The majority of pregnant women with major depression are not receiving treatment, and neither are most pregnant women with signs of mild depression or high risk for depression, according to an article in the July-August issue of General Hospital Psychiatry. Furthermore, a significant proportion of women receiving treatment may be receiving inadequate treatment.

The findings come from a study of 1,837 pregnant women who were surveyed in the waiting rooms of five American obstetrics clinics within one university region, using a standard questionnaire that detects signs of depression.

Of the women in the study, 276 met the criteria for being at risk of depression. All of these women had follow-up interviews with trained mental health workers who assessed them using the standard criteria used to diagnose depression, and asked them about their mental health and treatment history.

In all, 17 percent of the 276 women were found to be experiencing a serious depression. Another 23 percent had a history of major depression. Among women who were experiencing major depression at the time of the study, only 33 percent were receiving any treatment. Finally, of the 276 women with high depression risk, only 20 percent were receiving treatment, despite the fact that many had a history of depression.

When the researchers analyzed data on at-risk and depressed women who were receiving treatment, they found that only 43 percent of women taking anti-depressant medications (alone or in combination with talk therapy) had been taking them at the recommended dose for at least six weeks.

Heather Flynn, PhD, who led the study, calls the result very troubling. “These are women who meet the formal clinical criteria for the most severe form of depression. No one would argue that these women would benefit from some form of intervention, but only 33 percent of them were,” she said. “It may be impossible to closely monitor every pregnant woman at risk in the way this study did, but it certainly makes sense to ensure that women with clear depression get the help they need.”

Flynn and her colleague Sheila Marcus, MD, have led an effort to screen pregnant women for depression in the waiting rooms of obstetric clinics. They previously published results based on the waiting-room screening tests; the new study goes much further by performing a detailed psychological assessment using the criteria of the DSM-IV, the standard text for diagnosing mental health conditions.

Their results show no significant depression or depression-treatment differences among pregnant women of different races and ethnicities, employment situations, education levels, and marital or parental situations. The only factors that were found to increase a woman’s chance of treatment were severe symptoms at the time of the study, a history of major depression and a history of any psychiatric treatment.

This suggests that women who are already accustomed to accessing the mental health system may be most likely to do so if they experience depressive symptoms during pregnancy, while other women may not recognize their symptoms ? or may not know, or believe, that they can get help from a mental health provider.

Another major barrier to depression treatment may be the lack of awareness among the doctors who treat women during pregnancy, but this seems to have improved in recent years, says Flynn. Many women, however, still are never screened for depression or treated to prevent a recurrence of past depression.