Depressive symptoms in primary care pregnant women: prevalence and associated factors

Rafaela Santi Dell'Osbel, Maria Luisa Oliveira Gregoletto, Cleber Cremonese


Introduction: The onset of emotional disorders early in pregnancy is frequent, including depressive symptoms (DS) such as guilt, lack of appetite and energy. Objective: To measure the prevalence of depressive symptoms and associated factors in pregnant women attending primary care. Methods: Cross-sectional observational epidemiological study of pregnant women, who attend primary care in Caxias do Sul, Rio Grande do Sul, Brazil. Depressive symptoms were assessed using Patient Health Questionnaire (PHQ-9). Gross analysis was performed, in which prevalence ratios (PR) and respective confidence intervals (CI 95%) were calculated. The comparison of categorical variables occurred through the Chi-square test. The adjusted analysis was performed by Poisson regression, using the backwards technique, where the final model was constructed from the variables with p≤0.20 in the gross analysis. Results: The sample consisted of 76 pregnant women, of these 46.1% had depressive symptoms. The average age was 26.6 years (±5.95) and 72.4% were married or in a stable union. There was a significant association between depressive symptoms and marital status (PR: 1.54; 95% CI 1.00-2.37; p=0.045) and the occurrence of abortion in other pregnancies (PR: 1.72; 95% CI 1, 08-2.74; p=0.022). Conclusion: There was a high prevalence of depressive symptoms compared to regional studies in the pregnant women investigated. Factors associated with the outcome were marital status and history of abortion, which may cause problems during pregnancy and postpartum. Thus, there is a need for tools and strategies to identify the presence of depressive symptoms in early pregnancy, so that they can be diagnosed and treated.


depression; epidemiology; risk factors; pregnancy; primary health care


Aviram A, Hod M, Yogev Y. Maternal obesity: Implications for pregnancy outcome and long-term risks–a link to maternal nutrition. Int J Gynaecol Obstet. 2011;115:(Suppl 1):S6-10.

Kingsbury AM, Plotnikova M, Najman JM. Commonly occurring adverse birth outcomes and maternal depression: a longitudinal study. Public Health. 2018;155:43-54.

González-Mesa ES, Arroyo-González ML, Ibrahim-Díez N, Cazorla-Granados O. Mood state at the beginning of the pregnancy and its influence on obstetric and perinatal outcomes. J Psychosom Obstet Gynaecol. 2018:1-8.

Stewart BW, Wild CP. World cancer report 2014. Geneva: World Health Organization, 2014.

Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry. 2016;73(8):826-37.

McDonald S, Kehler H, Bayrampour H, Fraser-Lee N, Tough S. Risk and protective factors in early child development: Results from the All Our Babies (AOB) pregnancy cohort. Res Dev Disabil. 2016;58:20-30.

Lewis A, Austin E, Galbally M. Prenatal maternal mental health and fetal growth restriction: a systematic review. J Dev Orig Health Dis. 2016;7(4):416-28.

Shakeel N, Eberhard-Gran M, Sletner L, Slinning K, Martinsen EW, Holme I, et al. A prospective cohort study of depression in pregnancy, prevalence and risk factors in a multi-ethnic population. BMC Pregnancy Childbirth. 2015;15:5.

Brasil. Instituto Sírio-Libanês de Ensino e Pesquisa. Protocolos da atenção básica: saúde das mulheres. Ministério da Saúde, 2016.

Almeida MS, Nunes MA, Camey S, Pinheiro AP, Schmidt MI. Mental disorders in a sample of pregnant women receiving primary health care in Southern Brazil. Cad Saude Pública. 2012;28(2):385-94.

Bernard O, Gibson RC, McCaw-Binns A, Reece J, Coore-Desai C, Shakespeare-Pellington S, et al. Antenatal depressive symptoms in Jamaica associated with limited perceived partner and other social support: a cross-sectional study. PloS One. 2018;13(3):e0194338.

Giallo R, Pilkington P, McDonald E, Gartland D, Woolhouse H, Brown S. Physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum. Soc Psychiatry Psychiatr Epidemiol. 2017;52(7):815-28.

Verreault N, Costa D, Marchand A, Ireland K, Dritsa M, Khalifé S. Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset. J Psychosom Obstet Gynaecol. 2014;35(3):84-91.

Associação Brasileira de Empresas de Pesquisa (ABEP). Critério de classificação econômica Brasil. CCEB 2008: Base LSE 2008. Disponível em: Acesso em: 10 ago 2016.

World Health Organization (WHO). Self-help strategies for cutting down or stopping substance use: a guide. Geneva: WHO, 2010.

World Health Organization (WHO). Global recommendations on physical activity for health. Geneva: WHO, 2010.

Samur EA, Castillo C, Santoro RC, Aldea A. Propuesta de un nuevo estándar de evaluación nutricional en embarazadas. Rev Med Chile. 1997;125(12):1429-36.

Corrêa AMS, Escamilla RP, Sampaio MFA, Marin-Leon L, Panigassi G, Maranha LK, et al. Relatório técnico: Acompanhamento e avaliação da segurança alimentar de famílias brasileiras: validação de metodologia e de instrumento de coleta de informação. Campinas: Unicamp, 2004.

Cordás TA, Castilho S. Imagem corporal nos transtornos alimentares: instrumento de avaliação: Body Shape Questionnaire. Psiquiatr Biol. 1994;2(1):17-21.

Ferreira JES, Veiga GV. Confiabilidade (teste-reteste) de um questionário simplificado para triagem de adolescentes com comportamentos de risco para transtornos alimentares em estudos epidemiológicos. Rev Bras Epidemiol. 2008;11(3):393-401.

Santos IS, Tavares BF, Munhoz TN, Almeida LSP, Silva NTB, Tams BD, et al. Sensibilidade e especificidade do Patient Health Questionnaire-9 (PHQ-9) entre adultos da população geral. Cad Saúde Pública. 2013;29(8):1533-43.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13.

Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012;184(3):E191-6.

World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Geneva: WHO, 2000.

Coll CVN, Silveira MF, Bassani DG, Netsi E, Wehrmeister FC, Barros FC, et al. Antenatal depressive symptoms among pregnant women: Evidence from a Southern Brazilian population-based cohort study. J Affect Disord. 2017;209:140-6.

Bawahab JA, Alahmadi JR, Ibrahim AM. Prevalence and determinants of antenatal depression among women attending primary health care centers in Western Saudi Arabia. Saudi Med J. 2017;38(12):1237-42.

Pinto T, Vilela AA, Farias DR, Lepsch J, Cunha GM, Vaz JS, et al. Serum n-3 polyunsaturated fatty acids are inversely associated with longitudinal changes in depressive symptoms during pregnancy. Epidemiol Psychiatr Sci. 2017;26(2):157-68.

Costa ECV, Castanheira E, Moreira L, Correia P, Ribeiro D, Pereira MG. Predictors of emotional distress in pregnant women: the mediating role of relationship intimacy. J Ment Health. 2017:1-9.

Alqahtani AH, Al Khedair K, Al-Jeheiman R, Al-Turki HA, Al Qahtani NH. Anxiety and depression during pregnancy in women attending clinics in a University Hospital in Eastern province of Saudi Arabia: prevalence and associated factors. Int J Womens Health. 2018;10:101-8.

Easter A, Solmi F, Bye A, Taborelli E, Corfield F, Schmidt U, et al. Antenatal and postnatal psychopathology among women with current and past eating disorders: longitudinal patterns. Eur Eat Disord Rev. 2015;23(1):19-27.

Smedberg J, Lupattelli A, Mårdby AC, Øverland S, Nordeng H. The relationship between maternal depression and smoking cessation during pregnancy-a cross-sectional study of pregnant women from 15 European countries. Arch Womens Ment Health. 2015;18(1):73-84.

Orton S, Coleman T, Coleman-Haynes T, Ussher M. Predictors of postpartum return to smoking: a systematic review. Nicotine Tob Res. 2018;20(6):665-73.

Leis JA, Heron J, Stuart EA, Mendelson T. Associations between depressive and anxious symptoms and prenatal alcohol use. Matern Child Health J. 2012;16(6):1304-11.

Davis EC, Rotheram-Borus MJ, Weichle TW, Rezai R, Tomlinson M. Patterns of alcohol abuse, depression, and intimate partner violence among township mothers in South Africa over 5 years. AIDS Behav. 2017;21(Suppl 2):174-82.

Maselko J, Bates L, Bhalotra S, Gallis JA, O’Donnell K, Sikander S, et al. Socioeconomic status indicators and common mental disorders: evidence from a study of prenatal depression in Pakistan. SSM Populat Health. 2018;4:1-9.

Roomruangwong C, Kanchanatawan B, Sirivichayakul S, Maes M. High incidence of body image dissatisfaction in pregnancy and the postnatal period: Associations with depression, anxiety, body mass index and weight gain during pregnancy. Sex Reprod Healthc. 2017;13:103-9.

Vitolo MR. Nutrição: da gestação ao envelhecimento. 2ed. Rubio, 2014.



  • There are currently no refbacks.

Copyright (c) 2019 Rafaela Santi Dell'Osbel, Maria Luisa de Oliveira Gregoletto, Cleber Cremonese

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.