Friday, March 4, 2016

All-Cause Mortality Found to Be Higher in Women With Severe Postpartum Psychiatric Disorders

Women with first-onset episodes of severe postpartum psychiatric disorders had all-cause mortality rate ratios (MRRs) that were nearly four times higher than mothers with no previous psychiatric history, according to a report appearing today in AJP in Advance.

Importantly, the study found that the first year after diagnosis represented a time of very high relative suicide risk for the group of women with severe postpartum psychiatric disorders.

Danish researchers collected data on all women born in Denmark on Jan. 1, 1950, or later. The study cohort included 1,545,857 women who were followed from age 15 until death, emigration from Denmark, or until Dec. 31, 2011, whichever came first. (This time frame provided a maximum follow-up period of 42 years and a maximum age of 62 for the women in the cohort.)

The main exposure variable was defined as any first psychiatric inpatient or outpatient contact within the first 90 days postpartum. The main outcome measure was mortality rate ratios for deaths from natural or unnatural causes (such as death by suicide or accidents).

Of the 1,545,857 cohort members, 2,699 women had a first psychiatric contact recorded at an inpatient or outpatient treatment facility within three months after giving birth. Of these, 96 women died during the follow-up period.

Women with postpartum psychiatric disorders had a higher MRR (3.74) than women with children who had first inpatient or outpatient psychiatric contact outside the postpartum period (2.73) when compared with mothers with no psychiatric history. Unnatural cause of death represented 40.6% of fatalities among women with postpartum psychiatric disorders, and within the first year after diagnosis the suicide risk was drastically increased (MRR=289.42). In comparison, only 9.34% of mothers with no history of psychiatric disorders died from unnatural causes.

“The observed high relative risk of suicide in the postpartum period warrants special attention for this vulnerable group of women,” the authors stated. They proposed several recommendations based on the findings, emphasizing the need for clinicians to be alert to anxiety in women with postpartum mood symptoms, as “they are at a higher risk of self-harm because of the uncomfortable agitation they experience.”

The researchers concluded: “Screening programs of new mothers can increase awareness by providing important psychoeducation to mothers and by alerting health care providers of women who are experiencing suicidal thoughts.”

For more information, see the Psychiatric News article “Early Postpartum Depression Screenings Not Enough to Identify High-Risk Women.”

(Image: iStock/IvanJekic)


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