Trends in Postpartum Depressive Symptoms - 27 States, 2004, 2008, and 2012

Abstract

Postpartum depression is common and associated with adverse infant and maternal outcomes (e.g., lower breastfeeding initiation and duration and poor maternal and infant bonding) (1-3). A developmental Healthy People 2020 objective is to decrease the proportion of women delivering a live birth who experience postpartum depressive symptoms (PDS).* To provide a baseline for this objective, CDC sought to describe self-reported PDS overall, by reporting state, and by selected sociodemographic factors, using 2004, 2008, and 2012 data from the Pregnancy Risk Assessment Monitoring System (PRAMS). A decline in the prevalence of PDS was observed from 2004 (14.8%) to 2012 (9.8%) among 13 states with data for all three periods (p<0.01). Statistically significant (p<0.05) declines in PDS prevalence were observed for eight states, and no significant changes were observed for five states. In 2012, the overall PDS prevalence was 11.5% for 27 states and ranged from 8.0% (Georgia) to 20.1% (Arkansas). By selected characteristics, PDS prevalence was highest among new mothers who 1) were aged ≤19 years or 20-24 years, 2) were of American Indian/Alaska Native or Asian/Pacific Islander race/ethnicity, 3) had ≤12 years of education, 4) were unmarried, 5) were postpartum smokers, 6) had three or more stressful life events in the year before birth, 7) gave birth to term, low-birthweight infants, and 8) had infants requiring neonatal intensive care unit admission at birth. Although the study did not investigate reasons for the decline, better recognition of risk factors for depression and improved screening and treatment before and during pregnancy, including increased use of antidepressants, might have contributed to the decline. However, more efforts are needed to reduce PDS prevalence in certain states and subpopulations of women. Ongoing surveillance and activities to promote appropriate screening, referral, and treatment are needed to reduce PDS among U.S. women.

FIGURE

Percentage of new mothers with postpartum depressive symptoms — Pregnancy Risk Assessment Monitoring System (PRAMS) reporting states, 2004, 2008, 2012^†,§ * From year to year, PRAMS survey results are reported by varying numbers of states, New York City, and those areas of New York state outside of New York City (all of which, for simplicity, are referred to as “states” in this report). ^† The overall trend includes states with data for any period. Thirteen states had data for all three periods: Alaska, Colorado, Georgia, Hawaii, Maine, Maryland, Minnesota, Nebraska, Oregon, Rhode Island, Utah, Vermont, and Washington. ^§ Significant linear trend assessed using logistic regression model, which included birth year and state variables to account for baseline state-specific differences in prevalence.