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Oriana Vesga-López, MD; Carlos Blanco, MD, PhD; Katherine Keyes, MPH; Mark Olfson, MD, MPH; Bridget F. Grant, PhD, PhD; Deborah S. Hasin, PhD

Arch Gen Psychiatry. 2008;65(7):805-815.

Context  Psychiatric disorders and substance use during pregnancy are associated with adverse outcomes for mothers and their offspring. Information about the epidemiology of these conditions in this population is lacking.

Objective  To examine sociodemographic correlates, rates of DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking among past-year pregnant and postpartum women in the United States.

Design  National survey.

Setting  Face-to-face interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions.

Participants  A total of 43 093 respondents were interviewed, of whom 14 549 were women 18 to 50 years old with known past-year pregnancy status.

Main Outcome Measures  Prevalence of 12-month DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking.

Results  Past-year pregnant and postpartum women had significantly lower rates of alcohol use disorders and any substance use, except illicit drug use, than nonpregnant women. In addition, currently pregnant women had a lower risk of having any mood disorder than nonpregnant women. The only exception was the significantly higher prevalence of major depressive disorder in postpartum than in nonpregnant women. Age, marital status, health status, stressful life events, and history of traumatic experiences were all significantly associated with higher risk of psychiatric disorders in pregnant and postpartum women. Lifetime and past-year treatment-seeking rates for any psychiatric disorder were significantly lower among past-year pregnant than nonpregnant women with psychiatric disorders. Most women with a current psychiatric disorder did not receive any mental health care in the 12 months prior to the survey regardless of pregnancy status.

Conclusions  Pregnancy per se is not associated with increased risk of the most prevalent mental disorders, although the risk of major depressive disorder may be increased during the postpartum period. Groups of pregnant women with particularly high prevalence of psychiatric disorders were identified. Low rates of maternal mental health care underscore the need to improve recognition and delivery of treatment for mental disorders occurring during pregnancy and the postpartum period.

Author Affiliations: New York State Psychiatric Institute, New York (Drs Vesga-López, Blanco, and Olfson); Department of Psychiatry, College of Physicians and Surgeons (Drs Blanco and Olfson), and Department of Epidemiology, Mailman School of Public Health (Ms Keyes and Dr Hasin), Columbia University, New York; and Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland (Dr Grant).

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