Emergency department use among postpartum women with mental health disorders

Pluym, Ilina D.; Holliman, Kerry; Afshar, Yalda; Lee, Connie C.; Richards, Misty; Han, Christina S.; Krakow, Deborah; Rao, Rashmi

doi:10.1016/j.ajogmf.2020.100269

Cited by 15 publications

(13 citation statements)

References 24 publications

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“…PNA has also been suggested as a risk factor for paternal anxiety and depression in the perinatal period ( 29 , 30 ). It has also been reported that women with PNA may struggle to identify appropriate ways to seek medical support, and may access emergency medical care at a greater frequency than those without PNA ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

The approach to managing perinatal anxiety: A mini-review

et al. 2022

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Perinatal Anxiety (PNA) is defined as anxiety occurring during pregnancy and up to 12 months post-partum and is estimated to affect up to 20% of women. Risk factors for PNA are multiple and can be classed as psychological, social and biological. PNA negatively impacts on the mother, child and family. PNA is not well-recognized and diagnosis of PNA can be challenging for clinicians. There is currently no validated case-finding or diagnostic test available for PNA. PNA has been less extensively researched than perinatal depression (PND). Clinical guidance currently recommends pharmacological and psychological therapies for the management of women with PNA, however the limited research available suggests that other intervention types may also be effective with some evidence on the effectiveness of non-pharmacological interventions in primary care for PNA. This article provides a mini-review of PNA, summarizing current evidence around PNA including risk factors, the impact of PNA, the process of diagnosis of PNA and focussing predominantly on available management options for PNA.

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Section: Discussionmentioning

confidence: 99%

The approach to managing perinatal anxiety: A mini-review

et al. 2022

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“…Point prevalence of minor depression has been shown to be as high as 11-18% in pregnancy and 13-30% postpartum 20,63,65 . Prevalence estimates of other psychiatric diagnoses in the perinatal period include a prevalence of 11-21% for anxiety disorders, 2.8% for bipolar disorder, and 0.1-1% for psychotic disorders, with many more women likely experiencing subthreshold symptomatology [21][22][23]63,66 . The highest risk period for postpartum depression has been suggested to be the first 9 months postpartum 22 .…”

Section: Maternal Mental Illness 221 Definitions and Epidemiology Of ...mentioning

confidence: 99%

“…Prior research has suggested that approximately 0.2%-4.2% of women present to the emergency department for mental health concerns in the postpartum period 66,80,81 . A large retrospective population-based study in Ontario, Canada found that 1.1% of women visited the emergency department for a mental health concern in the first postpartum year, with a median time to index presentation of approximately 5 months, and in 60% of cases, the ED represented the first postpartum point of access for mental health care 80 .…”

Section: Severe Maternal Mental Illnessmentioning

confidence: 99%

“…Pre-pregnancy mental illness is also a strong risk factor for chronic mental illness beyond the first postpartum year, and for severe maternal mental illness including need for acute care and suicide attempts 67,69,70 . Women with pre-existing mental illness, including those with prior suicide attempts, have significantly higher rates of postpartum visits to the emergency department for both mental health concerns as well as medical indications, higher rates of postpartum psychiatric hospitalization, and increased risk of self-injury and suicide 66,[84][85][86][87]91,92 . A Danish registry-based study found that perinatal suicide risk was highest among women ≤1 year after initial psychiatric diagnosis 93 .…”

Section: Pre-existing Mental Illnessmentioning

confidence: 99%

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Twin pregnancy and severe maternal mental illness: a Canadian population-based cohort study

Lapinsky

Ray

Brown

et al. 2023

Arch Womens Ment Health

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Objective: To quantity the short-and long-term risks of severe maternal mental illness arising after a twin vs. singleton birth.Methods: This propensity-score weighted population-based retrospective cohort study comprised primiparous Canadian women aged 15-50 years. We compared 15,024 twin livebirths to 796,804 singletons livebirths, from 2003-2019. The primary composite outcome was a psychiatric emergency department visit, hospitalization, self-harm or suicide eventboth in the first year postpartum, and from 1 year postpartum up to 17 years post-delivery. Results:In the first year postpartum, after weighting, the rate of composite outcome events was 10.5 vs. 8.7 per 1000 person-years among twin and singleton births respectively (HR 1.21, 95% CI 1.07-1.47). Starting from 1 year postpartum, the corresponding rates were 5.9 vs. 6.1 per 1000 person-years (HR 0.96, 95% CI 0.89-1.04). Conclusions:Women with a twin birth may experience more severe adverse mental health within 1-year postpartum, but not in the long-term.I would like to thank everyone who assisted me with my studies and contributed to this thesis project. Specifically, I would like to thank my supervisor, Dr. Simone Vigod for her enthusiasm in working with an ObGyn resident, and her assistance, support, and encouragement throughout the process. I would also like to thank my thesis committee consisting of Dr. Hilary Brown, Dr. Kellie Murphy, and Dr. Joel Ray for their engagement with this project and ongoing support and positive feedback, as well as Kinwah Fung for her data support at ICES. As well, I would like to thank the University of Toronto Department of Obstetrics and Gynecology, and specifically Dr. Michèle Farrugia and Dr. John Kingdom for their logistical and financial support which allowed me to complete this degree during my residency. Finally, I would like to thank my friends and family for supporting me through the challenges and celebrating my successes.

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“…12 The predictors of ED visits are similar to those of patients who do not attend their clinic appointments: public insurance, younger age, cesarean delivery, and antepartum complications, 13 specifically mental health disorders. 14 If patients are not attending their clinic appointments, one could hypothesize that they may visit the ED for their routine postpartum care instead. The objective of our project was to determine whether shortening the time to initial postpartum visit from 6 weeks to 2 weeks can increase postpartum visit attendance of patients and decrease the rate of ED visits within 30 days after delivery.…”

Section: Introductionmentioning

confidence: 99%