Are pregnant women at higher risk of depression underdiagnosis?

Abstract

Background: we aim to estimate the prevalence of depression underdiagnosis among women and whether pregnant women are at higher risk STUDY DESIGN: we used data from the Brazilian National Survey (PNS 2013), a population-based study. All 22.455 women (18-49 years old) answered the Patient Health Questionnaire-9 (PHQ-9) and a questionnaire with sociodemographic, obstetric and clinical data. There were 2.605 (2.491 non-pregnant and 114 pregnant women) depressed women (PHQ-9 >8)with a clinical diagnosis of depression, in the last 30 days. Classification of depression underdiagnosis was made using the comparison between results obtained from the self-referred question evaluating clinical diagnosis of depression by providers and the results of the PHQ-9 application. Women with a PHQ-9 score > 8 and with a "No" answer in the clinical question were classified as depression underdiagnosis. Logistic regression models were performed to obtain crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI) RESULTS: Depression underdiagnosis prevalence was 71.2% and was more frequent among pregnant women in comparison with non-pregnant women (88.1% vs 68.0%; p = 0.002). In the adjusted analysis, being pregnant was significantly associated with depression underdiagnosis (aOR 3.55, 95% CI 1.66:7.60). Nonwhite skin color women were also at higher risk of depression underdiagnosis (aOR 1.53, 95% CI 1.09:2.14).

Limitations: the cross-sectional design and the lack of medical records data about assessment of mental health CONCLUSION(S): in Brazil, depression underdiagnosis by providers is prevalent and pregnant women and minority women are at higher risk of not receiving a correct mental health diagnosis.

Keywords: Antenatal depression; Depression during pregnancy; Depression underdiagnosis; Minority ethnic women; Prenatal care; Screening.