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Baker N, Bick D, Bamber L, Wilson CA, Howard LM, Bakolis I, Soukup T, Chang Y. A mixed methods systematic review exploring infant feeding experiences and support in women with severe mental illness. MATERNAL & CHILD NUTRITION 2023; 19:e13538. [PMID: 37276241 PMCID: PMC10483956 DOI: 10.1111/mcn.13538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/27/2023] [Accepted: 05/06/2023] [Indexed: 06/07/2023]
Abstract
There are many benefits of breastfeeding to women and their infants but meeting the recommended 6 months of exclusive breastfeeding is likely to be more challenging for women with severe mental illness (SMI). This is the first systematic review that aims to examine evidence of (a) infant feeding outcomes in women with SMI and the factors associated with this, (b) the experiences of infant feeding and infant feeding support for women with SMI, (c) interventions for supporting infant feeding among these women and (d) health care professionals' attitudes toward supporting infant feeding in women with SMI. Mixed methods systematic review was carried out using the principles of Joanna Briggs Institute's (JBI) 'convergent integrated' methodology. CINAHL, PsycINFO, Medline and MIDIRS were used to search literature between 1994 and 2022. The quality of selected articles was assessed using JBI critical appraisal tools and thematic synthesis was undertaken to obtain findings. Eighteen papers were included in the final review. Women with SMI were less likely to initiate and continue breastfeeding than women without SMI. Several challenges with breastfeeding were highlighted, and while these were often linked to women's mental health difficulties, inconsistent advice from health care professionals and poor support with breastfeeding further compounded these challenges. This review highlights that policy and practice need to take into account the individual challenges women with SMI face when planning, initiating and maintaining breastfeeding. Education and training for health care professionals are needed to enable them to provide tailored infant feeding support to women with SMI, which reflects their individual needs.
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Affiliation(s)
- Natasha Baker
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Louise Bamber
- Child and Maternal Mental Health Team, South London and Maudsley NHS Foundation TrustLondonUK
| | - Claire A. Wilson
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Child and Maternal Mental Health Team, South London and Maudsley NHS Foundation TrustLondonUK
| | - Louise M. Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics & Health Service and Population Research Department, School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Tayana Soukup
- Department of Surgery and CancerImperial College LondonLondonUK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Yan‐Shing Chang
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College LondonLondonUK
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Luan M, Yang F, Miao M, Yuan W, Gissler M, Arkema EV, Lu D, Li J, László KD. Rheumatoid arthritis and the risk of postpartum psychiatric disorders: a Nordic population-based cohort study. BMC Med 2023; 21:126. [PMID: 37013565 PMCID: PMC10071633 DOI: 10.1186/s12916-023-02837-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Postpartum psychiatric disorders (PPD) are common complications of childbirth. A common explanation for their development is that the psychological, hormonal, and immune changes associated with pregnancy and parturition may trigger psychiatric symptoms postpartum. Rheumatoid arthritis (RA) is characterized by abnormalities in the activity of the hypothalamic-pituitary-adrenal axis and of the immune system, but its association with PPD is unknown. We analyzed whether women with RA before childbirth have an increased risk of PPD. METHODS We conducted a large population-based cohort study including mothers of singleton births in the Danish (1995-2015), Finnish (1997-2013), and Swedish Medical Birth Registers (2001-2013) (N = 3,516,849). We linked data from the Medical Birth Registers with data from several national socioeconomic and health registers. Exposure was defined as having a diagnosis of RA before childbirth, while the main outcome was a clinical diagnosis of psychiatric disorders 90 days postpartum. We analyzed the association between RA and PPD using Cox proportional hazard models, stratified by a personal history of psychiatric disorders. RESULTS Among women without a history of psychiatric disorders, the PPD incidence rate was 32.2 in the exposed and 19.5 per 1000 person-years in the unexposed group; women with RA had a higher risk of overall PPD than their unexposed counterparts [adjusted hazard ratio (HR) = 1.52, 95% confidence intervals (CI) 1.17 to 1.98]. Similar associations were also observed for postpartum depression (HR = 1.65, 95% CI 1.09 to 2.48) and other PPD (HR = 1.59, 95% CI 1.13 to 2.24). Among women with a history of psychiatric disorders, the incidence rate of overall PPD was 339.6 in the exposed and 346.6 per 1000 person-years in the unexposed group; RA was not associated with PPD. We observed similar associations between preclinical RA (RA diagnosed after childbirth) and PPD to those corresponding to clinical RA. CONCLUSIONS Rheumatoid arthritis was associated with an increased PPD risk in women without, but not in those with a psychiatric history. If our findings are confirmed in future studies, new mothers with RA may benefit from increased surveillance for new-onset psychiatric disorders postpartum.
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Affiliation(s)
- Min Luan
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China.
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
- Clinical Research Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fen Yang
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Maohua Miao
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Wei Yuan
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth V Arkema
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Donghao Lu
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Kasaven LS, Raynaud I, Jalmbrant M, Joash K, Jones BP. The impact of the COVID-19 pandemic on perinatal services and maternal mental health in the UK. BJPsych Open 2023; 9:e13. [PMID: 36636816 PMCID: PMC9874036 DOI: 10.1192/bjo.2022.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND COVID-19 has created many challenges for women in the perinatal phase. This stems from prolonged periods of lockdowns, restricted support networks and media panic, alongside altered healthcare provision. AIMS We aimed to review the evidence regarding the psychological impact on new and expecting mothers following changes to antenatal and postnatal service provision within the UK throughout the pandemic. METHOD We conducted a narrative literature search of major databases (PubMed, Medline, Google Scholar). The literature was critically reviewed by experts within the field of antenatal and perinatal mental health. RESULTS Changes to service provision, including the introduction of telemedicine services, attendance of antenatal appointments without partners or loved ones, and lack of support during the intrapartum period, are associated with increased stress, depression and anxiety. Encouraging women and their partners to engage with aspects of positive psychology through newly introduced digital platforms and virtual service provision has the potential to improve access to holistic care and increase mental well-being. An online course, designed by Imperial College Healthcare NHS Trust in response to changes to service provision, focuses on postnatal recovery inspiration and support for motherhood (PRISM) through a 5-week programme. So far, the course has received positive feedback. CONCLUSIONS The pandemic has contributed to increased rates of mental illness among pregnant and new mothers in the UK. Although the long-term implications are largely unpredictable, it is important to anticipate increased prevalence and complexity of symptoms, which could be hugely detrimental to an already overburdened National Health Service.
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Affiliation(s)
- Lorraine S Kasaven
- Department of Surgery and Cancer, Imperial College London, UK; Cutrale Perioperative and Ageing Group, Imperial College London, UK; and Department of Obstetrics and Gynaecology, Queen Charlottes and Chelsea Hospital, Imperial College NHS Trust, UK
| | - Isabel Raynaud
- West Middlesex University Hospital, Chelsea and Westminster Hospitals NHS Trust, UK
| | | | - Karen Joash
- Department of Obstetrics and Gynaecology, Queen Charlottes and Chelsea Hospital, Imperial College NHS Trust, UK
| | - Benjamin P Jones
- Department of Surgery and Cancer, Imperial College London, UK; and Department of Obstetrics and Gynaecology, Queen Charlottes and Chelsea Hospital, Imperial College NHS Trust, UK
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Verbeke E, Bogaerts A, Nuyts T, Crombag N, Luyten J. Cost-effectiveness of mental health interventions during and after pregnancy: A systematic review. Birth 2022; 49:364-402. [PMID: 35322898 DOI: 10.1111/birt.12623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/29/2021] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mental health problems during and after pregnancy such as depression, anxiety, post-traumatic stress disorder (PTSD), or addiction are common and can have lifelong implications for both parents and offspring. This review investigates the cost-effectiveness of interventions tackling these problems, assesses the methodological quality of included studies, and indicates suggestions for further research. METHODS Thirteen databases were searched for economic evaluations of interventions related to antenatal, perinatal, and postnatal mental health conditions, published between 2000 and September 2021, in high-income countries. RESULTS Thirty-nine studies met all inclusion criteria. Interventions considered were screening programs, pharmacological treatments, and various forms of psychosocial and psychological support. Six studies reported that the intervention was cost-saving. Eighteen were cost-effective and seven likely to be cost-effective. Only six studies included health outcomes for the child; one study considered paternal health. The time horizon for which costs and consequences were considered was for most evaluations limited to 1 year (n = 18) or 2 years (n = 11) postpartum. CONCLUSIONS Given the importance of the subject, a relatively low number of studies have investigated the cost-effectiveness of interventions tackling mental health problems during and after pregnancy. The scant evidence available suggests good overall value for money. Likely, cost-effectiveness is underestimated as costly long-term consequences on offspring are systematically excluded. No evidence was found for several frequently occurring conditions. Further research is required to obtain reliable, long-term effectiveness data and to address the methodological challenges related to measuring all relevant health outcomes for all parties affected.
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Affiliation(s)
- Evelyn Verbeke
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Annick Bogaerts
- Department of Development & Regeneration, Women & Child, REALIFE research group, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium.,Faculty of Health, University of Plymouth, Devon PL4 8AA, UK
| | - Tinne Nuyts
- Department of Development & Regeneration, Women & Child, REALIFE research group, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Neeltje Crombag
- Department of Development and Regeneration, Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Jeroen Luyten
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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Directives anticipées en psychiatrie périnatale : une aide à la parentalité pour les femmes ayant un trouble bipolaire ? Encephale 2022; 48:719-721. [DOI: 10.1016/j.encep.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 11/21/2022]
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Burman CJ, Dempsey RC, Priest HM. Exploring men’s experiences and sense-making of bipolar disorder diagnoses and mood management: a photo-elicitation investigation. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2021.2018572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Craig J. Burman
- School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Robert C. Dempsey
- Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Helena M. Priest
- School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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Abstract
The tragedy of Daksha's death illustrates both the importance of perinatal mental health and the stigma associated with doctors seeking help. With this letter, we express our hope that the lasting legacy of her and others' tragic stories lies in the continuing improvement and worldwide expansion of perinatal psychiatric services and training so that those in greatest need receive the best care possible wherever - and whoever - they are.
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Dubreucq M, Lysaker PH, Dubreucq J. A qualitative exploration of stakeholders' perspectives on the experiences, challenges, and needs of persons with serious mental illness as they consider finding a partner or becoming parent. Front Psychiatry 2022; 13:1066309. [PMID: 36713897 PMCID: PMC9874152 DOI: 10.3389/fpsyt.2022.1066309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND While many persons with serious mental illness (SMI) consider intimate relationships and becoming parent as central parts of their lives deeply affecting wellbeing and recovery, others anticipate facing multiple challenges in these life domains. This qualitative study sought to explore the perspectives of persons with SMI and mental health providers (MHPs) with diverse backgrounds and practices on the experiences, challenges, needs and expectations of persons with SMI as they consider finding a partner or becoming parent. METHODS For this qualitative study, we conducted five focus groups between March and December 2020 for a total number of 22 participants (nine persons with SMI and thirteen MHPs) recruited from a center for psychiatric rehabilitation and a community mental health center in France. We used the inductive six-step process by Braun and Clarke for the thematic analysis. RESULTS Participants reported some challenges related to intimate relationships, stigma/self-stigma, disclosure and decision-making about start a family. Their expectations included: (i) psychoeducation about decision-making about finding a partner and starting a family; (ii) support in making empowered decisions about finding a partner, starting a family or disclosure to a prospective partner or their child; (iii) peer-support interventions; (iv) enhancing coping strategies; (v) integrated service provision including home treatment interventions, training to recovery-oriented practices and access to dedicated resources for providers. CONCLUSION In short, intimate relationships and desire to start a family for persons with SMI should be more considered in psychiatric rehabilitation and additional support and interventions should therefore be provided.
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Affiliation(s)
- Marine Dubreucq
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France.,GCSMS Rehacoor 42, Saint Etienne, France.,INSERM U1290, Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France
| | - Paul H Lysaker
- Roudebush VA Medical Center, Research Department, Indianapolis, IN, United States.,Department of Clinical Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Julien Dubreucq
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France.,Centre de Neurosciences Cognitive, UMR 5229, CNRS, Université Claude Bernard Lyon 1, Lyon, France.,Réseau Handicap Psychique, Grenoble, France.,Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Saint Etienne, Saint Etienne, France
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Perry A, Gordon-Smith K, Di Florio A, Craddock N, Jones L, Jones I. Mood episodes in pregnancy and risk of postpartum recurrence in bipolar disorder: The Bipolar Disorder Research Network Pregnancy Study. J Affect Disord 2021; 294:714-722. [PMID: 34343930 DOI: 10.1016/j.jad.2021.07.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Women with bipolar disorder (BD) are at high risk of mania/psychosis following childbirth. The risk factors for these episodes remain poorly understood and prospective studies are rare. Here, we examine whether mood episodes occurring within pregnancy predict postpartum recurrence in women with BD using a prospective design. METHOD 128 women with DSM-5 BD were followed from week 12 of pregnancy (baseline) to 12-weeks postpartum. Semi-structured interviews, supplemented by clinician questionnaires and case-note review, assessed lifetime psychiatric history at baseline, and perinatal psychopathology at two follow-up assessments: third-trimester of pregnancy and 12-weeks postpartum. RESULTS Postpartum follow-up data were obtained for 124/128 (97%) women [98 bipolar I disorder/schizoaffective-BD (BD-I/SA-BD group) and 26 bipolar II disorder/other specified BD and related disorder (BD-II/BD-OS group)]. Perinatal recurrence was high in both diagnostic groups (57% and 62% respectively). Women with BD-I/SA-BD were significantly more likely to experience mania/psychosis within 6 weeks postpartum (23%, n=22/96) compared to those with BD-II/BD-NOS (4%, n=1/25; p=0.042). In BD-I/SA-BD, mania/psychosis in pregnancy significantly elevated risk of mania/psychosis postpartum compared to remaining well (RR 7.0, p<0.001) and experiencing non-psychotic depression in pregnancy (RR 3.18, p=0.023) Limitations: Predominantly United Kingdom White sample and limited BD-II/BD-OS sample size. CONCLUSIONS Women with BD are at high risk of recurrence during pregnancy and the postpartum. Over and above risk conferred by a history of BD-I/SA-BD, mania/psychosis during pregnancy further increased risk of postpartum mania/psychosis in this high-risk group. These data may have important implications for prediction and management of severe postpartum recurrence of BD.
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Affiliation(s)
- Amy Perry
- Psychological Medicine, University of Worcester, Henwick Grove, Worcester WR2 6AJ, UK
| | | | - Arianna Di Florio
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Nick Craddock
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Lisa Jones
- Psychological Medicine, University of Worcester, Henwick Grove, Worcester WR2 6AJ, UK
| | - Ian Jones
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, UK
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Liu X, Plana-Ripoll O, Ingstrup KG, Agerbo E, Skjærven R, Munk-Olsen T. Postpartum psychiatric disorders and subsequent live birth: a population-based cohort study in Denmark. Hum Reprod 2021; 35:958-967. [PMID: 32227097 DOI: 10.1093/humrep/deaa016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/08/2020] [Indexed: 12/22/2022] Open
Abstract
STUDY QUESTION Are women with a history of first-onset postpartum psychiatric disorders after their first liveborn delivery less likely to have a subsequent live birth? SUMMARY ANSWER Women with incident postpartum psychiatric disorders are less likely to go on to have further children. WHAT IS KNOWN ALREADY Women are particularly vulnerable to psychiatric disorders in the postpartum period. The potential effects of postpartum psychiatric disorders on the mother's future chances of live birth are so far under-researched. STUDY DESIGN, SIZE, DURATION A population-based cohort study consisted of 414 571 women who had their first live birth during 1997-2015. We followed the women for a maximum of 19.5 years from the date of the first liveborn delivery until the next conception leading to a live birth, emigration, death, their 45th birthday or 30 June 2016, whichever occurred first. PARTICIPANTS/MATERIALS, SETTING, METHODS Postpartum psychiatric disorders were defined as filling a prescription for psychotropic medications or hospital contact for psychiatric disorders for the first time within 6 months postpartum. The outcome of interest was time to the next conception leading to live birth after the first liveborn delivery. Records on the death of a child were obtained through the Danish Register of Causes of Death. Cox regression was used to estimate the hazard ratios (HRs), stratified by the survival status of the first child. MAIN RESULTS AND THE ROLE OF CHANCE Altogether, 4327 (1.0%) women experienced postpartum psychiatric disorders after their first liveborn delivery. The probability of having a subsequent live birth was 69.1% (95% CI: 67.4-70.7%) among women with, and 82.3% (95% CI: 82.1-82.4%) among those without, postpartum psychiatric disorders. Women with postpartum psychiatric disorders had a 33% reduction in the rate of having second live birth (HR = 0.67, 95% CI: 0.64-0.69), compared to women without postpartum psychiatric disorders. The association disappeared if the first child died (HR = 1.01, 95% CI: 0.85-1.20). If postpartum psychiatric disorders required hospitalisations, this was associated with a more pronounced reduction in live birth rate, irrespective of the survival status of the first child (HR = 0.54, 95% CI: 0.47-0.61 if the first child survived, and HR = 0.49, 95% CI: 0.23-1.04 if the first child died). LIMITATIONS, REASONS FOR CAUTION The use of population-based registers allows for the inclusion of a representative cohort with almost complete follow-up. The large sample size enables us to perform detailed analyses, accounting for the survival status of the child. However, we did not have accurate information on stillbirths and miscarriages, and only pregnancies that led to live birth were included. WIDE IMPLICATIONS OF THE FINDINGS Our study is the first study to investigate subsequent live birth after postpartum psychiatric disorders in a large representative population. The current study indicates that postpartum psychiatric disorders have a significant impact on subsequent live birth, as women experiencing these disorders have a decreased likelihood of having more children. However, the variations in subsequent live birth rate are influenced by both the severity of the disorders and the survival status of the first-born child, indicating that both personal choices and decreased fertility may have a role in the reduced subsequent live birth rate among women with postpartum psychiatric disorders. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Danish Council for Independent Research (DFF-5053-00156B), the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No. 837180, AUFF NOVA (AUFF-E 2016-9-25), iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research (R155-2014-1724), Niels Bohr Professorship Grant from the Danish National Research Foundation and the Stanley Medical Research Institute, the National Institute of Mental Health (NIMH) (R01MH104468) and Fabrikant Vilhelm Pedersen og Hustrus Legat. The authors do not declare any conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- X Liu
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - O Plana-Ripoll
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - K G Ingstrup
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - E Agerbo
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - R Skjærven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - T Munk-Olsen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
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Baker N, Potts L, Jennings S, Trevillion K, Howard LM. Factors Affecting Infant Feeding Practices Among Women With Severe Mental Illness. Front Glob Womens Health 2021; 2:624485. [PMID: 34816188 PMCID: PMC8593974 DOI: 10.3389/fgwh.2021.624485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The health benefits of breastfeeding are well-established but for mothers with severe mental illness (SMI), the decision to breastfeed can be complex. Very few prior studies have investigated the infant feeding choices of women with SMI, or the factors associated with this. Our aims were to examine antenatal infant feeding intentions and infant feeding outcomes in a cohort of women admitted for acute psychiatric care in the first postpartum year. We also aimed to examine whether demographic and clinical characteristics associated with breastfeeding were similar to those found in previous studies in the general population, including age, employment, education, BMI, mode of delivery, smoking status, and social support. Methods: This study was a mixed-methods secondary analysis of a national cohort study, ESMI-MBU (Examining the effectiveness and cost-effectiveness of perinatal mental health services). Participants had been admitted to acute care with SMI in the first postpartum year. Infant feeding outcomes were retrospectively self-reported by women during a 1-month post-discharge interview. Free-text responses to questions relating to infant feeding and experience of psychiatric services were also explored using thematic analysis. Results: 144 (66.1%) of 218 women reported breastfeeding (mix feeding and exclusive breastfeeding). Eighty five percentage of the cohort had intended to breastfeed and of these, 76.5% did so. Factors associated with breastfeeding included infant feeding intentions, employment and non-Caucasian ethnicity. Although very few women were taking psychotropic medication contraindicated for breastfeeding, over a quarter (n = 57, 26.15%) reported being advised against breastfeeding because of their medication. Women were given this advice by psychiatry practitioners (40% n = 22), maternity practitioners (32.73% n = 18) and postnatal primary care (27.27% n = 15). Most women stopped breastfeeding earlier than they had planned to as a result (81.1% n = 43). Twenty five women provided free text responses, most felt unsupported with infant feeding due to inconsistent information about medication when breastfeeding and that breastfeeding intentions were de-prioritized for mental health care. Conclusion: Women with SMI intend to breastfeed and for the majority, this intention is fulfilled. Contradictory and insufficient advice relating to breastfeeding and psychotropic medication indicates that further training is required for professionals caring for women at risk of perinatal SMI about how to manage infant feeding in this population. Further research is required to develop a more in-depth understanding of the unique infant feeding support needs of women with perinatal SMI.
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Affiliation(s)
- Natasha Baker
- Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
| | - Laura Potts
- Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
| | - Stacey Jennings
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom
| | - Kylee Trevillion
- Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
| | - Louise M. Howard
- Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
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Perry A, Gordon-Smith K, Jones L, Jones I. Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review. Brain Sci 2021; 11:brainsci11010047. [PMID: 33406713 PMCID: PMC7824357 DOI: 10.3390/brainsci11010047] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 11/16/2022] Open
Abstract
Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1–2 in every 1000 deliveries. These episodes typically present as acute mania or depression with psychosis within the first few weeks of childbirth, which, as life-threatening psychiatric emergencies, can have a significant adverse impact on the mother, baby and wider family. The nosological status of postpartum psychosis remains contentious; however, evidence indicates most episodes to be manifestations of bipolar disorder and a vulnerability to a puerperal trigger. While childbirth appears to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum psychosis occurs are poorly understood. This review examines the current evidence with respect to potential aetiology and childbirth-related triggers of postpartum psychosis. Findings to date have implicated neurobiological factors, such as hormones, immunological dysregulation, circadian rhythm disruption and genetics, to be important in the pathogenesis of this disorder. Prediction models, informed by prospective cohort studies of high-risk women, are required to identify those at greatest risk of postpartum psychosis.
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Affiliation(s)
- Amy Perry
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
- Correspondence:
| | - Katherine Gordon-Smith
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
| | - Lisa Jones
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
| | - Ian Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK;
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13
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Dubreucq M, Dubreucq J. Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health. Front Psychiatry 2021; 12:630029. [PMID: 33995144 PMCID: PMC8113637 DOI: 10.3389/fpsyt.2021.630029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/15/2021] [Indexed: 01/18/2023] Open
Abstract
Later age of diagnosis, better expressive behaviors, increased use of camouflage strategies but also increased psychiatric symptoms, more unmet needs, and a general lower quality of life are characteristics often associated with female gender in autism spectrum disorder (ASD). Psychiatric rehabilitation has shown small to moderate effectiveness in improving patients' outcomes in ASD. Few gender differences have been found in the response to psychiatric rehabilitation. This might be related to the predominance of males in research samples, but also to the lack of programs directly addressing women's unmet needs. The objectives of the present paper were: (i) to review the needs for care of autistic women in romantic relationships and reproductive health; (ii) to review the existing psychosocial treatments in these domains; and (iii) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed and PsycINFO), following PRISMA guidelines, was conducted on autistic women's needs for care relating to psychiatric rehabilitation in romantic relationships and reproductive health. Out of 27 articles, 22 reported on romantic relationships and 16 used a quantitative design. Most studies were cross-sectional (n = 21) and conducted in North America or Europe. Eight studies reported on interventions addressing romantic relationships; no published study reported on interventions on reproductive health or parenting. Most interventions did not include gender-sensitive content (i.e., gender variance and gender-related social norms, roles, and expectations). Autistic women and autistic gender-diverse individuals may face unique challenges in the domains of romantic relationships and reproductive health (high levels of stigma, high risk of sexual abuse, increased psychiatric symptoms, and more unmet needs). We discussed the potential implications for improving women's access to psychiatric and psychosocial treatment, for designing gender-sensitive recovery-oriented interventions, and for future research.
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Affiliation(s)
- Marine Dubreucq
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - Julien Dubreucq
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France.,Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France.,Réseau Handicap Psychique, Grenoble, France
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14
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Abstract
Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high-income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.
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Affiliation(s)
- Louise M. Howard
- Section of Women's Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Hind Khalifeh
- Section of Women's Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
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15
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Catalao R, Mann S, Wilson C, Howard LM. Preconception care in mental health services: planning for a better future. Br J Psychiatry 2020; 216:180-181. [PMID: 31685038 DOI: 10.1192/bjp.2019.209] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
It is increasingly recognised that the preconception period is a window of opportunity to intervene to improve outcomes for women and the next generation. The importance of preconception mental health and comorbidity problems has not traditionally been taken into account by policy makers or mental health service providers. We argue that by addressing preconception physical and mental health in men and women, medical health professionals could improve health outcomes across the whole life course.
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Affiliation(s)
- Raquel Catalao
- NIHR Academic Clinical Fellow in Psychiatry, South London and Maudsley NHS Foundation Trust and Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sue Mann
- Public Health Consultant and Medical Adviser in Reproductive Health Programmes and Priorities, Public Health England, UK
| | - Claire Wilson
- Medical Research Council Clinical Research Training Fellow, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Louise M Howard
- NIHR Professor in Women's Mental Health, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Senior Investigator and Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust, UK
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Sahota PKC, Sankar PL. Bipolar Disorder, Genetic Risk, and Reproductive Decision-Making: A Qualitative Study of Social Media Discussion Boards. QUALITATIVE HEALTH RESEARCH 2020; 30:293-302. [PMID: 31409193 DOI: 10.1177/1049732319867670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this study, we present views on bipolar disorder and reproductive decision-making through an analysis of posts on Reddit™, a major Internet discussion forum. Prior research has shown that the Internet is a useful source of data on sensitive topics. This study used qualitative textual analysis to analyze posts on Reddit™ bipolar discussion boards that dealt with genetics and related topics. All thread titles over 4 years were reviewed (N = 1,800). Genetic risk was often raised in the context of Redditors' discussions about whether or not to have children. Reproductive decision-making for Redditors with bipolar was complex and influenced by factors from their past, present, and imagined future. These factors coalesced under a summative theme: for adults with bipolar disorder, what was the manageability of parenting a child? Reproductive decisions for individuals with bipolar disorder are complex, and Reddit™ is a novel source of information on their perspectives.
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Affiliation(s)
- Puneet K C Sahota
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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'What people diagnosed with bipolar disorder experience as distressing': A meta-synthesis of qualitative research. J Affect Disord 2019; 248:108-130. [PMID: 30731279 DOI: 10.1016/j.jad.2019.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is considered to have a significantly negative impact on functioning and prognosis is considered poor. Current treatments are modestly effective and predominantly focus on reducing extreme mood fluctuations and symptoms, yet less is known about what patients themselves describe as distressing. Therefore we aimed to assess this through a systematic review. METHODS A comprehensive literature search was conducted in four major bibliographic databases in August 2017, updated in July 2018. Qualitative studies exploring BD were included if they contained themes related to distress. First person accounts from people with BD discussing what they experience as distressing were extracted and synthesised using thematic synthesis. Author interpretations were also extracted to support the synthesis. RESULTS Twenty-four studies were included. Five main analytical themes were developed: 1) diagnosis, 2) loss, 3) uncertainty, 4) threat and 5) relationships. Two further crosscutting themes were identified as 1) stigma and 2) fear of relapse. Implications for interventions to focus on these causes of distress also emerged. LIMITATIONS The included studies did not adequately examine the authors' potential own biases and influences within their interpretations of the data. One author predominantly undertook data extraction and coding for the current review, although research team discussions led to an agreed consensus on themes. CONCLUSIONS This was the first qualitative study to specifically explore distress in BD. The meta-synthesis highlights important areas that people with BD experience as distressing. Adaptations to current interventions, to focus on what people find distressing could seek to improve treatment outcomes.
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Anke TMS, Slinning K, Skjelstad DV. "What if I get ill?" perinatal concerns and preparations in primi- and multiparous women with bipolar disorder. Int J Bipolar Disord 2019; 7:7. [PMID: 30826916 PMCID: PMC6397716 DOI: 10.1186/s40345-019-0143-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 01/19/2019] [Indexed: 01/21/2023] Open
Abstract
Background Women with bipolar disorder have a high risk of illness relapse postpartum, including psychosis. The aim of the study was to explore how perinatal women with bipolar disorder relate to the risk. What are their concerns? How do they prepare for the dual demands of mood episodes and motherhood? Methods A qualitative study was conducted. To ensure rich insight into the research questions, 13 primiparous and 13 multiparous women with bipolar disorder (I or II), were individually interviewed in pregnancy or early postpartum. Thematic analysis was applied. Results Across parity, concerns for illness relapse included concerns for depression and psychosis. Primiparous women worried about “the unknown” in relation to postpartum reactions. Overall, the most significant concerns were the impact of mood episodes on mothering and on the partner. Concerns regarding the infant were maternal medication, mood episodes affecting the child, and heredity. Resources and preparations included: support from the partner, the family, and health services; adjustment of daily life; and mental strategies. Women were aware of the postpartum risk, but their levels of personal concern varied between low, moderate and high. Women with low level of concern for illness relapse had made the least deliberations and preparations. A subgroup of women with high level of concern also had limited resources and preparations. Conclusions The findings highlight the importance of including a psychological and psychosocial focus in perinatal prevention planning and counselling. Even if women with BD are informed about the increased risk of illness relapse postpartum, they relate to it differently. Their level of personal concern impacts their perinatal deliberations and preparations, which in turn may impact postpartum adjustment. When counselling these women, it is important to assess their personal risk recognition, perinatal concerns and available resources and preparations, and support them accordingly. Extra attention should be given to women with a low level of concern, and women with a high level of concern who have limited resources and preparations. These women represent particularly vulnerable subgroups that are critical to identify and offer comprehensive follow-up.
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Affiliation(s)
- Teija M S Anke
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, 3004, Drammen, Norway.
| | - Kari Slinning
- Centre for Child and Adolescent Mental Health Eastern and Southern Norway, R.BUP, Oslo, Norway
| | - Dag Vegard Skjelstad
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, 3004, Drammen, Norway.,Vestre Viken Hospital Trust, Drammen; University of Oslo, Oslo, Norway
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Masters GA, Brenckle L, Sankaran P, Person SD, Allison J, Moore Simas TA, Ko JY, Robbins CL, Marsh W, Byatt N. Positive screening rates for bipolar disorder in pregnant and postpartum women and associated risk factors. Gen Hosp Psychiatry 2019; 61:53-59. [PMID: 31710859 PMCID: PMC6932868 DOI: 10.1016/j.genhosppsych.2019.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Bipolar disorder affects 2-8% of pregnant and postpartum women; untreated illness is associated with poor outcomes. This study aimed to describe bipolar disorder screening rates in obstetric settings and associated characteristics. METHOD Women were recruited during pregnancy through three months postpartum from 14 obstetric clinics in Massachusetts. The Mood Disorder Questionnaire (MDQ) was used to screen for bipolar disorder; a subset previously diagnosed with bipolar was also examined. Differences in characteristics by screening outcome were tested using chi-square and t-tests. RESULTS Of 574 participating women, 18.8% screened positive for bipolar disorder. Compared to those with negative, those with positive bipolar screens had 18.5-times the prevalence of positive substance use screens (11.1% vs. 0.6%, p < 0.001) and 3.4-times reported feeling they were not receiving adequate psychiatric help (24.0 vs. 7.0%, p < 0.001). Less than half of those with positive bipolar screens (42.0%) and 61.3% with pre-existing bipolar reported receiving current psychiatric care. CONCLUSIONS Almost one in five perinatal women screened positive for bipolar disorder. Positive screenings were associated with comorbid substance use and low treatment rates. This study highlights the importance of screening for bipolar disorder during the perinatal period and the need for systematic approaches to ensure adequate assessment and follow-up. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier: NCT02760004.
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Affiliation(s)
- Grace A. Masters
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655
| | - Linda Brenckle
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Padma Sankaran
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Sharina D. Person
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655
| | - Jeroan Allison
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Tiffany A. Moore Simas
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655,UMass Memorial Health Care, Worcester, MA
| | - Jean Y. Ko
- Centers for Disease Control and Prevention, Atlanta, GA,U.S. Public Health Service Commissioned Corps, Rockville, MD
| | | | - Wendy Marsh
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; UMass Memorial Health Care, Worcester, MA, United States of America.
| | - Nancy Byatt
- University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; UMass Memorial Health Care, Worcester, MA, United States of America.
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20
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Abstract
Pregnancy is a complex and vulnerable period that presents a number of challenges to women, including the development of postpartum psychiatric disorders (PPDs). These disorders can include postpartum depression and anxiety, which are relatively common, and the rare but more severe postpartum psychosis. In addition, other PPDs can include obsessive-compulsive disorder, post-traumatic stress disorder and eating disorders. The aetiology of PPDs is a complex interaction of psychological, social and biological factors, in addition to genetic and environmental factors. The goals of treating postpartum mental illness are reducing maternal symptoms and supporting maternal-child and family functioning. Women and their families should receive psychoeducation about the illness, including evidence-based discussions about the risks and benefits of each treatment option. Developing effective strategies in global settings that allow the delivery of targeted therapies to women with different clinical phenotypes and severities of PPDs is essential.
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