Antenatal identification of major depressive disorder: A cohort study

Objective: The purpose of this study was to estimate the frequency of identification of major depressive disorder by providers during prenatal care. Study Design: A cohort of pregnant women who were participating in a randomized controlled trial and who had received a diagnosis of major depressive disorder was examined. Women were included in the current study if prenatal clinic records were available and legible. Results: Clinical depression was noted in 56% of prenatal charts and on 24% of problem lists. Physicians and certified nurse midwives noted depression equally (P =.935); physicians more frequently noted mental health referral (23% vs 0%; P =.01), and midwives more frequently included depression on the problem list (P =.01). Recent medication use, which was stopped before conception or study participation, predicted notation of depression in the chart (P =.001). Conclusion: Depression frequently is missed during pregnancy and, when identified, is underacknowledged as a problem. Women who have not recently used antidepressant medication are more likely to be missed. Better screening and acknowledgment are needed.