Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study

Abstract

ObjectiveTo describe weekly admission rates for affective and non-affective psychosis, major depression and other psychiatric disorders in the early and late postpartum periods. To assess the impact of socioeconomic status, age and parity on admission rates.MethodsScottish maternity records were linked to psychiatric hospital admissions. 3290 pregnancy-related psychiatric admissions were assessed. Weekly admission rates were calculated for the pregnancy period, early postpartum period (6 weeks after birth) and late postpartum period (up to 2 years after birth), and compared with pre-pregnancy rates (up to 2 years before pregnancy). Admission rates were generated by calculating the total number of admissions for each time period divided by the number of weeks in the period. Incidence rate ratios (IRRs) were generated for each time period, using deprivation, age, parity and record of previous psychiatric hospital care-adjusted Poisson regression models.ResultsWomen from more deprived social quintiles accounted for the largest proportion of admissions across all time periods. Compared with pre-pregnancy period, admission rates fell during pregnancy, increased markedly during the early postpartum period, and remained elevated for 2 years after childbirth. Within the most affluent quintile, admission IRRs were higher in the early postpartum period (IRR=1.29, 95% CI 1.02 to 1.59) than in the late postpartum period (IRR=0.87, 95% CI 0.74 to 0.98). For the late postpartum period, there was a positive association between higher maternal age and admission IRRs (ages 20–35 years, IRR=1.35, 95% CI 1.16 to 1.54 and age>40 years IRR=1.72, 95% CI 1.41 to 2.09).ConclusionsRates of psychiatric admission fell during pregnancy and increased in the early postpartum period (particularly during the first 2 weeks after birth), and remained elevated above baseline during the 2-year late postpartum period. An understanding of how social deprivation, age and parity might influence risk of psychiatric admission at different time points could help to target perinatal mental health services more effectively.

Sex differences in depression during pregnancy and the postpartum period

“…The postpartum period confers an increased risk of depression in comparison with other periods in women's lives (Vesga‐Lopez et al, ), but corresponding data in fathers have not been reported. Severe psychiatric morbidity in relation to childbirth, such as postpartum psychosis, postpartum psychiatric admissions, and postpartum suicide, have been described exclusively for mothers (Lindahl et al, ; Munk‐Olsen et al, ; Esscher et al, ; Langan Martin et al, ). It is quite possible that these are unique maternal experiences, but it remains to be established whether the postpartum period is a vulnerability period for severe psychiatric morbidity in fathers also.…”

Phenotypical characteristics of postpartum psychosis: A clinical cohort study

“…Since the 19 th Century PP has been widely appreciated as a severe disease, requiring acute intervention. Moreover, epidemiologic studies consistently report a greatly increased risk in psychiatric inpatient admissions within 6 weeks after childbirth compared to any other period in a woman's life . Many of these first‐onset severe postpartum episodes are, in retrospect, the initial presentation of bipolar disorder.…”

Admission to psychiatric hospital for mental illnesses 2 years prechildbirth and postchildbirth in Scotland: a health informatics approach to assessing mother and child outcomes

“…15 It is recognised that women in the early postpartum period (0 to 6 weeks after childbirth) are at particularly elevated risk of requiring psychiatric admission. 16 17 In our previous study, we found that this risk remains elevated for up to 2 years postchildbirth. 16 …”

“… 16 17 In our previous study, we found that this risk remains elevated for up to 2 years postchildbirth. 16 …”