title: Antenatal identification of major depressive disorder: a cohort study.
abstract: OBJECTIVE
  The purpose of this study was to estimate the frequency of identification of major depressive disorder by providers during prenatal care.
  
  
  METHODS
  A cohort of pregnant women who were participating in a randomized controlled trial and who had received a diagnosis of major depressive disorder was examined. Women were included in the current study if prenatal clinic records were available and legible.
  
  
  RESULTS
  Clinical depression was noted in 56% of prenatal charts and on 24% of problem lists. Physicians and certified nurse midwives noted depression equally (P = .935); physicians more frequently noted mental health referral (23% vs 0%; P = .01), and midwives more frequently included depression on the problem list (P = .01). Recent medication use, which was stopped before conception or study participation, predicted notation of depression in the chart (P = .001).
  
  
  CONCLUSIONS
  Depression frequently is missed during pregnancy and, when identified, is underacknowledged as a problem. Women who have not recently used antidepressant medication are more likely to be missed. Better screening and acknowledgment are needed.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lucile S. Packard Children's Hospital at Stanford, Stanford, CA, USA. dlyell@stanford.edu
authors.forename: Deirdre J
authors.initials: DJ
authors.lastname: Lyell
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Chambers
authors.forename: Dana
authors.initials: D
authors.lastname: Steidtmann
authors.forename: Esther
authors.initials: E
authors.lastname: Tsai
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.forename: Amy
authors.initials: A
authors.lastname: Wong
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care; D016032:Randomized Controlled Trials as Topic
chemical_list: D000928:Antidepressive Agents