Approximately 1 in 10 women suffers from depression during pregnancy. Little is known about whether antepartum depression affects a mother's length of stay at delivery. We aimed to compare peripartum length of stay in women with and without depressive symptoms during pregnancy.
Methods:
This study involved secondary data analysis of a larger study exploring antepartum depression. Each subject completed the Center for Epidemiological Studies Depression Scale (CES-D). We used bivariate analyses to compare patient characteristics of women with and without an elevated CES-D, and we used a multivariate Poisson regression to evaluate predictors of length of stay.
Results:
The study sample included 867 pregnant women. Overall, 18% of study subjects scored ≥16 on the CES-D. In bivariate analyses, a longer stay was associated with an elevated CES-D and minority race, antepartum complications, cesarean delivery, prematurity, multiple gestation, and neonatal length of stay. In the final multivariate model adjusting for sociodemographic, antepartum, and obstetric factors, an elevated CES-D was associated with a significantly longer peripartum stay (0.26 days, CI 0.04-0.48).
Conclusions:
Depressive symptoms during pregnancy predict an increase in peripartum length of stay.
HolmesJ, HouseA. Psychiatric illness predicts poor outcome after surgery for hip fracture: A prospective cohort study. Psychol Med, 2000; 30:921–929.
3.
HosakaT, AokiT, WatanabeT, OkuyamaT, KurosawaH. Comorbidity of depression among physically ill patients and its effect on the length of hospital stay. Psychiatry Clin Neurosci, 1999; 53:491–495.
4.
KoopmansCT, DonkerMC, RuttenFH. Length of hospital stay and health services use of medical inpatients with comorbid noncognitive mental disorders: A review of the literature. Gen Hosp Psychiatry, 2005; 27:44–56.
5.
NgTP, NitiM, TanWC, CaoZ, OngKC, EngP. Depressive symptoms and chronic obstructive pulmonary disease: Effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Arch Intern Med, 2007; 167:60–67.
6.
NuyenJJ, SpreeuwenbergPM, GroenewegenPP, van den BosGA, SchellevisFG. Impact of preexisting depression on length of stay and discharge destination among patients hospitalized for acute stroke: Linked register-based study. Stroke, 2008; 39:132–138.
7.
OxladM, StubberfieldJ, StuklisR, EdwardsJ, WadeTD. Psychological risk factors for increased post-operative length of hospital stay following coronary artery bypass graft surgery. J Behav Med, 2006; 29:179–190.
8.
SaravaySSM, LavinMM. Psychiatric comorbidity and length of stay in the general hospital. A critical review of outcome studies. Psychosomatics, 1994; 35:233–252.
9.
VerboskyLA, FrancoKN, ZrullJP. The relationship between depression and length of stay in the general hospital patient. J Clin Psychiatry, 1993; 54:177–181.
10.
DefrancesCJ, HallMJ. 2005 National Hospital Discharge Survey. Advance data from vital and health statistics, No. 395. Hyattsville, MD: National Center for Health Statistics, 2007.
11.
KurkiT, HiilesmaaV, RaitasaloR, MattilaH, YlikorkalaO. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol, 2000; 95:487–490.
12.
OrrST, JamesSA, Blackmore PrinceC. Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland. Am J Epidemiol, 2002; 156:797–802.
ChambersCD, JohnsonKA, DickLM, FelixRJ, JonesKL. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med, 1996; 335:1010–1015.
15.
CosteiAM, KozerE, HoT, ItoS, KorenG. Perinatal outcome following third trimester exposure to paroxetine. Arch Pediatr Adolesc Med, 2002; 156:1129–1132.
16.
KallenB. Neonate characteristics after maternal use of antidepressants in late pregnancy. Arch Pediatr Adolesc Med, 2004; 158:312–316.
17.
Moses-KolkoEL, BogenD, PerelJet al.Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: Literature review and implications for clinical applications. JAMA, 2005; 293:2372–2383.
18.
ZeskindPS, StephensLE. Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Pediatrics, 2004; 113:368–375.
19.
JohnsonTR, ZettelmaierMA, WarnerPA, HayashiRH, AvniM, LukeB. A competency based approach to comprehensive pregnancy care. Womens Health Issues, 2000; 10:240–247.
20.
RobinsLLN, HelzerJJE, CroughanJJ, RatcliffKKS. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen psychiatry, 1981; 38:381–389.
21.
RostK, BurnamMA, SmithGR. Development of screeners for depressive disorders and substance disorder history. Med Care, 1993; 31:189–200.
22.
RadloffLS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas, 1977; 1:385–401.
23.
CorcoranK, FisherJ. Measures for clinical practice: A sourcebook. New York: Free Press, 1987.
24.
CampbellSB, CohnJF. Prevalence and correlates of postpartum depression in first-time mothers. J Abnorm Psychol, 1991; 100:594–599.
25.
HusainBA, NeffJA, HarringtonJB, HughesMD, StoneRH. Depression in rural communities: Validating the CES-D scale. J Community Psychol, 1980; 8:20–27.
26.
MyersJK, WeissmanMM. Use of a self-report symptom scale to detect depression in a community sample. Am J Psychiatry, 1980; 137:1081–1084.
27.
ChangGG. Alcohol-screening instruments for pregnant women. Alcohol Res Health, 2001; 25:204–209.
28.
BradleyKA, Boyd-WickizerJ, PowellSH, BurmanML. Alcohol screening questionnaires in women: A critical review. JAMA, 1998; 280:166–171.
29.
KotelchuckM. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health, 1994; 84:1414–1420.
FieldT, Hernandez-ReifM, DiegoM, SchanbergS, KuhnC. Stability of mood states and biochemistry across pregnancy. Infant Behav Dev, 2006; 29:262–267.
32.
KellyR, ZatzickD, AndersT. The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics. Am J Psychiatry, 2001; 158:213–219.
33.
MargolisLH, KotelchuckM, ChangHY. Factors associated with early maternal postpartum discharge from the hospital. Arch Pediatr Adolesc Med, 1997; 151:466–472.
34.
LarssonC, SydsjoG, JosefssonA. Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms. Obstet Gynecol, 2004; 104:459–466.
35.
BeckCT. Predictors of postpartum depression: An update. Nurs Res, 2001; 50:275–285.
36.
RobertsonE, GraceS, WallingtonT, StewartDE. Antenatal risk factors for postpartum depression: A synthesis of recent literature. Gen Hosp Psychiatry, 2004; 26:289–295.
37.
GotlibIH, WhiffenVE, MountJH, MilneK, CordyNI. Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol, 1989; 57:269–274.
38.
MargolisLH, KotelchuckM. Midwives, physicians, and the timing of maternal postpartum discharge. J Nurse Midwifery, 1996; 41:29–35.
39.
WeissM, RyanP, LokkenL, NelsonM. Length of stay after vaginal birth: Sociodemographic and readiness-for-discharge factors. Birth, 2004; 31:93–101.
