Use of primary health care prior to a postpartum psychiatric episode

Abstract

Objective. Childbirth is a strong trigger of psychiatric episodes. Nevertheless, use of primary care before these episodes is not quantified. The aim was to study the use of general practice in Denmark from two years before to one year after childbirth in women who developed postpartum psychiatric disorders. Design. A matched cohort study was conducted including women who gave birth in the period 1996–2010. Women were divided into four groups: (i) all mothers with postpartum psychiatric episodes 0–3 months after birth, n = 939; 2: All mothers with a postpartum psychiatric episode 3–12 months after birth, n = 1 436; and (iii) two comparison groups of mothers, total n = 6 630 among 320 620 eligible women. Setting. Denmark. Subjects. Women born in Denmark after 1 January 1960, restricting the cohort to women who gave birth to their first singleton child between 1 January 1996 and 20 October 2010. Main outcome measures. The main outcome measures were consultation rates, consultation rate ratios, and rate differences. Results. Women who developed a psychiatric episode after childbirth had higher GP consultation rates before, during, and after the pregnancy. Women with a psychiatric episode 0–3 months postpartum had 6.89 (95% CI 6.60; 7.18) mean number of consultations during pregnancy, corresponding to 1.52 (95% CI 1.22; 1.82) more visits than the comparison group. Conclusion. Women with a postpartum psychiatric episode had higher use of GP-based primary health care services years before the childbirth, and in this specific group of patients childbirth itself triggered a marked increase in the number of GP contacts postpartum.

Ações do programa de puerpério na atenção primária: uma revisão integrativa

“…In Brazil, investigations are restricted to the immediate and late puerperium, addressing remote puerperium only when it comes to breastfeeding, and the latter focusing on the child. International studies dealt with remote puerperium in a maximum of two and a half years postpartum 34,36 , with a predominance of PDD investigation [46][47][48][50][51][52] . While many women traverse puerperium without intercurrences, others experience significant issues that may persist for weeks, months or even more than 4 years after giving birth 7,8 , indicating these women's need for care over time.…”

“…According to an Australian study 50 , a health professional's investigation about the past or current mental health of women is associated with the search for help throughout the perinatal period. In Denmark, it was found that puerperae who developed a psychiatric episode had higher rates of consultation by health professionals before, during and after pregnancy 52 .…”

Postpartum mental health study flawed by fetal loss omission

“…The recent study of postpartum psychiatric illness [ 1 ] is unfortunately flawed by the decision by Munk-Olsen et al. to exclude effects of prior pregnancy losses.…”

“…Record linkage has also shown elevated rates of primary care following abortion [ 4 ]. Prior abortions may therefore explain higher recourse to primary care before delivery for women more prone to postpartum disorders [ 1 ].…”

“…Unfortunately, Munk-Olsen's studies are disturbingly inconsistent in their methodologies. For example, in their primary care study [ 1 ], they (a) exclude all women with any history of treatment for mental health disorders prior to childbirth and (b) also show the consultation rate ratio for two years before childbirth through to one year after.…”