Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence

Abstract

Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed to do in the present study. We designed a descriptive prospective study and included information from Danish population registers to study first-time ever and recurrent psychiatric episodes during the perinatal period, including treatment at psychiatric facilities and general practitioners (GPs). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods across moderate and severe perinatal psychiatric episodes.

Trend of antidepressants before, during, and after pregnancy across two decades—A population‐based study

“…This study showed that the prevalence of AD use in 1 year after birth was higher than AD use during pregnancy, but lower than AD use in 1 year before pregnancy. The time after birth is a vulnerable time for new mothers and may herald the potential onset of new psychiatric conditions such as postpartum depression (Munk‐Olsen et al, ). At the same time, women are still cautious of taking medicine at the postpartum period especially when they are breastfeeding.…”

“…in 1 year before pregnancy. The time after birth is a vulnerable time for new mothers and may herald the potential onset of new psychiatric conditions such as postpartum depression(Munk-Olsen et al, 2016).At the same time, women are still cautious of taking medicine at the postpartum period especially when they are breastfeeding. A previous study showed that it takes about 2 years after birth to reach the prevalence level of AD use before pregnancy(Jimenez-Solem et al, 2013).…”

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.…”

Adverse life events increase risk for postpartum psychiatric episodes: A population-based epidemiologic study

“…Women experience MDD at twice the rate of men across their lifetime including episodes of depression that occur outside of the perinatal period (Kessler, ; Pedersen et al., ; Seedat et al., ). However, women are particularly vulnerable to psychiatric illness in the postpartum period (Munk‐Olsen, Laursen, Pedersen, Mors, & Mortensen, ; Munk‐Olsen et al., ) for a range postpartum psychiatric disorders including postpartum depression (PPD) and postpartum psychosis. PPD in particular has a prevalence of 10–15% across the world and greater prevalence in high‐risk populations of women (Gavin et al., ).…”