All-Cause Mortality in Women With Severe Postpartum Psychiatric Disorders
Abstract
Objective:
Method:
Results:
Conclusions:
Method
Study Design
Data Sources
Definition of Exposure Categories
Statistical Analysis
Results
Exposure Categories | Deceased (N) | Person-Years at Risk |
---|---|---|
Postpartum-onset mothers | 96 | 33,891 |
Non-postpartum-onset mothers | 5,475 | 2,324,419 |
Non-postpartum-onset nonmothers | 3,531 | 929,621 |
Mothers with no psychiatric history | 15,244 | 37,881,122 |
Nonmothers with no psychiatric history | 9,049 | 27,304,371 |
Charlson comorbidity index | ||
Charlson score of 0b | 11,423 | 64,389,832 |
Charlson score ≥1c | 21,972 | 4,083,593 |
Family history of mental illness | ||
Negative family historyd | 29,070 | 61,056,776 |
Positive family historye | 4,325 | 7,416,649 |
Alcohol or substance abuse | ||
Negative historyf | 26,379 | 67,254,815 |
Positive historyg | 7,016 | 1,218,610 |
All-Cause Mortality Rates
Model 1b | Model 2c | Model 3d | ||||
---|---|---|---|---|---|---|
Case Categories | MRR | 95% CI | MRR | 95% CI | MRR | 95% CI |
Postpartum-onset mothers | 3.94 | 3.22–4.81 | 3.93 | 3.21–4.80 | 3.74 | 3.06–4.57 |
Non-postpartum-onset mothers | 4.43 | 4.33–4.53 | 4.42 | 4.32–4.52 | 2.73 | 2.67–2.79 |
Non-postpartum-onset nonmothers | 9.66 | 9.32–10.01 | 9.62 | 9.29–9.97 | 6.15 | 5.94–6.38 |
Mothers with no psychiatric history | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
Nonmothers with no psychiatric history | 1.84 | 1.79–1.90 | 1.84 | 1.79–1.89 | 1.76 | 1.71–1.81 |
Alcohol or Substance Abuseb | No Alcohol or Substance Abusec | |||
---|---|---|---|---|
Exposure Categories | MRR | 95% CI | MRR | 95% CI |
Postpartum-onset mothers | 5.72 | 4.31–7.59 | 3.03 | 2.38–4.02 |
Non-postpartum-onset mothers | 5.24 | 5.10–5.39 | 1.74 | 1.68–1.80 |
Non-postpartum-onset nonmothers | 9.94 | 9.48–10.43 | 4.85 | 4.61–5.09 |
Mothers with no psychiatric history | 4.43 | 4.25–4.62 | 1.00 | Reference |
Nonmothers with no psychiatric history | 6.99 | 6.43–7.60 | 1.71 | 1.69–1.77 |
Natural and Unnatural Causes of Death
Natural Causes of Death | Unnatural Causes of Death | ||||
---|---|---|---|---|---|
Diagnostic Groups | N | % | N | % | Total |
Mental and behavioral disorders associated with the puerperiuma | 7 | 12.3 | 9 | 23.1 | 16 |
Neurotic, stress-related, and somatoform disordersb | 10 | 17.5 | 6 | 15.4 | 16 |
Mood (affective) disordersc | 14 | 24.6 | 7 | 17.9 | 21 |
Schizophrenia, schizotypal, and delusional disordersd | 13 | 22.8 | 10 | 25.6 | 23 |
Other disorderse | 13 | 22.8 | 7 | 17.9 | 20 |
Total | 57f | 100.0 | 39g | 100.0 | 96 |
Suicide Rates
Model 1 (suicides)a | Model 2 (suicides and accidents)b | |||||
---|---|---|---|---|---|---|
Exposure Categories | N | MRR | 95% CI | N | MRR | 95% CI |
Short-term risk: ≤ 1 year after diagnosis of postpartum psychiatric disorderc | 8 | 289.42 | 144.02–581.62 | –d | 83.60 | 43.42–160.97 |
Long-term risk: > 1 year after diagnosis of postpartum psychiatric disordere | 21 | 39.97 | 25.90–61.70 | 30 | 15.88 | 11.08–22.77 |
Short-term risk: ≤ 1 year after diagnosis in non-postpartum-onset mothersf | 152 | 120.62 | 105.24–138.26 | 196 | 41.15 | 36.91–45.87 |
Long-term risk: > 1 year after diagnosis in non-postpartum-onset mothersg | 651 | 29.14 | 26.52–32.02 | 1,305 | 15.78 | 14.89–16.73 |
Short-term risk: ≤ 1 year after diagnosis in non-postpartum-onset nonmothersh | 175 | 228.91 | 192.37–272.40 | 222 | 60.13 | 52.08–69.42 |
Long-term risk: > 1 year after diagnosis in non-postpartum-onset nonmothersi | 639 | 69.27 | 62.11–77.25 | 1,087 | 29.56 | 27.45–31.85 |
Mothers with no psychiatric history | 390 | 1.00 | Reference | 1,272 | 1.00 | Reference |
Nonmothers with no psychiatric history | 483 | 1.90 | 1.67–2.17 | 2,192 | 1.99 | 1.85–2.14 |
Discussion
All-Cause Mortality
Unnatural Causes of Death and Suicide Risk
Mortality Rates in Mothers Compared With Childless Women
Methodological Considerations
Clinical Recommendations
References
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