Mental health materials - B

MENTAL HEALTH AMONG WOMEN OF REPRODUCTIVE AGE

2014

CDC’s Division of Reproductive Health works to improve
mental health among women of reproductive age

Form Approved
OMB No: 0920-0956
Exp. Date: March 31, 2016

Many women of reproductive age experience
poor mental health. This fact sheet describes
how CDC’s Division of Reproductive Health
works to improve the mental health of women
of reproductive age through surveillance and
research. It describes important findings on
rates of treatment and diagnosis, risk factors
for poor mental health, outcomes for women
and infants, and more.
Age 15-44 is considered “reproductive age.”
Better diagnosis and treatment can improve mental health
among women of reproductive age.

Why is CDC’s Division of Reproductive Health
studying this issue?
❚❚ Poor mental health can
»» Damage family relations and social life.
»» Prevent a woman from functioning at school, at home,

or at work
❚❚ Poor mental health is associated with substance use
❚❚ Poor mental health may put women at risk for future
chronic disease, such as diabetes and heart disease
❚❚ Poor mental health may cause problems with
»» Pregnancy
»» Maternal-infant bonding
»» Maternal functioning
»» Infant and child health and development
❚❚ Depression and anxiety are common among this group.
So are other mental health issues.
»» This is true for pregnant, postpartum, and

nonpregnant women age 15-44.

What is CDC’s Division of Reproductive Health
doing to address mental health among women of
reproductive age?
We seek to develop public health strategies for addressing
mental health among women of reproductive age. Below
is a snapshot of our work.
We study this group by conducting routine national and
state-based surveillance on their:
❚❚ Depression and other mental health conditions.
❚❚ Diagnosis and treatment of mental health conditions.

We do this by analyzing data from the Pregnancy Risk
Assessment Monitoring System (PRAMS), the Behavioral
Risk Factor Surveillance System (BRFSS), Substance Abuse
and Mental Health Services Administration’s National
Survey on Drug Use and Health, National Survey on Drug
Use and Health (NSDUH), and other sources. We create
optimal screening questions for postpartum depression
and anxiety for the PRAMS (www.cdc.gov/PRAMS).
We conduct epidemiologic studies to identify risk factors
and health conditions associated with depression, anxiety,
and poor mental health among this group.
We monitor both reproductive health and infant outcomes
among women with depression and anxiety through
surveillance and epidemiologic studies.

National Center for Chronic Disease Prevention and Health Promotion
Division of Reproductive Health

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MENTAL HEALTH AMONG WOMEN OF REPRODUCTIVE AGE

PAGE 2
Form Approved
OMB No: 0920-0956
Exp. Date: March 31, 2016

What is CDC’s Division of Reproductive Health doing to
address mental health among women of reproductive
age? (continued)

We assist states with state-based surveillance on
depression among women of reproductive age. We
compile and disseminate information on the mental health
of this group to the scientific community, states, CDC
partner organizations, and the public.
We publish reports and systematic reviews, make
presentations, and maintain a web site (http://www.cdc.
gov/reproductivehealth/Depression/).

Depression and other mental health issues are common
among women of reproductive age.
Data from the 2005-2009 NSDUH show that about 1 out
of 10 women of reproductive age had at least one major
depressive episode in the past year.

Certain groups of women are at higher risk of
poor mental health.
For nonpregnant women 18-44 years of age, risk factors
for major depression include:
❚❚ Older age
❚❚ Less education
❚❚ Being unmarried
❚❚ Inability to work or being unemployed
❚❚ Lower income

One out of 10 women experienced at least one major
depressive episode in the past year.

Data from the 2006 and 2007 BRFSS show that more than
Pregnant
14% of nonpregnant U.S. women 18-44 Pregnant
years
of age had
Women
Women
current major or minor depression. The data also show
that 3% had current serious psychological distress.

We know that some groups are less likely to receive a
diagnosis of depression than other groups.
Those least likely to receive a diagnosis are:
❚❚ Younger women (65%)
❚❚ African American women (73%)
❚❚ Hispanic women (68%)
❚❚ Women from other nonwhite racial and
ethnic groups (68%)
❚❚ Uninsured women (66%)

Among a group of pregnant women in Washington and
Oregon, about 1 out of 10 (9%) women in the group had
a diagnosed mental health condition.

Among a group of pregnant women in Washington and
Oregon, mental health was one of the top 3 types of
maternal complications during pregnancy.

34%

DIAGNOSIS among Pregnant and
Non-Pregnant Women with Depression
Stigma

26%

Opposition

42%

Cost

34%
% 34%
42

55%

Stigma

55%

66%

41%

59%

50%

TREATMENT among Pregnant and
Non-Pregnant Women with Depression

Opposition

26%

Common barriers to treatment among pregnant and
nonpregnant U.S. women are cost (55%), opposition to
treatment (42%), and stigma (26%).

Treatment
Only half of depressed pregnant (50%) and nonpregnant
(54%) women receive treatment. Common barriers to
treatment among pregnant and nonpregnant U.S. women are
cost (55%), opposition to treatment (42%), and stigma (26%).
Prescription medicine and counseling are two treatments.
For those women who do receive treatment, prescription
medication is the most common form for both pregnant
(40%) and nonpregnant (47%) women, followed by
counseling (36% for both pregnant and nonpregnant
women).

What has CDC found?

What Keeps Women of Reproductive Age from
Getting Treatment for Mental Health Conditions?

Data from the 2009 PRAMS show that the percentage
of women in 29 states with self-reported postpartum
depressive symptoms ranged from 8% in Illinois to
20% in Arkansas.

66% Cost
41% 41%
66%

59% 59% 50% 50%

50% 50%54% 54%

46% 46%

Received diagnosis

Received treatment

Depression went undiagnosed

Did not receive treatment

50%

54%

46%

MENTAL HEALTH AMONG WOMEN OF REPRODUCTIVE AGE

PAGE 3
Form Approved
OMB No: 0920-0956
Exp. Date: March 31, 2016

Depression often goes undiagnosed.
In a U.S. sample of women, two-thirds (66%) of past-year
depression in pregnant women and 59% of past-year
depression in nonpregnant women went undiagnosed.
Women with frequent mental distress have unique health
behaviors and health environments.
❚❚ Among low-income women, those with frequent
mental distress were found to be more likely to use less
effective forms of contraception.
❚❚ Women with frequent mental distress are more likely to

smoke and to be overweight or obese.
❚❚ Women with frequent mental distress have less social

support before becoming pregnant.
Depressed women are at increased risk of chronic disease
and substance use.
❚❚ Among U.S. women with major depression, most (89%)
have one or more chronic physical conditions or risk
factors, such as diabetes, smoking, binge or heavy
drinking, obesity, and physical inactivity.
❚❚ Women who quit smoking during pregnancy are almost

two times as likely (1.8 times) to start smoking again
during the postpartum period if they experienced
postpartum depressive symptoms.
❚❚ A higher percentage of women with current major

(18%) or minor (18%) depression or a past diagnosis
of depression (20%) reported binge or heavy
drinking compared to women with no history of
depression (15%).

Postpartum depression is associated with depression
before or during pregnancy.
About half (54%) of women with postpartum depression
had depression diagnosed before or during pregnancy.
We can point to additional risk factors for postpartum
depressive symptoms.
Postpartum depressive symptoms are associated with:
❚❚ Young maternal age
❚❚ Partner-related stress or physical abuse
❚❚ Traumatic or financial stress
❚❚ Tobacco use during pregnancy

Postpartum depression or anxiety affects infants’ health.
In an insured population, infants of mothers with
postpartum depression or anxiety had more sick/
emergency visits and an increased risk of hospitalization
than infants of mothers with no depression or anxiety.

What is the direction of future work by the CDC’s
Division of Reproductive Health?
❚❚ Evaluating ways to get depressed women diagnosed

and treated.
❚❚ Examining ways to integrate mental health services into

routine healthcare for women of reproductive age.

For further information, please visit
http://www.Depression/reproductive/address_here
or http://www.address/here

MENTAL HEALTH AMONG WOMEN OF REPRODUCTIVE AGE

PAGE 4
Form Approved
OMB No: 0920-0956
Exp. Date: March 31, 2016

Definitions
Depression:
❚❚ Minor Depression: 2-4 symptoms out of the 9 below,
with at least one symptom being #1 or #2
❚❚ Major Depression: at least 5 symptoms out of the 9

below, with at least one symptom being #1 or #2
1. Depressed mood
2. Markedly diminished interest or pleasure in all,
or almost all, activities
3. Significant weight loss when not dieting or
weight gain
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or
inappropriate guilt
8. Diminished ability to think or concentrate,
or indecisiveness
9. Recurrent thoughts of death, suicidal ideation,
or a suicide attempt

Frequent Mental Distress:
❚❚ Reporting that mental health, including stress,
depression, and problems with emotions, was not good
for at least 14 days out of the previous month.
Serious Psychological Distress:
❚❚ Based on a score of at least 13 on the Kessler-6 (K6) screening instrument, which assesses frequency of
the following feelings in the past 30 days: nervous,
hopeless, restless or fidgety, so depressed that nothing
could cheer you up, everything was an effort, and
worthless. A score of at least 13 is correlated with
severe mental illness.