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Am Fam Physician. 2004;70(1):175-179

At least one in five women will experience depression in her lifetime. The prevalence of depression in women is greatest during the reproductive years. Studies estimate that 20 to 30 percent of nonpregnant women presenting to primary care clinics for any reason meet the criteria for depression, although one half of these cases are not recognized. A prevalence study in women treated at family planning clinics confirmed these high rates of depression and identified significantly elevated rates of risk factors for reproductive conditions among women who are depressed.

Berenson and colleagues surveyed 5,583 low-income suburban women treated at family planning clinics in Texas. All new patients younger than 40 years were asked to complete the survey unless they were pregnant or within four weeks after delivery. The survey, available in both English and Spanish, covered sociodemographic factors as well as six sections concerning health and health risk behaviors. The survey incorporated the 13-item short form of the Beck Depression Inventory.

Approximately one half (48 percent) of the 4,726 women who completed the survey were white, 22 percent were black, and approximately 25 percent were Hispanic. Around 30 percent reported being married, and an additional 52 percent stated that they were unmarried but had a partner. Overall, about 30 percent of women met the criteria for depression. Mild symptoms were identified in 11.8 percent of the survey respondents, moderate symptoms in 14 percent, and severe symptoms in 4.8 percent.

Depressive symptoms were more common in Hispanic women (20.1 percent) than in black women (16.1 percent) or white women (19.7 percent). Statistical analysis associated moderate or severe depression with the factors of Hispanic ethnicity, low educational achievement, unemployment, and having no current partner. Depression was associated with young age at first intercourse, increased number of lifetime sexual partners, not using contraception at first and most recent intercourse, history of sexually transmitted disease, more than three pregnancies, early age at first pregnancy, sex after using alcohol or drugs, and no sexual activity in the previous three months. Depression also was associated with regular smoking, young age at initiation of smoking, current use of alcohol, and young age at first intoxication.

Multivariate logistic regression identified 11 factors that were significantly related to moderate to severe depression. The strongest relationships (highest odds ratios) were for the following factors: having more than six sexual partners (2.12), initiating contraception use at an age younger than 12 years (1.98), current smoking (1.67), not completing high school (1.66), abstaining from sexual activity in the previous three months (1.52), being Hispanic (1.38), and working fewer than 10 hours a week (1.42).

The authors conclude that many women seeking reproductive services have depression and that risk factors and associated behaviors for reproductive conditions cluster in women with depression. In particular, these women are likely to have unprotected intercourse and to have low levels of resources for social support. The constellation of adverse factors may be further exacerbated by use of drugs or alcohol to self-treat depressive symptoms. The authors call on physicians to be alert for depression in female patients and to inquire about risky sexual or reproductive behaviors in women who are depressed.

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