Depression is the most commonly diagnosed medical condition among women veterans ages 18 to 44; however, depression symptoms occurring during pregnancy have not been well-studied in this population.
Pregnant veterans were recruited from 15 Veterans Health Administration sites across the United States; our sample included 501 participants. Sociodemographic characteristics, military service, health status, and pregnancy related factors, as well as the Edinburgh Postnatal Depression Scale (EPDS), were collected as part of a telephone survey. Additional data were obtained from electronic health record data. We used multivariable logistic regression models to examine factors associated with an EPDS score suggestive of clinically significant depressive symptoms (≥10).
Prenatal EPDS scores of 10 or greater were calculated for 28% of our sample. Our final model indicated that factors associated with decreased odds of an EPDS score of 10 or greater included spousal or partner support during pregnancy (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.16–0.77) and employment (aOR, 0.40; 95% CI, 0.24–0.67). A past diagnosis of anxiety (aOR, 2.54; 95% CI, 1.43–4.50), past antidepressant use (aOR, 3.27; 95% CI, 1.71–6.24), and active duty service (aOR, 1.91; 95% CI, 1.08–3.37) were associated with increased odds of having an EPDS score of 10 or greater.
This is the first quantitative estimate of depression symptoms in pregnant veterans across multiple Veterans Affairs facilities. The prevalence of depression symptomology was greater than the high end of prevalence estimates in the general pregnant population. Given that the risk of depression increases during the postpartum period, women who can be identified with depressive symptomatology during pregnancy can be offered critical resources and support before giving birth.
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Aimee R. Kroll-Desrosiers, PhD, is a biostatistician in the Department of Population and Quantitative Health Sciences at the University of Massachusetts Medical School.
Sybil L. Crawford, PhD, is a Professor in the Graduate School of Nursing and adjunct faculty in the Clinical and Population Health Research program at the University of Massachusetts Medical School.
Tiffany A. Moore Simas, MD, MPH, MEd, FACOG, is Associate Professor of Obstetrics and Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences, and Vice-Chair and Research Division Director of the Department of Obstetrics and Gynecology at the University of Massachusetts Medical School.
Melissa A. Clark, PhD, is Professor of Population and Quantitative Health Sciences in the Division of Epidemiology at the University of Massachusetts Medical School.
Lori A. Bastian, MD, MPH, is Director of the Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center at the VA Connecticut Healthcare System. She is a Professor of Medicine at Yale University School of Medicine.
Kristin M. Mattocks, PhD, MPH, is Associate Chief of Staff for Research and Education at VA Central Western Massachusetts Healthcare System and Associate Professor of Population and Quantitative Health Sciences and Psychiatry at the University of Massachusetts Medical School.
Published online: May 16, 2019
Accepted: April 12, 2019
Received in revised form: April 11, 2019
Received: August 15, 2018
This study was supported by VA Health Services Research & Development IIR13-81 and CIN 13-407.
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.