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Kenneth D. Mandl, MD, MPH; Edward Z. Tronick, PhD; Troyen A. Brennan, MD, JD, MPH; Hillel R. Alpert, MPM; Charles J. Homer, MD, MPH

Arch Pediatr Adolesc Med. 1999;153:808-813.

Objective  To determine whether women who frequently bring their neonates for problem-oriented primary care visits or emergency department visits are at elevated risk of having depressive symptoms.

Design  Analysis of 2 prospective cohort studies of mothers and their infants: (1) a telephone interview study of mothers and infants after birth at an urban teaching hospital (the hospital cohort) and (2) the 1988 National Maternal and Infant Health Survey, a nationally representative sample of women who had live births in 1988.

Participants  A total of 1015 women in the hospital cohort surveyed at 3 and 8 weeks post partum and 6779 women with data from the national survey.

Main Outcome Measure  Depressive symptoms above the Center for Epidemiologic Studies Depression Scale cutoff score of 15.

Results  After controlling for sociodemographic variables and parity, women exhibited high levels of depressive symptoms if their infants had more than 1 problem-oriented primary care visit (hospital cohort: odds ratio, 2.0 [95% confidence interval, 1.1-4.3]; national survey cohort: odds ratio, 2.0 [95% confidence interval, 1.5-3.0]). Women were more likely to have high levels of depressive symptoms if their infants had even 1 emergency department visit (hospital cohort: odds ratio, 3.2 [95% confidence interval, 1.5-6.9]). Frequent well-child visits were not associated with maternal depressive symptoms.

Conclusions  Neonatal health care use patterns predict women at risk for postpartum depression. Recognition of these signature patterns of service use by pediatric health care providers may facilitate early diagnosis and treatment of postpartum depression and improve outcomes for women and their families.

From the Division of Emergency Medicine (Dr Mandl), Program in Clinical Effectiveness (Drs Mandl and Homer and Mr Alpert), and Child Development Unit (Dr Tronick), Children's Hospital, Department of Quality Measurement and Improvement, Brigham and Women's Hospital (Dr Brennan), and Harvard Medical School (Drs Mandl, Tronick, Brennan, and Homer), Boston, Mass.

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