title: A life course perspective on depressive symptoms in mid-pregnancy.
abstract: OBJECTIVE
  To examine the prevalence of depressive symptoms in mid-pregnancy and their relation to life circumstances across the life course in a community-based sample.
  
  
  METHODS
  The Pregnancy Outcomes and Community Health (POUCH) Study enrolled women at 16-26 weeks' gestation from 52 clinics in five Michigan communities. At enrollment women completed a screening instrument for depressive symptoms (CES-D) and questions about life circumstances covering three "periods," i.e. previous 6 months, adulthood, and childhood. Questions were grouped into sub-constructs (e.g., abuse, economic, substance use, loss, and legal) for each "period" and evaluated in relation to CES-D scores. Analyses included 1321 POUCH participants divided into three subgroups: teens; women > or =20 years insured by Medicaid (disadvantaged); and women > or =20 years not insured by Medicaid (advantaged).
  
  
  RESULTS
  A positive CES-D screen (> or =16) was more common in teens (46%) and disadvantaged women (47%) than in advantaged women (23%). Recent problems (previous 6 months) with abuse, economics, and substance use in someone close were each associated with higher adjusted mean CES-D scores (2.3-7.5 increase) in the three subgroups of women. In life course analyses, abuse and substance use in teens, and abuse and economic problems in disadvantaged and advantaged women were strongly linked to higher adjusted mean CES-D scores when these problems occurred both in childhood and adulthood (range 2.2-7.1 increase), whereas the associations were more modest when problems were confined to childhood.
  
  
  CONCLUSIONS
  Strategies for addressing the public health problem of depressive symptoms in mid-pregnancy will benefit from a life course perspective.
authors.affiliation: Department of Epidemiology, Michigan State University, East Lansing, 48824, USA. Holzman@msu.edu
authors.forename: Claudia
authors.initials: C
authors.lastname: Holzman
authors.forename: Janet
authors.initials: J
authors.lastname: Eyster
authors.forename: Linda Beth
authors.initials: LB
authors.lastname: Tiedje
authors.forename: Lee Anne
authors.initials: LA
authors.lastname: Roman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Seagull
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Rahbar
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003863:Depression / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D017579:Domestic Violence / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008016:Life Change Events; D008484:Medicaid; D008824:Michigan / Q000453:epidemiology; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000453:epidemiology*; D011262:Pregnancy Trimester, Second; D037841:Pregnant People / Q000208:ethnology / Q000523:psychology*; D011296:Prenatal Diagnosis; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology; D035862:Vulnerable Populations