Screening for depression in pregnant women with HIV infection

OBJECTIVE: To determine the utility of screening for depression in pregnant women with human immunodeficiency virus (HIV) infection. STUDY DESIGN: Women with HIV infection who received prenatal care at an inner-city institution between March 2004 and March 2006 were offered the Beck Depression Inventory (BDI), a screening tool to detect depressive symptomatology. Scores > 9 were considered positive. RESULTS: Of 51 subjects who participated, 53% had positive screening scores for depression. Of those whose scores were positive, 33% had no prior history of psychiatric illness. Those in whom HIV was diagnosed during pregnancy had higher mean and median BDI scores than those with HIV diagnosed before pregnancy (21.2 vs. 13.3 and 21 vs. 9.5, respectively; p = 0.049). Two factors were associated with positive screenings: history of psychiatric disease (p = 0.001) and history of substance abuse (p = 0.042). Patients with positive screenings first presented for prenatal care at a later gestational age and had fewer prenatal visits than those without evidence of depression (14.9 vs. 12.0, p = 0.035 and 9.2 vs. 11.3, p = 0.045). More than half (56%) who screened positive received psychological care during the prenatal period. CONCLUSION: Women with HIV infection should routinely be screened for depression during pregnancy. Those with positive screens should be offered formal psychological evaluation.