Asking the tough questions: obstetrical screening for depression and intimate partner violence.

Abstract

he prevalence of depression during pregnancy is estimated to be 13%- 20%, while rates of IPV may be as high as 20%. These rates might not be an accurate re- flection due to inadequate screening practices. Detection rates for depression during pregnancy may be as low as 0.8%. Similarly, detection of IPV during pregnancy is low but is increased when the provider repeatedly screens during multiple prenatal appoint- ments. Most women report that the first incidence of IPV occurred during pregnancy and often continues throughout the pregnancy. Screening and detection of depression and IPV are important, especially during pregnancy. Depression and IPV during pregnancy have many negative sequelae includ- ing increased risk preterm delivery, low birth weight infants, risk of miscarriage, and neonatal death. Health care providers should screen for depression and intimate partner violence throughout pregnancy thus increasing detection. Current screening tools and techniques that are useful for health care providers to properly screen pregnant women for depression and intimate partner violence will be reviewed. The American College of Obstetricians and Gynecologists (ACOG) report that almost 75% of pregnant women initiate prenatal care in the first trimester, averag- ing 12- 13 prenatal visits throughout their pregnancy. 1 These frequent prenatal visits provide an opportunity to build trust and rapport with the health care team, creating an environment which is ideal to screen for depression and intimate partner violence (IPV). Within the parameters of a trusting therapeutic relationship, a pregnant woman is more likely to divulge personal information that may affect her safety and health care. While depression and intimate partner violence (IPV) are prevalent in all populations, pregnant women bear an unequal burden of these mental and social issues. Perinatal depression. Perinatal depression is defined as depression that occurs during pregnancy or up to one year postpartum. Common symptoms of depression include having depressed mood, loss of interest or pleasure, changes in weight, changes in sleep patterns, fatigue, feelings of worthlessness, inability to concentrate, or recur- rent thoughts of death. Though depression is more common in women than men, depression disproportionately affects women of childbearing age. 2 This increased risk of depression coupled with the changes associated with pregnancy, places women at an increased risk of depression both during and after pregnancy. 3 The prevalence of depression during pregnancy is estimated to be as high as 20%. 4