title: Patterns and predictors of treatment outcome for antenatal major depression.
abstract: BACKGROUND
  Antenatal major depression is a relatively common and potentially debilitating illness, but knowledge of its treatment outcomes and strategies is still lacking. This study aimed to explore the clinical profiles and treatment outcomes of patients with antenatal major depression, to look for patterns and associations that could guide subsequent research and clinical applications.
  
  
  METHODS
  From May 2006 to November 2010, 118 consecutive patients with antenatal major depression were naturalistically assessed over eight months of individualised therapy, and their characteristics were assessed as potential predictors of treatment outcome.
  
  
  RESULTS
  All participants accepted supportive counselling and case management, although only 51 (43.2%) participants accepted low-dose antidepressant therapy. Overall, 95 (80.5%) of them were successfully discharged, while 12 (10.2%) required extended treatment into the postnatal period. An equation for prognosticating the need for extended treatment was obtained using multiple logistic regression analysis, which incorporated three predictors: previous depression (odds ratio [OR] 12.4, 95% confidence interval [CI] 1.40-110; p = 0.024); maternal age < 26 years or > 35 years (OR 6.88, 95% CI 1.67-28.4; p = 0.008); and no use of antidepressant (OR 6.94, 95% CI 0.79-60.9; p = 0.080). Among participants with previous depression and at either extreme of maternal age, the number needed to treat with antidepressants to avert extended treatment was three.
  
  
  CONCLUSIONS
  The majority of women with antenatal major depression recovered after receiving short-term treatment. Those with previous depression and who were of relative extreme maternal age were most likely to benefit from antidepressant treatment to expedite recovery.
authors.affiliation: Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.|Duke-NUS Medical School, Singapore.
authors.forename: Tze-Ern
authors.initials: TE
authors.lastname: Chua
authors.affiliation: Office of Clinical Sciences - Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
authors.forename: John Carson
authors.initials: JC
authors.lastname: Allen
authors.affiliation: Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Loretta
authors.initials: L
authors.lastname: Ang
authors.affiliation: Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Li Lian
authors.initials: LL
authors.lastname: Ong
authors.affiliation: Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Ying Chia
authors.initials: YC
authors.lastname: Ch'ng
authors.affiliation: Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.|Postnatal Depression Intervention Programme, KK Women's and Children's Hospital, Singapore.|Duke-NUS Medical School, Singapore.
authors.forename: Helen
authors.initials: H
authors.lastname: Chen
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D019090:Case Management; D003376:Counseling; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D011613:Psychotherapy; D012044:Regression Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: antenatal; antidepressant; major depression; psychiatric case management; treatment outcome