Risks and predictors of readmission for a mental disorder during the postpartum period.

National Centre for Register-Based Research, University of Aarhus, Taasingegade 1, Aarhus C, Denmark.
Archives of general psychiatry (Impact Factor: 13.75). 03/2009; 66(2):189-95. DOI: 10.1001/archgenpsychiatry.2008.528
Source: PubMed

ABSTRACT It has been suggested that the risk of inpatient psychiatric readmissions is elevated during the postpartum period. To our knowledge, no prior study has compared mothers and nonmothers to determine whether the risk of readmission differs between these 2 groups of women.
To compare mothers and nonmothers to assess whether childbirth increases the risk for psychiatric readmission and to identify predictors of psychiatric readmission during the postpartum period.
A population-based cohort study merging data from the Danish Civil Registration System and the Danish Psychiatric Central Register.
The population of Denmark.
Two partly overlapping study populations included a total of 28 124 women, 10 218 of whom were mothers, who were followed up from January 1, 1973, through June 30, 2005. Main Outcome Measure Readmission rates to psychiatric hospitals during the 12 months after childbirth (first live-born child).
The period of highest risk of psychiatric readmission in new mothers was 10 to 19 days post partum (relative risk [RR], 2.71; 95% confidence interval [CI], 1.68-4.37), and the period of lowest risk was during pregnancy (0.54; 0.43-0.69). Childbirth was associated with an increased risk of readmission during the first postpartum month, after which risk for readmission was higher among nonmothers (RR, 1.53; 95% CI, 1.31-1.80). A previous diagnosis of bipolar affective disorder was the strongest predictor of readmissions 10 to 19 days post partum (RR, 37.22; 95% CI, 13.58-102.04). In all, 26.9% of mothers with this diagnosis were readmitted within the first postpartum year.
Mothers with mental disorders have lower readmission rates compared with women with mental disorders who do not have children. However, the first month after childbirth is associated with increased risk of psychiatric readmission, and women with a history of bipolar affective disorder are at particular risk of postpartum psychiatric readmissions.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The association between childhood sexual abuse (CSA) and major depression disorder (MDD) gives reason to suspect that many mothers with postpartum depression (PPD) have a history of CSA. However, few studies have investigated how CSA and PPD are related. In this case study we explore how the experience of incest intertwines with the experience of postpartum depression. We focus on participant subject "Nina," who has experienced both. We interviewed her three times and we analysed the interviews with Giorgi's phenomenological descriptive method to arrive at a contextualised meaning structure. Nina's intruding fantasies of men who abuse her children merge with her recollections of her own incest experiences. She may succeed in forcing these fantasies out of her consciousness, but they still alter her perceptions, thoughts, and emotions. She feels overwhelmed and succumbs to sadness, while she also is drawn towards information about CSA, which in turn feeds her fantasies. The psychodynamic concepts of repetition compulsion, transference, and projection may provide some explanation of Nina's actions, thoughts, and emotions through her past experiences. With our phenomenological stance, we aim to acknowledge Nina's descriptions of her everyday life here and now. With reference to Husserl, Heidegger, Merleau-Ponty, and Minkowski, we show that Nina's past is not a dated memory; rather it determines the structure of her consciousness that constitutes her past as her true present and future. Incest dominates Nina's world, and her possibilities for action are restricted by this perceived world. Any suspension of action implies anguish, and she resolves this by incest-structured action that in turn feeds and colours her expectations. Thus anxiety and depression are intertwined in the structure of this experience.
    International Journal of Qualitative Studies on Health and Well-Being 07/2011; 6(3). DOI:10.3402/qhw.v6i3.7244 · 0.93 Impact Factor
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the last years hundreds of studies have been done worldwide to investigate “postnatal depression”. Nevertheless there is no evidence, that postnatal psychiatric symptoms form an entity. Furthermore the classification of these symptoms into three syndromes (“postpartum blues”, “postnatal depression” and “postpartum psychosis”), that has been established in the recent years, seems to be not sufficient. Therefore this survey will focus on investigations on the prevalence of mentally ill mothers in the broad psychiatric spectrum.
    Psychiatrie und Psychotherapie 12/2012; 7(4). DOI:10.1007/s11326-011-0180-7