Subscribe to RSS
DOI: 10.1055/s-0039-1694759
Postpartum Psychiatric Admissions in the United States
Funding A.M.F. is supported by a career development award (K08HD082287) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.![](https://www.thieme-connect.de/media/ajp/202102/lookinside/thumbnails/10-1055-s-0039-1694759_190179-1.jpg)
Abstract
Objective This study aimed to assess risk for postpartum psychiatric admissions in the United States.
Study Design This study used the 2010 to 2014 Nationwide Readmissions Database to identify psychiatric admissions during the first 60 days after delivery hospitalization. Timing of admission after delivery discharge was determined. We fit multivariable log-linear regression models to assess the impact of psychiatric comorbidity on admission risk, adjusting for patient, obstetrical, and hospital factors.
Results Of 15.7 million deliveries from 2010 to 2014, 11,497 women (0.07%) were readmitted for a primary psychiatric diagnosis within 60 days postpartum. Psychiatric admissions occurred relatively consistently across 10-day periods after delivery hospitalization discharge. Psychiatric diagnoses were present among 5% of women at delivery but 40% of women who were readmitted postpartum for a psychiatric indication. In the adjusted model, women with psychiatric diagnoses at delivery hospitalization were 9.7 times more likely to be readmitted compared with those without psychiatric comorbidity. Women at highest risk for psychiatric admission were those with Medicare and Medicaid, in lower income quartiles, and of younger age.
Conclusion While a large proportion of psychiatric admissions occurred among a relatively small proportion of at-risk women, admissions occurred over a broad temporal period relative to other indications for postpartum admission.
Note
This study was presented at the 2019 Annual Meeting of the Society for Maternal-Fetal Medicine.
Publication History
Received: 08 April 2019
Accepted: 05 July 2019
Article published online:
14 August 2019
© 2019. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Brummelte S, Galea LA. Depression during pregnancy and postpartum: contribution of stress and ovarian hormones. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34 (05) 766-776
- 2 Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet 2014; 384 (9956): 1775-1788
- 3 Bansil P, Kuklina EV, Meikle SF. et al. Maternal and fetal outcomes among women with depression. J Womens Health (Larchmt) 2010; 19 (02) 329-334
- 4 Shlomi-Polachek I, Fung K, Meltzer-Brody S, Vigod SN. Short stay vs long stay postpartum psychiatric admissions: a population-based study. Arch Women Ment Health 2017; 20 (04) 505-513
- 5 Beck CT. A meta-analysis of predictors of postpartum depression. Nurs Res 1996; 45 (05) 297-303
- 6 Johannsen BM, Larsen JT, Laursen TM, Bergink V, Meltzer-Brody S, Munk-Olsen T. All-cause mortality in women with severe postpartum psychiatric disorders. Am J Psychiatry 2016; 173 (06) 635-642
- 7 Langan Martin J, McLean G, Cantwell R, Smith DJ. Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study. BMJ Open 2016; 6 (01) e008758
- 8 Polachek IS, Fung K, Vigod SN. First lifetime psychiatric admission in the postpartum period: a population-based comparison to women with prior psychiatric admission. Gen Hosp Psychiatry 2016; 40: 25-32
- 9 Davey HL, Tough SC, Adair CE, Benzies KM. Risk factors for sub-clinical and major postpartum depression among a community cohort of Canadian women. Matern Child Health J 2011; 15 (07) 866-875
- 10 Barker LC, Kurdyak P, Fung K, Matheson FI, Vigod S. Postpartum psychiatric emergency visits: a nested case-control study. Arch Women Ment Health 2016; 19 (06) 1019-1027
- 11 Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB. New parents and mental disorders: a population-based register study. JAMA 2006; 296 (21) 2582-2589
- 12 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project (HCUP). Introduction to the HCIP Nationwide Readmissions Database (NRD) 2010–2015. November 2017. Accessed 23 July, 2019 at: https://www.hcup-us.ahrq.gov/db/nation/nrd/Introduction_NRD_2010-2015.pdf
- 13 Kurtz SM, Lau EC, Ong KL, Adler EM, Kolisek FR, Manley MT. Which clinical and patient factors influence the national economic burden of hospital readmissions after total joint arthroplasty?. Clin Orthop Relat Res 2017; 475 (12) 2926-2937
- 14 Vejpongsa P, Bhise V, Charitakis K. et al. Early readmissions after transcatheter and surgical aortic valve replacement. Catheter Cardiovasc Interv 2017; 90 (04) 662-670
- 15 Poojary P, Saha A, Chauhan K. et al. Predictors of hospital readmissions for ulcerative colitis in the United States: a national database study. Inflamm Bowel Dis 2017; 23 (03) 347-356
- 16 Kuklina EV, Whiteman MK, Hillis SD. et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J 2008; 12 (04) 469-477
- 17 Clapp MA, Little SE, Zheng J, Robinson JN. A multi-state analysis of postpartum readmissions in the United States. Am J Obstet Gynecol 2016; 215 (01) 113.e1-113.e10
- 18 Wen T, Yu VX, Wright JD. et al. Postpartum length of stay and risk for readmission among women with preeclampsia. J Matern Fetal Neonatal Med 2018 DOI: 10.1080/14767058.2018.1514382
- 19 Wen T, Wright JD, Goffman D. et al. Postpartum venous thromboembolism readmissions in the United States. Am J Obstet Gynecol 2018; 219 (04) 401.e1-401.e14
- 20 Friedman B, Conwell Y, Delavan RR, Wamsley BR, Eggert GM. Depression and suicidal behaviors in Medicare primary care patients under age 65. J Gen Intern Med 2005; 20 (05) 397-403
- 21 Social Security Administration. Disability evaluation under social security. Accessed July 4, 2019 at: https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm
- 22 ACOG Committee Opinion No. 757: screening for perinatal depression. Obstet Gynecol 2018; 132: e208-e212
- 23 Collins NL, Dunkel-Schetter C, Lobel M, Scrimshaw SC. Social support in pregnancy: psychosocial correlates of birth outcomes and postpartum depression. J Pers Soc Psychol 1993; 65 (06) 1243-1258
- 24 Goyal D, Gay C, Lee KA. How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers?. Womens Health Issues 2010; 20 (02) 96-104
- 25 Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 2008; 65 (07) 805-815