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*Mortality data in this table are voluntarily reported from 122 cities in the United States, most of which have populations of ≥100,000. A death is reported by the place of its occurrence and by the week that the death certificate was filed. Fetal deaths are not included.

† Pneumonia and influenza.

$ Because of changes in reporting methods in this Pennsylvania city, these numbers are partial counts for the current week. Complete counts will be available in 4 to 6 weeks 1 Because of Hurricane Katrina, weekly reporting of deaths has been temporarily disrupted. **Total includes unknown ages.

The Morbidity and Mortality Weekly Report (MMWR) Series is prepared by the Centers for Disease Control and Prevention (CDC) and is available free of charg in electronic format. To receive an electronic copy each week, send an e-mail message to listserv@listserv.cdc.gov. The body content should read SUBscribe m toc. Electronic copy also is available from CDC's Internet server at http://www.cdc.gov/mmwr or from CDC's file transfer protocol server at ftp://ftp.ca publications/mmwr. Paper copy subscriptions are available through the Superintendent of Documents, U.S. Government Printing Office, Washington, D telephone 202-512-1800.

Data in the weekly MMWR are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of br Friday; compiled data on a national basis are officially released to the public on the following Friday. Data are compiled in the National Center for Publ Informatics, Division of Integrated Surveillance Systems and Services. Address all inquiries about the MMWR Series, including material to be consi publication, to Editor, MMWR Series, Mailstop E-90, CDC, 1600 Clifton Rd., N.E., Atlanta, GA 30333 or to www.mmwrq@cdc.gov.

All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appre Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organiz their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of these sites. URL addresses MMWR were current as of the date of publication.

✩U.S. Government Printing Office: 2008-723-026/41087 Region IV ISSN: 0149-2195

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ATLANTA, GA 30333
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
DEPARTMENT OF HEALTH AND HUMAN SERVICES

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Prevalence of Self-Reported Postpartum Depressive Symptoms 17 States, 2004-2005

Postpartum depression (PPD) affects 10%-15% of mothers ithin the first year after giving birth (1). Younger moths and those experiencing partner-related stress or physiI abuse might be more likely to develop PPD (2,3). CDC alyzed data from the Pregnancy Risk Assessment Moniring System (PRAMS) for 2004-2005 (the most recent ta available) to 1) assess the prevalence of self-reported stpartum depressive symptoms (PDS) among mothers selected demographic characteristics and other possible sk factors for PDS and 2) determine factors that identify others most likely to develop PPD. This report summazes the results of that analysis, which indicated that, durig 2004-2005, the prevalence of self-reported PDS in 17 .S. states ranged from 11.7% (Maine) to 20.4% (New Mexico). Younger women, those with lower educational tainment, and women who received Medicaid benefits. or their delivery were more likely to report PDS. State and ocal health departments should evaluate the effectiveness f targeting mental health services to these mothers and corporating messages about PPD into existing programs g., domestic violence services) for women at higher risk. PRAMS is an ongoing, state-specific, population-based arveillance project that collects self-reported information n maternal attitudes and experiences before, during, and fter delivery of a live infant. PRAMS is administered by DC in collaboration with participating states and cities nd is designed to be representative of women in particiating states who have delivered during the preceding 2-6 onths (4). Response rates were ≥70% for 2004 and 2005 each of the 17 participating states. During 2004–2005,

Alaska, Colorado, Georgia, Hawaii, Maryland, Maine, Minnesota, North Carolina, Nebraska, New Mexico, New York (excluding New York City), Oregon, Rhode sland, South Carolina, Utah, Vermont, and Washington.

these 17 states included two questions on self-reported PDS in their PRAMS surveys: 1) "Since your new baby was born, how often have you felt down, depressed, or hopeless?" and 2) "Since your new baby was born, how often have you had little interest or little pleasure in doing things?" The response choices were "always," "often," "sometimes," “rarely,” and “never"; women who said “often" or "always" to either question were classified as experiencing selfreported PDS. Because of their high sensitivity (96%), these two questions have been recommended as a depression casefinding instrument by health professionals (5,6). Chi-square tests were used to test for significant differences (p<0.05) in the proportion of women reporting PDS by demographic characteristics and other possible risk factors for PDS within each of the 17 states; approximate 95% confidence intervals for these proportions were calculated. To measure the strength of the association overall, the median difference across all states in the proportion of women reporting PDS between two levels of each covariate was calculated. Sample

Confidence intervals are approximate because, when adjusting for the clustered survey design, the confidence intervals computed were close to but not equal to +1.96 x standard error.

INSIDE

366 Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food

10 States, 2007

370 Malnutrition and Micronutrient Deficiencies Among
Bhutanese Refugee Children - Nepal, 2007

373 Automated Detection and Reporting of Notifiable
Diseases Using Electronic Medical Records Versus
Passive Surveillance-Massachusetts, June 2006-July 2007
376 Notice to Readers
377 QuickStats

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS for DISEASE CONTROL AND PREVENTION

The MMWR series of publications is published by the Coordinating Center for Health Information and Service, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.

Suggested Citation: Centers for Disease Control and Prevention. [Article title]. MMWR 2008;57: [inclusive page numbers].

Centers for Disease Control and Prevention
Julie L. Gerberding, MD, MPH.

Director

Tanja Popovic, MD, PhD

Chief Science Officer

James W. Stephens, PhD Associate Director for Science

Steven L. Solomon, MD

Director, Coordinating Center for Health Information and Service
Jay M. Bernhardt, PhD, MPH

Director, National Center for Health Marketing
Katherine L. Daniel, PhD

Deputy Director, National Center for Health Marketing
Editorial and Production Staff

Frederic E. Shaw, MD, JD
Editor, MMWR Series
Teresa F. Rutledge

(Acting) Managing Editor, MMWR Series
Douglas W. Weatherwax
Lead Technical Writer-Editor
Donald G. Meadows, MA
Jude C. Rutledge
Writers-Editors
Peter M. Jenkins

(Acting) Lead Visual Information Specialist Lynda G. Cupell

Malbea A. LaPete

Visual Information Specialists Quang M. Doan, MBA

Erica R. Shaver

Information Technology Specialists

Editorial Board

William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN

David W. Fleming, MD, Seattle, WA

William E. Halperin, MD, DrPH, MPH, Newark, NJ
Margaret A. Hamburg, MD, Washington, DC

King K. Holmes, MD, PhD, Seattle, WA
Deborah Holtzman, PhD, Atlanta, GA

John K. Iglehart, Bethesda, MD
Dennis G. Maki, MD, Madison, WI
Sue Mallonee, MPH, Oklahoma City, OK
Stanley A. Plotkin, MD, Doylestown, PA
Patricia Quinlisk, MD, MPH, Des Moines, IA
Patrick L. Remington, MD, MPH, Madison, WI
Barbara K. Rimer, DrPH, Chapel Hill, NC
John V. Rullan, MD, MPH, San Juan, PR
Anne Schuchat, MD, Atlanta, GA
Dixie E. Snider, MD, MPH, Atlanta, GA
John W. Ward, MD, Atlanta, GA

sizes varied for each estimate because women who we missing data on any variable (<5% of all women) we excluded from analysis of that variable. The analysis conducted using statistical software to adjust for the cer plex survey design and produce statewide estimates. Es mates based on small sample sizes (fewer than 3. respondents) were considered to be unreliable.

The maternal characteristics analyzed included age a delivery, race/ethnicity, education, marital status, ar receipt of Medicaid for delivery. Possible risk factors for PD included in the analysis were low infant birth weigh (<2,500 g), admission to a neonatal intensive-care ur (NICU), number of previous live births, tobacco use dus ing the last 3 months of pregnancy, physical abuse befor or during pregnancy, and experiencing emotional, fina cial, partner-related, or traumatic stress during the 11 months before delivery. Women were considered physical abused if they said that a current or former husbare partner had pushed, hit, slapped, kicked, choked, or ph cally hurt them in any way during the 12 months befor or during the most recent pregnancy. Women who reporte smoking one or more cigarettes on an average day wer classified as using tobacco during the last 3 months pregnancy.

During 2004-2005, overall prevalence of self-reporte PDS ranged from 11.7% (Maine) to 20.4% (New Mexic (Table 1). Demographic characteristics significantly ass ciated with PDS in all of the 17 states were maternal ag marital status, maternal education, and Medicaid covera for delivery. Among the 17 states, the median percentag point difference in PDS prevalence was 13.4 percentag points between the youngest and oldest mothers, 13 between the lowest and highest education groups, 9.7 marital status, and 11.0 by Medicaid receipt. In 13 of th 16 states for which data were available, a significant ass ciation was observed between race/ethnicity and PDS, wi non-Hispanic white women having a lower prevalence PDS compared with women of other racial/ethnic group

PDS was significantly associated with five possible ri factors in all or nearly all of the 17 states (Table 2). T number of states with significant associations and sta

Stressors during pregnancy were categorized as 1) emotional (a very sick fam member had to go into the hospital or someone close to the respondent died: financial (the respondent moved to a new address, her husband/partner lost job, she lost her job, or she had a lot of bills she could not pay; 3) partner-rela (the respondent separated or divorced from her husband/partner, she argu more than usual with her husband/partner, or her husband/partner said he not want her to be pregnant); and 4) traumatic (the respondent was home she was involved in a physical fight, she or her husband/partner went to jai someone close to her had a problem with drinking/drugs).

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