Depression, depressive symptoms and treatments in women who have recently given birth: UK population study

Problem

Many women experience depression in the year after they have given birth, which may have severe consequences for the mother and, in turn, have adverse effects on their children. However, limited information is available on how and when depression is recognised and treatment given in clinical practice.

Approach

Using UK electronic health records from The Health Improvement Network primary care database, we identified women who have given live birth between 2000 and 2013. We estimated the prevalence of postnatal depression, depression, depressive symptoms, antidepressant or non-pharmacological treatment within a year after birth.

Findings

We found that of 206,517 women 23,623 (11%) 11% had a record of depressive diagnoses or symptoms in their primary care electronic health records within the first year after delivery. In total, 25,691 (12%) received antidepressant treatment and 6,848 (3%) had a referral for non-pharmacological treatment. The vast majority of women receiving pharmacological treatment were initiated on SSRIs (92%). There were some peaks in recording of depressive diagnoses and symptoms and initiation of SSRI treatment soon after delivery (6 to 8 weeks), coinciding with the time of postnatal maternal check-up consultations although they continued to be recorded throughout the first year after delivery. The time to the initiation of SSRI treatment after the delivery has become earlier in the more recent years although the overall rate of initiation of SSRI within the year after delivery has not changed.

Younger women were much more likely to have a record of depressive diagnoses or symptoms compared to women aged 30 years or older (Relative Risk for postnatal depression: Age 15 – 19: 1.92 (1.76 to 2.10), Age 20 – 24: 1.49 (1.39 to 1.59) vs Age 30 – 34)). The pattern of SSRI initiation followed the same trend with nearly 1 in 5 women aged between 15 – 19 years receiving SSRI treatment in the first year after delivery.

The risk of depression increased with increasing social deprivation and similar patterns were observed for both SSRI treatment and non-pharmacological treatment.

Consequences

Our study demonstrates that for many women depression and depressive symptoms were ‘picked up’ and treatment initiated at the time of the maternal check-up consultation in accordance to guidelines on antenatal and postnatal mental health care. Yet, our results also revealed that depression is not limited to the immediate period after delivery and emphasis the needs for health care professionals to be alert to signs and symptoms of depression throughout the first year after delivery.