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Depression in women found under-diagnosed

More than one in 10 reproductive-aged women had a major depressive episode in the past year, representing nearly 1.2 million women in the United States, according to study results. Over half of those women, both pregnant and nonpregnant, did not receive a diagnosis, and almost half did not receive treatment with prescription medication.

“Women are disproportionately affected, as they are almost twice as likely as men to report lifetime history of major depressive episode,” the researchers wrote, adding that depression affects up to 16% of reproductive-age women in the US.

Jean Ko, PhD, and colleagues from the Centers for Disease Control and Prevention identified 375 pregnant and 8,657 nonpregnant women aged 18 to 44 years who met DSM-IV criteria for past-year major depressive episode. The women were part of the 2005 to 2009 National Surveys on Drug Use and Health, which is sponsored by the US Substance Abuse and Mental Health Services Administration. Treatment and counseling was assessed through self-reports.

Pregnant women (65.9%) who had a major depressive episode were undiagnosed more often than nonpregnant women (58.6%; 95% CI, 1.0-1.3). Ko and colleagues found that 49.6% of pregnant women and 53.7% of nonpregnant received treatment (95% CI, 0.90-1.1). Prescription medication was the most common form of treatment for both pregnant (39.6%) and non-pregnant (47.4%) women.

Overall, 38.9% (95% CI, 37.1-40.6) of women who had a major depressive episode during the past year reported unmet treatment needs. The most common barriers to treatment among these women were cost (54.8%; 95% CI, 51.7-57.9), opposition to treatment (41.7%; 95% CI, 39.3-44.1), concerns about mental health stigma (26.3%; 95% CI, 24.1-28.6), time or transportation limitations (18.1%; 95% CI, 16.0-20.4) and not knowing where to go for treatment (16.7%; 95% CI, 14.9-18.6).  Treatment barriers and unmet treatment needs did not differ according to pregnancy status.

Ko and colleagues wrote that the study results have several public health implications, including the following:

• Reproductive health visits can serve as opportunities to assess depressive symptoms and recommend treatment options.

• Expanding insurance coverage for mental health treatment is needed to address untreated depression in women and the costs associated with treatment.

• Given the large number of women using prescription medication for depression, a greater understanding of the effects of antidepressant medication on fetuses and breast-feeding children is necessary.

Disclosure: The researchers report no relevant financial disclosures.