Typical somatic symptoms of pregnancy and their impact on a diagnosis of major depressive disorder.
OBJECTIVE
We sought to determine whether trimester of pregnancy influences the ability to diagnose major depressive disorder (MDD).


METHODS
Eight hundred thirty-eight subjects completed a Composite International Diagnostic Interview and the Edinburgh Postnatal Depression Scale (EPDS) before 17 weeks of pregnancy, at 26-30 weeks of pregnancy and at 4-12 weeks postpartum. Subjects responded to a checklist of MDD symptoms regardless of stem question endorsement. We compared rates of symptom expression by response (Y/N) to stem questions, and trimester, using logit analysis. Receiver operating characteristic curves determined optimal EPDS thresholds.


RESULTS
Most symptoms from the DSM-IV checklist were endorsed significantly more often in the first compared to later trimesters (odds ratios ranged from 1.39 to 14.16 for the first vs. later trimesters), independent of response to depression stem questions or medication treatment. Despite this, stem-positive and stem-negative groups differed significantly for 10 out of 13 symptoms (odds ratios, 2.29-6.89), independent of trimester. The EPDS had an optimal cutoff of 10 and showed acceptable predictive value.


CONCLUSIONS
Pregnant women commonly experience somatic and other symptoms in this first trimester, but depressed women still differ from those who are not depressed. "Appetite increase," "oversleeping" and "increase in energy" (e.g., agitation) were uninformative with regard to an MDD diagnosis.
Yonkers
Kimberly Ann
KA
Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA. kimberly.yonkers@yale.edu
Smith
Megan V
MV
Gotman
Nathan
N
Belanger
Kathleen
K
D000328:Adult; D000465:Algorithms; D000704:Analysis of Variance; D015986:Confounding Factors, Epidemiologic; D003237:Connecticut; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological / Q000592:standards*; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008404:Massachusetts; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000188:drug therapy; D011264:Pregnancy Trimesters / Q000502:physiology / Q000523:psychology; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics; D012372:ROC Curve