Course of Depressive Symptoms across Pregnancy in African American Women

Introduction: Although African American women are at increased risk for antenatal depression, less is known regarding the course of antenatal depression symptoms among African American women. Because pregnancy is a state of rapid physical and mental changes, we examined if depression symptoms changed between the second and third trimesters in a sample of pregnant African American women. Methods: A nonprobability sample of women was recruited from obstetrics clinics within a large Midwestern health system. African American women in their second trimester (N = 189) completed an initial study visit; a convenience sample of 37 women (19.6%) completed a second identical study visit during their third trimester. The 20-item Center for Epidemiological Studies Depression Scale (CES-D) was used to measure depressive symptoms; a CES-D score of 16 or higher equates with clinical depression and a CES-D score of 23 or higher indicates major depression. Paired t tests and correlation coefficients were used to estimate change in depression symptoms. Results: Mean (SD) second-and third-trimester CES-D scores were not statistically significantly different (15.3 [10.6] and 15.1 [10.3], respectively; P =.87) and were moderately and significantly correlated (r = 0.65; P <.001). Prevalence of CES-D scores of 16 or higher was 43.2% (n = 16) in the second trimester and 37.8% (n= 14) in the third trimester, which was not significantly different (P =. 77). Between the 2 visits, 67.6% (n = 25) were classified identically with a CES-D scores of 16 or higher with only fair agreement between the 2 measures (kappa = 0.33). Prevalence of CES-D scores of 23 or higher was 27.0% (n = 10) and 21.6% (n = 8) in the second and third trimesters, respectively, and was not significantly different (P =.69). Between the 2 visits, 83.8% (n = 31) were classified identically with CES-D scores of 23 or higher, with moderate agreement between the 2 measures (kappa = 0.56). Discussion: Depression symptoms were relatively constant across the latter 2 trimesters of pregnancy. The second trimester may be an appropriate time to screen women for antenatal depression, as it is less likely to be affected by early-pregnancy somatic events yet is early enough that intervention may impart positive health benefits for mother and child. (C) 2013 by the American College of Nurse-Midwives.