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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.
(Obstet Gynecol 2006;107:798806)
regnancy is a common event among reproductiveage women and is often thought to be a time of
happiness for the expectant mother. However, studies
suggest that physical functioning and perceptions of
well-being among women in the latter stages of
pregnancy and the puerperium is lower compared
with the prepregnancy period.1 4 Haas and colleagues3 reported lower physical functioning and
poorer perceptions of health among women in the
second and third trimesters of pregnancy compared
with their prepregnancy state. Studies also suggest
that depressive symptoms are highly prevalent during
late pregnancy and the postpartum period.2,57 Zayas
and colleagues5 found that 50% of pregnant women in
the third trimester had depressive symptomatology. A
meta-analysis7 found depression rates of 12% and 14%
in the second and third trimesters, respectively.
Despite the documentation of poorer functioning
and prevalent depressive symptomatology, only a few
studies have examined the association of depressive
symptoms with health-related quality of life in pregnancy. These studies, however, have limited generalizability, because most analyses were conducted
among white, middle-class samples1,8,9 or in late pregnancy. Fewer data exist for racially and economically
diverse samples2 or among women in the first or
Fig. 1. Conceptual model, incorporating sociodemographic characteristics, clinical factors, and social
support, as covariates for the association of depressive symptomatology
with health-related quality of life in
early pregnancy.
Nicholson. Quality of Life in Early
Pregnancy. Obstet Gynecol 2006.
Nicholson et al
799
Definition
Number of Items
10
4
2
5
4
2
3
5
800
Nicholson et al
Nicholson et al
RESULTS
Of the 221 potential eligible participants, 175 women
agreed to participate and completed the survey for a
participation rate of 79%. Twenty-seven women
(15%) of the study sample was classified as having
elevated depressive symptomatology as evidenced by
a Center for Epidemiologic Studies Depression score
of 16 or greater. The mean age of the population was
28 6.2 years. The majority of women were AfricanAmerican (49%), followed by Whites (38%), Asians
(11%) and others (2%). Sixty-eight percent of subjects
had commercial health insurance and 64% were
employed at the time of the survey. Over half of the
women were married and 87% had completed more
than 12 years of education. Sixty-four percent of the
women were multiparous (one or more prior pregnancies), while 36% were nulliparous. Twenty-seven
percent of the sample had one or more current
medical conditions, while 28% had one or more past
medical conditions. The average gestational age at
data collection was 14.6 6.4 weeks.
There were statistically significant differences in
sociodemographic factors, social support, and clinical
factors among women with and without depressive
symptoms (Table 2). Seventy percent of women with
depressive symptoms were black compared with 44%
of women without depressive symptoms. Twenty-six
percent of women with depressive symptoms were on
Medicaid compared with 20% without depressive
symptoms. There were modest differences in the
amount of social support between the two groups. A
larger percentage of women with depressive symptoms received the majority of their emotional support
from someone other than their significant other compared with women without depressive symptoms.
Women with depressive symptoms were more likely
to be single and to have one or more chronic medical
conditions.
Women with elevated depressive symptoms had
statistically significantly lower scores in Role-Physical,
General Health, Bodily Pain, and Vitality compared
with women without depressive symptoms (Table 3).
Statistically significantly lower scores in Social Functioning, Role-Emotional, and Mental Health were
also found among women with depressive symptoms
compared with women without depressive symptoms.
801
Table 2. Sociodemographics, Social Support, and Clinical Factors by Depression Status (N 175)
Depression Status
No Depressive Symptoms
(CES-D < 16) (n 148)
Characteristics
Age (y)
Race
White
African American
Other
Payment source
Commercial
Medicaid
Employment status
Employed
Not Employed
Education (y)
12
12
Marital status
Married
Single
Support by significant other
Amount of support by significant other
Little or moderate
A great deal
Most support other than significant other
Parity
No prior deliveries
One prior delivery
Two or more deliveries
1 Chronic conditions
1 Current conditions
Prior preterm birth or spontaneous abortion
Gestational age (mo)
Body mass index
Depressive symptoms
(CES-D > 16) (n 27)
28.8 6.5
27.3 6.4
60 (41)
66 (44)
21 (15)
5 (19)
19 (70)
3 (10)
119 (80)
28 (18)
20 (74)
7 (26)
45 (31)
103 (69)
10 (37)
17 (63)
18 (12)
130 (88)
4 (15)
23 (85)
93 (62)
55 (37)
141 (95)
11 (41)
15 (56)
26 (96)
29 (20)
119 (80)
71 (48)
5 (19)
22 (81)
16 (59)
18 (32)
52 (35)
48 (32)
28 (19)
25 (17)
47 (32)
13.4 6.0
26.6 7.8
12 (44)
51 (9)
10 (37)
11 (41)
7 (26)
6 (22)
14.7 6.1
29.2 13.4
P
.3
.04*
.04*
.04*
.4
.02*
.04*
.04*
.03*
.2
.01
.2
.3
.3
.1
Diabetes (3), chronic hypertension (8), heart disease (5), urinary tract infection or pyelonephritis (11), asthma (12).
Chronic hypertension (3), heart disease, gonorrhea (3), chlamydia (4), herpes (1), bacterial vaginosis (1), vaginal bleeding (7), cervical
dysplasia (2), asthma (1), urinary tract infection or pyelonephritis (9), others (2).
802
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Table 3. Median Health-Related Quality of Life Scores in Early Pregnancy by Depression Status
Depression Status
HRQoL Domains
Physical Functioning
Role-Physical
Bodily Pain
General Health
Vitality
Social Functioning
Role-Emotional
Mental Health
Nondepressed
(CES-D < 16) (n 148)
Depressed
(CES-D > 16) (n 27)
P*
85
75
74
77
45
88
90
84
75
25
62
67
25
50
50
60
.2
.006
.01
.001
.001
.001
.001
.001
HRQoL, health-related quality of life; CES-D, Center for Epidemiological Studies of Depression.
Center for Epidemiological Studies of Depression scores 16 or more indicate higher depressive symptomatology; scores less than 16 indicate
lower depressive symptomatology.
* P value is derived from the Wilcoxon rank sum test of comparison of medians.
Denotes that the median health-related quality of life score in women with depressive symptoms compared with women with no depressive
symptoms is statistically significantly different at P .05.
Physical Functioning
Role-Physical
Bodily Pain
General Health
Vitality
Social Functioning
Role-Emotional
Mental Health
Adjusted Median
Unadjusted Median
Adjusted Median
79
62
76
77
45
83
90
83
75 (6188)
24 (1046)
62 (4875)
67 (5875)
25 (1437)
50 (2080)
20 (1130)
60 (5070)
69 (4593)
32 (850)
57 (4471)
66 (5578)
34 (2047)
47 (3659)
34 (1751)
61 (5072)
Data represent the unadjusted median health-related quality of life score and 95% confidence interval for each health-related quality of life
domain among women with depressive symptoms.
Data represent adjusted median health-related quality of life score and 95% confidence interval for each health-related quality of life
domain among women with depressive symptoms after adjustment for participant characteristics.
Nicholson et al
DISCUSSION
803
804
Nicholson et al
0.2 (8, 5)
18* (7, 30)
8 (24, 17)
0.3 (12, 11)
0. (12, 11)
3 (9, 3)
6
6
(0.5, 2)
(13, 0.6)
13 (27, 0.2)
0.4 (3, 2.5)
RP
28* (41, 15)
8 (18, 3)
PF
15* (22, 8)
13 (19, 7)
BP
(16, 3)
(17, 24)
(27, 7)
(5, 13)
(33, 12)
(26, 17)
6
5
9
4
10
11
GH
1.8 (5, 9)
2 (9, 4)
9* (5, 15)
3 (0.9, 6)
11* (19, 3)
10* (17, 3)
Vit
(14, 7)
(8, 13)
(4, 13)
(16, 18)
(4.6, 3.7)
(3.9, 4.3)
3
2
4
4*
SF
(8, 6)
(5, 3)
3
17*
(3, 15)
(4, 13)
7*
4*
2 (7, 11)
0.6 (10, 11)
5
6
13* (28, 3)
3 (12, 7)
RE
3 (17, 11)
1 (2, 19)
9 (5, 24)
7 (22, 6)
2 (8, 19)
13 (7, 29)
8 (24, 7)
2 (14, 10)
MH
3 (2, 8)
5 (5, 11)
2 (3, 8)
2 (3, 7)
3 (3, 9)
9* (15, 4)
PF, Physical Functioning; RP, Role-Physical; BP, Bodily Pain; GH, General Health; Vit, Vitality; SF, Social Functioning; RE, Role-Emotional; MH, Mental Health.
Unemployed status and unknown income were not significantly associated with any health-related quality of life domain and are therefore not included in table. Each beta coefficient
represents the absolute difference in the health-related quality of life score for women with the characteristic of interest compared with women without the characteristic of interest.
* P .05.
African American
Income $35 K
Social support by
significant other
Great deal of support
Support other than
significant other
2 prior deliveries
1 prior chronic
conditions
1 current conditions
Characteristics
Table 5. The Association of Sociodemographic, Social Support, and Clinical Characteristics With Health-Related Quality of Life in
Multivariate Analysis
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