive Symptomatology, and the Structured Clinical Interview for DSM-IV for a maximum of three assessments during the initial 3-5-week p ostpartum period. Results: The estimated rate of major depressive disorder during the postpar tum period among women in this setting was between 6.5% and 8.5%. Only 50% of the depressed women reported onset following birth. Bottle-feeding and n ot living with one's spouse or significant other were associated with depre ssion at the first evaluation; persistent depressive symptoms were linked w ith the presence of other young children at home. Greater severity of depre ssive symptoms at first contact predicted major depressive disorder several weeks later. Conclusions: Rates of postpartum depression among Latina and African Americ an postpartum women are similar to epidemiologic rates for Caucasian postpa rtum and nonpostpartum women. As previously shown for Caucasian women, majo r depressive disorder in many Latina and African American postpartum women begins before delivery, revealing the need to screen pregnant women for dep ression.