title: Depression among female family planning patients: prevalence, risk factors, and use of mental health services.
abstract: BACKGROUND
  Depression is a common, yet underdiagnosed mental health problem among women of reproductive age. Whereas risk factors and treatment of depression have been well studied among women of all ages, little attention has been paid to the prevalence of depression and clinical outcomes of clinical depressive symptoms among women who visit public family planning clinics.
  
  
  METHODS
  A total of 588 female patients of three North Carolina health department family planning clinics were screened for their depressive symptoms. Women who screened positive for depressive symptoms during the initial assessment were referred for further mental health evaluation and treatment. Multivariate logistic regression was performed to examine risk factors of depressive symptoms, and a flow chart was used to demonstrate referral process and outcomes.
  
  
  RESULTS
  Approximately half of the women in the study evidenced high levels of depressive symptoms that were consistent with having a clinically relevant mental health problem. Results from multivariate analysis found that being classified as currently depressed was significantly associated with previous treatment for depression (OR = 5.43), no social support (OR = 3.57), and unemployment (OR = 3.21). Caucasians were significantly more likely than African Americans to be depressed (OR = 2.63), and teenagers and women with low levels of education were more likely to evidence depression (OR = 1.99 and OR = 1.78, respectively). Few of the patients who were classified as depressed and were referred for further mental health evaluation followed through with the referrals.
  
  
  CONCLUSIONS
  These findings underscore the importance of providing routine screening of women for depression within the context of family planning services and providing referrals, follow-up, and mental health treatment to those women in need.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. llee2@jhsph.edu
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Lee
authors.forename: Cecilia E
authors.initials: CE
authors.lastname: Casanueva
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D011203:Poverty; D015995:Prevalence; D012017:Referral and Consultation; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D016387:Women's Health; D014932:Women's Health Services / Q000706:statistics & numerical data