Original Article Depression Screening in the Pregnant Soldier Wellness Program Amy L. O’Boyle, MD, Everett F. Magann, MD, Robert E. Ricks, Jr, MD, Michael Doyle, MD, and John C. Morrison, MD Objectives: The purpose of this study was to determine the preva- lence of depression among active-duty low-risk pregnant women using the Edinburgh Postnatal Depression Scale. Rates for depression have been reported to be as high as 13% during pregnancy and 12 to 22% postpartum, with postpartum suicidal ideation at nearly 7%. Methods: From April 2002 through March 2003, 82 women receiving prenatal care at Madigan Army Medical Center completed screening questionnaires during pregnancy and/or postpartum visits. Results: A total of 97 questionnaires were administered (71 antepartum and 26 postpartum). During pregnancy, 24% of individuals screened scored positive. During the postpartum, 19% scored positive. A total of 15 women were screened twice during the study period. One woman was screened twice during pregnancy and the remaining 14 were screened once antepartum and once postpartum. Suicidal ideation was present in 11% of those screened during pregnancy and in 15% post- partum. Conclusions: Active-duty women appear to have a higher rate of de- pression and suicidal ideation compared with rates in nonmilitary pop- ulations; perhaps such screening should become a standard practice. Key Words: active duty, depression, military women, postpartum, pregnancy M ajor depression is the most prevalent psychiatric disor- der in the United States and costs an estimated $44 billion annually in the United States. 1,2 Depression is a seri- ous disease and has a higher mortality rate than many other common chronic illnesses, with suicide occurring in 15% of untreated individuals. 2 Despite the frequency of depressive disorders, the proportion of those who actually obtain treat- ment by a mental health specialist is less than 50%. Depres- sion is nearly twice as common in women compared with men, and nearly 20% of women have at least one episode of treatable depression. 2 Postpartum depression occurs in as many as one in eight pregnancies in the United States, making it more common than gestational diabetes, preeclampsia, or preterm delivery, 3 yet recognition and treatment of depression in contemporary medical literature and in obstetric residency training programs has been very limited. 3 Depression is encountered frequently by obstetrician-gynecologists in clinical practice, but is still often unrecognized and untreated. 2,4,5 In a recent survey of 282 obstetricians-gynecologists regarding depression screen- ing, most perceived it as difficult to carry out in everyday practice, and some questioned whether such screening could actually improve outcomes. 6 In 2002, the American College of Obstetricians and Gy- necologists and the Scottish Intercollegiate Guidelines Net- work recommended routine depression screening during preg- nancy and in the postpartum period, using the Edinburgh Postnatal Depression Scale (EPDS). 2,7 The prevalence of postpartum depression in active-duty service women is un- known. A PubMed search (1966 to June 2003) using the terms “pregnancy, active-duty women, depression, postpar- From the Departments of Obstetrics and Gynecology at the Naval Medical Center Portsmouth, Portsmouth, VA; Operational Medicine Clinical Ser- vices Division, USAMEDCOM, Fort Sam Houston, TX; Madigan Army Hospital, Tacoma WA; and the University of Mississippi Medical Center, Jackson, MS. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. The authors are military service members; this work was prepared as part of official duties. Correspondence to Dr. John C. Morrison, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State St., Jackson, MS 39216 – 4505. Email: jmorrison@ob-gyn.umsmed.edu Accepted October 20, 2004. Copyright © 2005 by The Southern Medical Association 0038-4348/05/9804-0416 Key Points • Postpartum depression occurs in as many as one in eight pregnancies in the United States, is linked with poor mother-infant bonding, and in the most extreme cases is linked with infanticide and/or suicide. • The rate of positive screening for depression in this military population was twice that reported for non- military populations. • The rate of suicidal ideation in the postpartum mili- tary population is also much higher than that observed in the nonmilitary population. 416 © 2005 Southern Medical Association