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.

Figure 1

First-time and recurrent psychiatric episodes in the perinatal period treated at psychiatric inpatient facilities. Information on admissions to psychiatric treatment facilities came from the Psychiatric Central Register, with data available since 1969. Y axis: permille (out of 1000)=per 1000 births.

Figure 2

First-time and recurrent psychiatric episodes in the perinatal period treated at psychiatric outpatient facilities. Information on outpatient treatment at psychiatric treatment facilities came from the Psychiatric Central Register, with data available since 1995. Y axis: permille (out of 1000)=per 1000 births.

Figure 3

First-time and recurrent GP-provided prescriptions with antidepressants or antipsychotics in the perinatal period. Information on GP-provided prescriptions came from the Danish National Prescription Registry, with data available since 1995. Y axis: permille (out of 1000)=per 1000 births. GP, general practitioner.