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Depressive Symptoms and Health-Related Quality of Life in Early Pregnancy

From the ¹Department of Gynecology and Obstetrics, Division of General Internal Medicine, ²Department of Medicine, and the ³Welch Center for Prevention, Epidemiology, and Clinical Research, the Johns Hopkins School of Medicine; the ⁴Women's and Children's Health Policy Center, Department of Population and Family Health Sciences, and the ⁵Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

OBJECTIVE: Depressive symptoms can be associated with lower health-related quality of life in late pregnancy. Few studies have quantified the effect of depressive symptoms in early pregnancy or among a racially and economically diverse group. Our goal was to estimate the independent association of depressive symptoms with health-related quality of life among a diverse group of women in early pregnancy.

METHODS: We conducted a cross-sectional study of 175 pregnant women receiving prenatal care in a community and university-based setting. We related the presence of depressive symptoms, defined as a Center for Epidemiologic Studies Depression Scale score of 16 or more to health-related quality of life scores from the 8 Medical Outcomes Study Short Form domains: Physical Functioning, Role-Physical, Bodily Pain, Vitality, General Health, Social Functioning, Role-Emotional, and Mental Health. Quantile regression was used to measure the independent association of depressive symptoms with each of the 8 domains.

RESULTS: The study sample was 49% African American, 38% white, and 11% Asian. Mean (± standard deviation) gestational age was 14 ± 6 weeks.The prevalence of depressive symptoms was 15%. Women with depressive symptoms had significantly lower health-related quality of life scores in all domains except Physical Functioning. After adjustment for sociodemographic, clinical, and social support factors, depressive symptoms were associated with health-related quality of life scores that were 30 points lower in Role-Physical, 19 points lower in Bodily Pain, 10 points lower in General Health, and 56 points lower in Role-Emotional.

CONCLUSION: Women in early pregnancy with depressive symptoms have poor health-related quality of life. Early identification and management of depressive symptoms in pregnant women may improve their sense of well-being.

LEVEL OF EVIDENCE: II-2

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