One in six pregnant women – or 16% of pregnant women – attending maternity services across Ireland are at probable risk of depression during their pregnancy, according to a new survey launched today by a Trinity College Dublin research team and the Irish Obstetric Services.
Ireland has the second highest birth rate in Europe, with an average of just under 68,000 births a year (2014). This means that in one year, over 11,000 women could be experiencing or at risk of depression during pregnancy.
There is increasing evidence that depression during pregnancy can have an influence on obstetric health and may compromise the physical and mental health of the infant. However, screening for antenatal depression is not routine in Ireland’s maternity hospitals and perinatal mental health services are grossly under-resourced in comparison to other comparable EU countries, according to the research clinicians.
The Well Before Birth study – the first such incidence study to be carried out in Ireland – shows that prevalence rates of depression amongst women giving birth in Ireland are high, and may be higher than those recorded in other OECD countries. Literature from other OECD countries shows prevalence rates of antenatal depression ranging from 10% to 15%. In total, over 5,000 pregnant women at all stages of pregnancy attending six maternity hospitals or centres were questioned for the Irish study.
Veronica O’Keane, Professor in Psychiatry at Trinity, and the lead research investigator, said that women in Ireland should be screened for depression early in their antenatal care plan and should be encouraged to seek help.
“Properly caring for the mental health of women during pregnancy protects the longer-term mental health of both mother and child,” Professor O’Keane said.
“Antenatal depression, as we are seeing with this study, is common. Rates of depression during pregnancy among women in Ireland are at least as high, and probably higher, than in other EU countries.”
“We now know that hormonal changes that happen during pregnancy can actually contribute to the development of depression,” she continued. “This is why it is so important that depression is screened for during pregnancy and that women are encouraged to look for support. If we don’t do this as a systematic part of our antenatal care plan, we are putting women at risk, not only of suffering distress, but of being compromised before birth and so less able to cope with the additional stresses of caring for a baby.”
Emerging and increasing scientific evidence has shown that women who suffer from depression during pregnancy have an increased risk of pre-eclampsia, caesarean section and epidural during labour, preterm delivery and low birth weight. For the baby, it may lead to neurodevelopmental and behavioural disadvantage during infancy and an increased risk of mental health problems in childhood and later life, she explained.
The Irish study also shows that rates of depression increase with advancing pregnancy. Women in Irish maternity services show rates of 13.8% in the second trimester and 17.2% in the third trimester. This compares with rates of 12% and 14% respectively in a landmark UK study (Avon Longitudinal Study of Parents and Children). In addition, the Irish study shows that rates of depression are higher amongst women from lower socio-economic groups and with lower educational attainment. Rates of depression are also higher for younger pregnant women, particularly for girls under 18 years of age (22%), and for women who have had higher numbers of pregnancies and births.
The researchers used the Edinburgh Postnatal Depression Scale (EPDS) as a recognised screening tool. A score of 13 or over on this EPDS scale was used as an indication of probable depression, which according to researchers is at the higher-end of an indication of probability. In addition, information on the participant’s age, gestational week, gravidity (the number of times that a woman has been pregnant) and parity (the number of times that a woman has given birth to a foetus with a gestational age of 24 weeks or more) were gathered.
The study has been compiled by the REDEEM research group, based in the Trinity College Institute of Neurosciences (TCIN), TCD and the Irish Obstetric Services from Dublin, Cork, Limerick and Castlebar. The Trinity team was led by Professor Veronica O’Keane and the Obstetric Services Team was led by Professor Fionnuala McAuliffe, Obstetrician & Gynaecologist at the National Maternity Hospital.
This prevalence survey is part of a longer-term research study being undertaken by the REDEEM Group, Trinity, investigating the effects of depression on pregnant women, the foetus and the infant.
Well Before Birth – Key Facts
- 16% of women attending maternity services were at probable risk of depression.
- Risk of depression increased as pregnancy advanced; 12.9% of women are at risk in the first trimester, 13.8% in the second and 17.2% in the third.
- 22% of women under 18 were at risk of depression.
- 5007 women aged between 18 and 49 were surveyed for the study.
- 63% of the women in the sample had an undergraduate degree or higher, indicating that this was a population skewed towards higher socio-economic status.
- Participants were recruited from: The National Maternity Hospital, Dublin; The Rotunda Hospital, Dublin; Cork University Hospital, Cork; Mayo General Hospital, Castlebar; University Hospital Limerick; and Community Antenatal Clinics, Tallaght, Co. Dublin.
- Data was collected between January and September 2016