Are pregnant women at higher risk of depression underdiagnosis?

Abstract

Backgroundwe aim to estimate the prevalence of depression underdiagnosis among women and whether pregnant women are at higher risk Study Designwe 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) ResultsDepression 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). Limitationsthe 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