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Barker LC, Brown HK, Bronskill SE, Fung K, Kurdyak P, Zaheer J, Vigod SN. Non-fatal self-harm and suicide following postpartum psychiatric emergency department visits: A population-based retrospective cohort study. Psychiatry Res 2024; 335:115856. [PMID: 38484607 DOI: 10.1016/j.psychres.2024.115856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/04/2024] [Accepted: 03/09/2024] [Indexed: 04/14/2024]
Abstract
In a population-based cohort of postpartum individuals in Ontario, Canada, this study aimed to determine the risk of non-fatal self-harm and suicide within one year of an initial postpartum psychiatric emergency department (ED) visit (2008-2020), and the key associated factors. Of 16,475 postpartum individuals with psychiatric ED visits, 714 (4.3 %) had non-fatal self-harm within one year, and 23 (0.15 %) died by suicide. Risk was substantially higher for those with self-harm at the initial presentation. Further efforts to connect individuals with postpartum psychiatric ED visits with needed inpatient care and outpatient follow-up are required to reduce non-fatal self-harm and suicide risk.
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Affiliation(s)
- Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada.
| | - Hilary K Brown
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada; Department of Health & Society, University of Toronto Scarborough, Toronto, Canada
| | - Susan E Bronskill
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada
| | | | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada
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Barker LC, Fung K, Zaheer J, Brown HK, Bronskill SE, Kurdyak P, Vigod SN. Risk of Repeat Psychiatric Emergency Department Visits in the Postpartum Period: A Population-Based Retrospective Cohort Study. Ann Emerg Med 2024; 83:360-372. [PMID: 38069965 DOI: 10.1016/j.annemergmed.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/18/2023] [Accepted: 11/01/2023] [Indexed: 03/24/2024]
Abstract
STUDY OBJECTIVE Approximately 1 in 100 postpartum individuals visit an emergency department (ED) for a psychiatric reason. Repeat visits can signify problems with the quality of care received during or after the initial visit; this study aimed to understand risk for repeat postpartum psychiatric ED visits. METHODS This population-based cohort study used Ontario, Canada health administrative data available through ICES (formerly the Institute for Clinical Evaluative Sciences) to identify all individuals discharged from postpartum psychiatric ED visits (2008 to 2021) and measured the proportion with one or more repeat psychiatric ED visit within 30 days. Using modified Poisson regression, we calculated the association between one or more repeat visits and sociodemographic, medical, obstetric, infant, continuity of care, past service use, and index ED visit characteristics both overall and stratified by psychiatric diagnosis. RESULTS Of 14,100 individuals, 11.7% had one or more repeat psychiatric ED visits within 30 days. Repeat visit risk was highest for those with schizophrenia-spectrum disorders (28.2%, adjusted risk ratio 2.41; 95% confidence interval 1.88 to 3.08, versus 9.5% anxiety referent). Low (versus no) psychiatric care continuity, prior psychiatric ED visits and admissions, and initial visits within 90 days postpartum were also associated with increased risk, whereas intentional self-injury was associated with reduced risk. In diagnosis-stratified analyses, the factors most consistently associated with repeat ED visits were past psychiatric ED visits and admissions, and initial visits within 90 days postpartum. CONCLUSIONS Over 1 in 10 postpartum psychiatric ED visits are followed by a repeat visit within 30 days. Targeted approaches are needed across clinical populations to reduce repeat ED visits in this population with young infants.
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Affiliation(s)
- Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada.
| | | | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K Brown
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada; Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Susan E Bronskill
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada
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Dewidar O, McHale G, Al Zubaidi A, Bondok M, Abdelrazeq L, Huang J, Jearvis A, Aliyeva K, Alghamyan A, Jahel F, Greer-Smith R, Tufte J, Barker LC, Elmestekawy N, Sharp MK, Horsley T, Prats CJ, Jull J, Wolfenden L, Cuervo LG, Hardy BJ, Roberts JH, Ghogomu E, Obuku E, Owusu-Addo E, Nicholls SG, Mbuagbaw L, Funnell S, Shea B, Rizvi A, Tugwell P, Bhutta Z, Welch V, Melendez-Torres GJ. Motivations for investigating health inequities in observational epidemiology: a content analysis of 320 studies. J Clin Epidemiol 2024; 168:111283. [PMID: 38369078 DOI: 10.1016/j.jclinepi.2024.111283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES To enhance equity in clinical and epidemiological research, it is crucial to understand researcher motivations for conducting equity-relevant studies. Therefore, we evaluated author motivations in a randomly selected sample of equity-relevant observational studies published during the COVID-19 pandemic. STUDY DESIGN AND SETTING We searched MEDLINE for studies from 2020 to 2022, resulting in 16,828 references. We randomly selected 320 studies purposefully sampled across income setting (high vs low-middle-income), COVID-19 topic (vs non-COVID-19), and focus on populations experiencing inequities. Of those, 206 explicitly mentioned motivations which we analyzed thematically. We used discourse analysis to investigate the reasons behind emerging motivations. RESULTS We identified the following motivations: (1) examining health disparities, (2) tackling social determinants to improve access, and (3) addressing knowledge gaps in health equity. Discourse analysis showed motivations stem from commitments to social justice and recognizing the importance of highlighting it in research. Other discourses included aspiring to improve health-care efficiency, wanting to understand cause-effect relationships, and seeking to contribute to an equitable evidence base. CONCLUSION Understanding researchers' motivations for assessing health equity can aid in developing guidance that tailors to their needs. We will consider these motivations in developing and sharing equity guidance to better meet researchers' needs.
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Affiliation(s)
- Omar Dewidar
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Bruyère Research Institute, University of Ottawa, Ottawa, Canada.
| | - Georgia McHale
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Ali Al Zubaidi
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada; School of Medicine, University College Cork, Cork, Ireland
| | - Mostafa Bondok
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Leenah Abdelrazeq
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada; Department of Health Sciences, Carelton University, Ottawa, Canada
| | - Jimmy Huang
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Alyssa Jearvis
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Khadija Aliyeva
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Amjad Alghamyan
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Fatima Jahel
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | | | | | - Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, Canada; Women's College Hospital, Toronto, Canada
| | - Nour Elmestekawy
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Melissa K Sharp
- Department of General Practice, Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Clara Juandro Prats
- Applied Health Research Center, St. Michael's Hospital, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Luke Wolfenden
- Cochrane Public Health, School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia
| | - Luis Gabriel Cuervo
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization (PAHO/WHO), Washington, DC, USA; Department of Paediatrics, Obstetrics & Gynaecology, and Preventive Medicine, Doctoral School, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Billie-Jo Hardy
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janet Hatchet Roberts
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Ottawa, Canada
| | | | - Ekwaro Obuku
- Africa Centre for Systematic Reviews & Knowledge Translation, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ebenezer Owusu-Addo
- Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sarah Funnell
- Department of Family Medicine, Queen's University, Kingston, Canada; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Bev Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Anita Rizvi
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Zulfiqar Bhutta
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Centre for Excellence in Women and Child Health and Institute of Global Health and Development, The Aga Khan University, Karachi, Pakistan
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Dewidar O, Al-Zubaidi A, Bondok M, Abdelrazeq L, Huang J, Jearvis A, Barker LC, Elmestekawy N, Goghomu E, Rader T, Tufte J, Greer-Smith R, Waddington HS, Nicholls SG, Little J, Hardy BJ, Horsley T, Young T, Cuervo LG, Sharp MK, Chamberlain C, Shea B, Craig P, Lawson DO, Rizvi A, Wiysonge CS, Kredo T, Francis D, Kristjansson E, Bhutta Z, Antequera A, Melendez-Torres GJ, Pantoja T, Wang X, Jull J, Roberts JH, Funnell S, White H, Krentel A, Mahande MJ, Ramke J, Wells G, Petkovic J, Pottie K, Niba L, Feng C, Nguliefem MN, Tugwell P, Mbuagbaw L, Welch V. Reporting of equity in observational epidemiology: A methodological review. J Glob Health 2024; 14:04046. [PMID: 38491911 PMCID: PMC10903926 DOI: 10.7189/jogh.14.04046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024] Open
Abstract
Background Observational studies can inform how we understand and address persisting health inequities through the collection, reporting and analysis of health equity factors. However, the extent to which the analysis and reporting of equity-relevant aspects in observational research are generally unknown. Thus, we aimed to systematically evaluate how equity-relevant observational studies reported equity considerations in the study design and analyses. Methods We searched MEDLINE for health equity-relevant observational studies from January 2020 to March 2022, resulting in 16 828 articles. We randomly selected 320 studies, ensuring a balance in focus on populations experiencing inequities, country income settings, and coronavirus disease 2019 (COVID-19) topic. We extracted information on study design and analysis methods. Results The bulk of the studies were conducted in North America (n = 95, 30%), followed by Europe and Central Asia (n = 55, 17%). Half of the studies (n = 171, 53%) addressed general health and well-being, while 49 (15%) focused on mental health conditions. Two-thirds of the studies (n = 220, 69%) were cross-sectional. Eight (3%) engaged with populations experiencing inequities, while 22 (29%) adapted recruitment methods to reach these populations. Further, 67 studies (21%) examined interaction effects primarily related to race or ethnicity (48%). Two-thirds of the studies (72%) adjusted for characteristics associated with inequities, and 18 studies (6%) used flow diagrams to depict how populations experiencing inequities progressed throughout the studies. Conclusions Despite over 80% of the equity-focused observational studies providing a rationale for a focus on health equity, reporting of study design features relevant to health equity ranged from 0-95%, with over half of the items reported by less than one-quarter of studies. This methodological study is a baseline assessment to inform the development of an equity-focussed reporting guideline for observational studies as an extension of the well-known Strengthening Reporting of Observational Studies in Epidemiology (STROBE) guideline.
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Affiliation(s)
- Omar Dewidar
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Ali Al-Zubaidi
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- School of Medicine, University College Cork, Cork, Ireland
| | - Mostafa Bondok
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leenah Abdelrazeq
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jimmy Huang
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alyssa Jearvis
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Nour Elmestekawy
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Elizabeth Goghomu
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Tamara Rader
- Freelance health research librarian, Ottawa, Ontario, Canada
| | - Janice Tufte
- Hassanah Consulting, Seattle, Washington State, USA
| | - Regina Greer-Smith
- Healthcare Research Associates, LLC/S.T.A.R. Initiative, California, USA
| | - Hugh S Waddington
- London School of Hygiene and Tropical Medicine, London, UK
- London International Development Centre, London, UK
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Office for Patient Engagement in Research Activity (OPERA), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Billie-Jo Hardy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | - Taryn Young
- Centre for Evidence Based Health Care, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Luis Gabriel Cuervo
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization (PAHO/WHO), Washington, DC, USA
- Doctoral Programme on Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Melissa K Sharp
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Craig
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anita Rizvi
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Centre for Evidence Based Health Care, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Damian Francis
- School of Health and Human Performance, Georgia College, Milledgeville, Georgia, USA
| | - Elizabeth Kristjansson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Zulfiqar Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Alba Antequera
- Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - GJ Melendez-Torres
- Department of Public Health and Sports Science, University of Exeter College of Medicine and Health, Exeter, UK
| | - Tomas Pantoja
- Family Medicine Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada
| | - Janet Jull
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Janet Hatcher Roberts
- World Health Organization Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Ottawa, Canada
| | - Sarah Funnell
- Department of Family Medicine, Faculty of Health Sciences, Queen’s University, Kingston, Ontario
| | | | - Alison Krentel
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Johnson Mahande
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Tanzania
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - George Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Pottie
- C.T. Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Loveline Niba
- Department of Public Health, The University of Bamenda, Bamenda, Cameroon
- Nutrition and Health Research Group (NHRG), Bamenda, Cameroon
| | - Cindy Feng
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Miriam N Nguliefem
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Barker LC, Zaheer J, Hussain Z, France J, Rodriguez A, Lubotzky-Gete S, Berkhout S, Dmytryshyn R, Dunn S, Gupta R, Hosseiny F, Sirotich F, Soklaridis S, Voineskos AN, Vigod SN. Experiences of Sexual and Reproductive Health Care Access for Women and Nonbinary People With Early Psychosis: Towards an Integrated Perspective of Service Users and Clinicians. Can J Psychiatry 2024; 69:33-42. [PMID: 37448301 PMCID: PMC10867406 DOI: 10.1177/07067437231187460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Individuals with psychosis are at elevated risk of adverse sexual and reproductive health (SRH) outcomes, and not receiving adequate SRH care. SRH is important for youth, yet little is known about SRH care access and experiences among those with early psychosis. This study explored SRH care experiences among women and nonbinary individuals with early psychosis. METHOD We conducted semistructured qualitative interviews with 19 service users (cisgender and transgender women, nonbinary individuals) receiving care in 2 early psychosis programs in Ontario, Canada. We also conducted semistructured interviews and focus groups with 36 clinicians providing SRH or mental health care to this population. Participants were asked about SRH care access/provision experiences and the interplay with psychosis. Using a social interactionist orientation, a thematic analysis described and explained service user and clinician perspectives regarding SRH care. RESULTS Amongst both service users and clinician groups, common themes developed: (a) diversity of settings: SRH services are accessed in a large range of spaces across the health care system, (b) barriers in nonpsychiatric SRH care settings: psychosis impacts the ability to engage with existing SRH services, (c) invisibility of SRH in psychiatric settings: SRH is rarely addressed in psychiatric care, (d) variability of informal SRH-related conversations and supports, and cutting across all of the above themes, (e) intersecting social and cultural factors impacted SRH services access. CONCLUSIONS SRH is important for health and wellbeing; improvements are urgently needed across the healthcare system and within early psychosis programs to meet this population's multifaceted SRH needs.
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Affiliation(s)
- Lucy C. Barker
- Women's College Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Zakia Hussain
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Ananka Rodriguez
- Slaight Centre Early Intervention Service, Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Suze Berkhout
- Department of Psychiatry, University of Toronto, Ontario, Canada
- University Health Network, Toronto, Canada
| | - Robert Dmytryshyn
- Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Sheila Dunn
- Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Renu Gupta
- Women's College Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Fardous Hosseiny
- Canadian Mental Health Association-Toronto, Ottawa, Canada
- Atlas Institute for Veterans and Families, Ottawa, Canada
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Canada
| | - Frank Sirotich
- Canadian Mental Health Association-Toronto, Ottawa, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Education, Centre for Addiction and Mental Health, Toronto, Canada
| | - Aristotle N. Voineskos
- Department of Psychiatry, University of Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Simone N. Vigod
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
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6
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Wright E, Martinovic J, de Camps Meschino D, Barker LC, Philipp DA, Israel A, Hussain-Shamsy N, Mukerji G, Wang V, Chatterjee A, Vigod SN. A virtual mother-infant postpartum psychotherapy group for mothers with a history of adverse childhood experiences: open-label feasibility study. BMC Psychiatry 2023; 23:950. [PMID: 38110902 PMCID: PMC10726650 DOI: 10.1186/s12888-023-05444-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVES Mothers with a history of adverse childhood experiences (ACE) are at elevated risk for postpartum mental illness and impairment in the mother-infant relationship. Interventions attending to maternal-infant interactions may improve outcomes for these parents and their children, but barriers to accessing in-person postpartum care limit uptake. We adapted a postpartum psychotherapy group for mothers with mental illness (e.g., mood, anxiety, trauma-related disorders) and ACE for live video-based delivery, and evaluated feasibility, acceptability, and preliminary efficacy in an open-label pilot study. METHODS We recruited adults with children (6-18 months) from a perinatal psychiatry program in Toronto, Canada. The intervention was a live video-based 12-week interactive psychotherapy group focused on maternal symptoms and maternal-infant relationships. The primary outcome was feasibility, including feasibility of recruitment and retention, fidelity of the intervention, and acceptability to patients and group providers. Maternal clinical outcomes were compared pre- to post-intervention, as secondary outcomes. RESULTS We recruited 31 participants (mean age 36.5 years (SD 3.9)) into 6 groups; 93.6% (n = 29) completed post-group questionnaires, and n = 20 completed an optional post-group acceptability interview. Mean weekly group attendance was 83% (IQR 80-87); one participant (3.2%) dropped out. All group components were implemented as planned, except for dyadic exercises where facilitator observation of dyads was replaced with unobserved mother-infant exercises followed by in-group reflection. Participant acceptability was high (100% indicated the virtual group was easy to access, beneficial, and reduced barriers to care). Mean maternal depressive [Edinburgh Postnatal Depression Scale: 14.6 (SD 4.2) vs. 11.8 (SD 4.2), paired t, p = 0.005] and post-traumatic stress [Posttraumatic Stress Disorder Checklist for DSM-5: 35.5 (SD 19.0) vs. 27.1 (SD 16.7)], paired t, p = 0.01] symptoms were significantly lower post vs. pre-group. No differences were observed on mean measures of anxiety, emotion regulation or parenting stress. CONCLUSIONS Recruitment and retention met a priori feasibility criteria. There were significant pre- to post-group reductions in maternal depressive and post-traumatic symptoms, supporting proceeding to larger-scale implementation and evaluation of the intervention, with adaptation of dyadic exercises.
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Affiliation(s)
- Elisabeth Wright
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
| | - Jovana Martinovic
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Diane de Camps Meschino
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Diane A Philipp
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Garry Hurvitz Centre for Community Mental Health at Sickkids, Toronto, ON, Canada
| | - Aliza Israel
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Neesha Hussain-Shamsy
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
| | - Geetha Mukerji
- Department of Medicine, Temerty Faculty of Medicine, Sunnybrook Health Sciences Center, King's College Circle, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, Canada
| | - Vivienne Wang
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Antara Chatterjee
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
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Barker LC, Vigod SN. Reproductive Health Among Those with Schizophrenia Spectrum Disorders: An Overview of Considerations Related to the Premenopausal Period, Pregnancy and Postpartum, and the Menopausal Transition, with a Focus on Recent Findings. Curr Psychiatry Rep 2023; 25:793-802. [PMID: 37906350 DOI: 10.1007/s11920-023-01472-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE OF REVIEW Schizophrenia spectrum disorders (SSD) impact many aspects of reproductive health for women and non-binary and transgender individuals assigned female at birth. In this narrative review, we highlight considerations and recent research related to (1) the premenopausal period, (2) pregnancy and postpartum, and (3) the menopausal transition. RECENT FINDINGS Most recent research has focused on pregnancy and the postpartum period, and specifically on elucidating perinatal risk factors, adverse obstetrical and neonatal outcomes (and modifiable contributors such as smoking), long-term child health, and psychotropic medications (with reassuring results related antipsychotic-associated gestational diabetes mellitus and neurodevelopmental outcomes). Much less recent focus has been on menstruation and menopause, although some research has highlighted the relative worsening of illness peri-menstrually and peri-menopausally. Despite the many important reproductive considerations for those with SSD, many aspects including menstruation and menopause have received very little attention. Further research is needed on how to best support women, non-binary, and transgender people assigned female at birth with SSD throughout the lifespan.
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Affiliation(s)
- Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
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Barker LC, Vigod SN, Hussain Z, France J, Rodriguez A, Lubotzky-Gete S, Berkhout S, Dmytryshyn R, Dunn S, Gupta R, Hosseiny F, Sirotich F, Soklaridis S, Voineskos A, Zaheer J. Sexual health experiences of women and non-binary people with early psychosis: qualitative study. BJPsych Open 2023; 9:e146. [PMID: 37551106 PMCID: PMC10594085 DOI: 10.1192/bjo.2023.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Women and gender-diverse people with early psychosis are at risk for suboptimal sexual health outcomes, yet little research has explored their sexual health experiences. AIMS This study explored sexual health experiences and related priorities among women and gender-diverse people with early psychosis, to identify opportunities for improvements in sexual health and well-being. METHOD Semi-structured individual qualitative interviews explored how patient participants (n = 19, aged 18-31 years, cisgender and transgender women and non-binary individuals) receiving clinical care from early psychosis programmes in Ontario, Canada, experienced their sexual health, including sexual function and behaviour. Thematic analysis was conducted, with triangulation from interviews/focus groups with clinicians (n = 36) who provide sexual and mental healthcare for this population. RESULTS Three key themes were identified based on patient interviews: theme 1 was the impact of psychotic illness and its treatments on sexual function and activity, including variable changes in sex drive, attitudes and behaviours during acute psychosis, vulnerability to trauma and medications; theme 2 related to intimacy and sexual relationships in the context of psychosis, with bidirectional effects between relationships and mental health; and theme 3 comprised autonomy, identity and intersectional considerations, including gender, sexuality, culture and religion, which interplay with psychosis and sexual health. Clinicians raised each of these priority areas, but emphasised risk prevention relative to patients' more holistic view of their sexual health and well-being. CONCLUSIONS Women and non-binary people with early psychosis have wide-ranging sexual health priorities, affecting many facets of their lives. Clinical care should incorporate this knowledge to optimise sexual health and well-being in this population.
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Affiliation(s)
- Lucy C. Barker
- Department of Psychiatry, Women's College Hospital, Canada; Department of Psychiatry, University of Toronto, Canada; and Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Simone N. Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Zakia Hussain
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Julia France
- Department of Psychiatry, Women's College Hospital, Toronto, Canada
| | - Ananka Rodriguez
- Slaight Centre Early Intervention Service, Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Suze Berkhout
- Department of Psychiatry, University of Toronto, Canada; and Department of Psychiatry, University Health Network, Toronto, Canada
| | - Robert Dmytryshyn
- Family Practice Health Centre, Women's College Hospital, Toronto, Canada; and Department of Family and Community Medicine, University of Toronto, Canada
| | - Sheila Dunn
- Family Practice Health Centre, Women's College Hospital, Toronto, Canada; and Department of Family and Community Medicine, University of Toronto, Canada
| | - Renu Gupta
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Fardous Hosseiny
- Canadian Mental Health Association, Toronto, Canada; Atlas Institute for Veterans and Families, Ottawa, Canada; and University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Canada
| | - Frank Sirotich
- Canadian Mental Health Association, Toronto, Canada; and Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, University of Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Canada; and Education, Centre for Addiction and Mental Health, Toronto, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, University of Toronto, Canada; and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Canada; and Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
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Barker LC, Fung K, Zaheer J, Brown HK, Bronskill SE, Kurdyak P, Vigod SN. Risk of hospital admission after discharge from postpartum psychiatric emergency department visits: A focus on the social determinants of health. Gen Hosp Psychiatry 2023; 83:27-34. [PMID: 37031500 DOI: 10.1016/j.genhosppsych.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/17/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE Of those with postpartum psychiatric emergency department (ED) visits, a minority of receive hospital admission at their initial visit. Among those discharged, we aimed to determine subsequent risk of psychiatric admission, and understand how social determinants of health (SDOH) - individually and collectively - impact this risk. METHOD From all postpartum individuals discharged from psychiatric ED visits in Ontario, Canada (2008-2020)(n = 13,130), we generated adjusted relative risks (aRR) for psychiatric inpatient admission within 365 days post-ED visit by four SDOH (age, neighbourhood income, community size, immigration) and other clinical factors. Using latent class analysis (LCA) to identify subgroups based on clustering of SDOH, we then compared adjusted risk across subgroups. RESULTS Psychiatric admission occurred for 9.5% (n = 1242) within 365 days. Across SDOH, risk was lower among adolescents (vs. ≥35 years aRR 0.80, 95%CI 0.65-0.97) and immigrants (<5 years in Canada vs. Canadian-born/long-term residents 0.70, 0.51-0.96; ≥5 years in Canada 0.79, 0.65-0.95). Among four identified subgroups, compared to the "older/urban/high-income" subgroup (11.1% admission), the "urban/immigrant/low-income" (7.6%; 0.68, 0.55-0.82) and "young/rural/low-income" subgroups (9.7%; 0.78, 0.63-0.96), but not the "semi-urban/middle-income" subgroup (9.5%; 0.86, 0.73-1.01), were at lower admission risk. CONCLUSIONS Future research is needed to explore reasons for SDOH-based differences in admission risk, and inform equitable postpartum services.
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Affiliation(s)
- Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada
| | | | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K Brown
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada; Department of Health & Society, University of Toronto Scarborough, Toronto, Canada
| | - Susan E Bronskill
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Hospital, Toronto, Canada.
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Leslie K, Barker LC, Brown HK, Chen S, Dennis CL, Ray JG, Saunders N, Taylor C, Vigod S. Risk of interpersonal violence during and after pregnancy among people with schizophrenia: a population-based cohort study. CMAJ 2023; 195:E322-E329. [PMID: 36878538 PMCID: PMC9987232 DOI: 10.1503/cmaj.220689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Schizophrenia is associated with increased risk of experiencing interpersonal violence. Little is known about risk specifically around the time of pregnancy. METHODS This population-based cohort study included all individuals (aged 15-49 yr) listed as female on their health cards who had a singleton birth in Ontario, Canada, between 2004 and 2018. We compared those with and without schizophrenia on their risk of an emergency department (ED) visit for interpersonal violence in pregnancy or within 1 year postpartum. We adjusted relative risks (RRs) for demographics, prepregnancy history of substance use disorder and history of interpersonal violence. In a subcohort analysis, we used linked clinical registry data to evaluate interpersonal violence screening and self-reported interpersonal violence during pregnancy. RESULTS We included 1 802 645 pregnant people, 4470 of whom had a diagnosis of schizophrenia. Overall, 137 (3.1%) of those with schizophrenia had a perinatal ED visit for interpersonal violence, compared with 7598 (0.4%) of those without schizophrenia, for an RR of 6.88 (95% confidence interval [CI] 5.66-8.37) and an adjusted RR of 3.44 (95% CI 2.86-4.15). Results were similar when calculated separately for the pregnancy (adjusted RR 3.47, 95% CI 2.68-4.51) period and the first year postpartum (adjusted RR 3.45, 95% CI 2.75-4.33). Pregnant people with schizophrenia were equally likely to be screened for interpersonal violence (74.3% v. 73.8%; adjusted RR 0.99, 95% CI 0.95-1.04), but more likely to self-report it (10.2% v. 2.4%; adjusted RR 3.38, 95% CI 2.61-4.38), compared with those without schizophrenia. Among patients who did not self-report interpersonal violence, schizophrenia was associated with an increased risk for a perinatal ED visit for interpersonal violence (4.0% v. 0.4%; adjusted RR 6.28, 95% CI 3.94-10.00). INTERPRETATION Pregnancy and postpartum are periods of higher risk for interpersonal violence among people with schizophrenia compared with those without schizophrenia. Pregnancy is a key period for implementing violence prevention strategies in this population.
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Affiliation(s)
- Kelly Leslie
- Departments of Psychiatry (Leslie, Barker, Dennis, Vigod), of Medicine (Ray) and of Pediatrics (Saunders), Temerty Faculty of Medicine, University of Toronto; Women's College Hospital and Women's College Research Institute (Barker, Brown, Dennis, Taylor, Vigod); Institute for Health Policy, Management and Evaluation (Barker, Brown, Ray, Saunders, Vigod); ICES (Barker, Brown, Chen, Ray, Saunders, Taylor, Vigod); Department of Health and Society (Brown), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; St. Michael's Hospital (Ray); Edwin Leong Centre for Healthy Children (Saunders), Hospital for Sick Children, Toronto, Ont
| | - Lucy C Barker
- Departments of Psychiatry (Leslie, Barker, Dennis, Vigod), of Medicine (Ray) and of Pediatrics (Saunders), Temerty Faculty of Medicine, University of Toronto; Women's College Hospital and Women's College Research Institute (Barker, Brown, Dennis, Taylor, Vigod); Institute for Health Policy, Management and Evaluation (Barker, Brown, Ray, Saunders, Vigod); ICES (Barker, Brown, Chen, Ray, Saunders, Taylor, Vigod); Department of Health and Society (Brown), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; St. Michael's Hospital (Ray); Edwin Leong Centre for Healthy Children (Saunders), Hospital for Sick Children, Toronto, Ont
| | - Hilary K Brown
- Departments of Psychiatry (Leslie, Barker, Dennis, Vigod), of Medicine (Ray) and of Pediatrics (Saunders), Temerty Faculty of Medicine, University of Toronto; Women's College Hospital and Women's College Research Institute (Barker, Brown, Dennis, Taylor, Vigod); Institute for Health Policy, Management and Evaluation (Barker, Brown, Ray, Saunders, Vigod); ICES (Barker, Brown, Chen, Ray, Saunders, Taylor, Vigod); Department of Health and Society (Brown), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; St. Michael's Hospital (Ray); Edwin Leong Centre for Healthy Children (Saunders), Hospital for Sick Children, Toronto, Ont
| | - Simon Chen
- Departments of Psychiatry (Leslie, Barker, Dennis, Vigod), of Medicine (Ray) and of Pediatrics (Saunders), Temerty Faculty of Medicine, University of Toronto; Women's College Hospital and Women's College Research Institute (Barker, Brown, Dennis, Taylor, Vigod); Institute for Health Policy, Management and Evaluation (Barker, Brown, Ray, Saunders, Vigod); ICES (Barker, Brown, Chen, Ray, Saunders, Taylor, Vigod); Department of Health and Society (Brown), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; St. Michael's Hospital (Ray); Edwin Leong Centre for Healthy Children (Saunders), Hospital for Sick Children, Toronto, Ont
| | - Cindy-Lee Dennis
- Departments of Psychiatry (Leslie, Barker, Dennis, Vigod), of Medicine (Ray) and of Pediatrics (Saunders), Temerty Faculty of Medicine, University of Toronto; Women's College Hospital and Women's College Research Institute (Barker, Brown, Dennis, Taylor, Vigod); Institute for Health Policy, Management and Evaluation (Barker, Brown, Ray, Saunders, Vigod); ICES (Barker, Brown, Chen, Ray, Saunders, Taylor, Vigod); Department of Health and Society (Brown), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; St. Michael's Hospital (Ray); Edwin Leong Centre for Healthy Children (Saunders), Hospital for Sick Children, Toronto, Ont
| | - Joel G Ray
- Departments of Psychiatry (Leslie, Barker, Dennis, Vigod), of Medicine (Ray) and of Pediatrics (Saunders), Temerty Faculty of Medicine, University of Toronto; Women's College Hospital and Women's College Research Institute (Barker, Brown, Dennis, Taylor, Vigod); Institute for Health Policy, Management and Evaluation (Barker, Brown, Ray, Saunders, Vigod); ICES (Barker, Brown, Chen, Ray, Saunders, Taylor, Vigod); Department of Health and Society (Brown), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; St. Michael's Hospital (Ray); Edwin Leong Centre for Healthy Children (Saunders), Hospital for Sick Children, Toronto, Ont
| | - Natasha Saunders
- Departments of Psychiatry (Leslie, Barker, Dennis, Vigod), of Medicine (Ray) and of Pediatrics (Saunders), Temerty Faculty of Medicine, University of Toronto; Women's College Hospital and Women's College Research Institute (Barker, Brown, Dennis, Taylor, Vigod); Institute for Health Policy, Management and Evaluation (Barker, Brown, Ray, Saunders, Vigod); ICES (Barker, Brown, Chen, Ray, Saunders, Taylor, Vigod); Department of Health and Society (Brown), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; St. Michael's Hospital (Ray); Edwin Leong Centre for Healthy Children (Saunders), Hospital for Sick Children, Toronto, Ont
| | - Clare Taylor
- Departments of Psychiatry (Leslie, Barker, Dennis, Vigod), of Medicine (Ray) and of Pediatrics (Saunders), Temerty Faculty of Medicine, University of Toronto; Women's College Hospital and Women's College Research Institute (Barker, Brown, Dennis, Taylor, Vigod); Institute for Health Policy, Management and Evaluation (Barker, Brown, Ray, Saunders, Vigod); ICES (Barker, Brown, Chen, Ray, Saunders, Taylor, Vigod); Department of Health and Society (Brown), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; St. Michael's Hospital (Ray); Edwin Leong Centre for Healthy Children (Saunders), Hospital for Sick Children, Toronto, Ont
| | - Simone Vigod
- Departments of Psychiatry (Leslie, Barker, Dennis, Vigod), of Medicine (Ray) and of Pediatrics (Saunders), Temerty Faculty of Medicine, University of Toronto; Women's College Hospital and Women's College Research Institute (Barker, Brown, Dennis, Taylor, Vigod); Institute for Health Policy, Management and Evaluation (Barker, Brown, Ray, Saunders, Vigod); ICES (Barker, Brown, Chen, Ray, Saunders, Taylor, Vigod); Department of Health and Society (Brown), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; St. Michael's Hospital (Ray); Edwin Leong Centre for Healthy Children (Saunders), Hospital for Sick Children, Toronto, Ont.
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Taylor CL, Brown HK, Saunders NR, Barker LC, Chen S, Cohen E, Dennis CL, Ray JG, Vigod SN. Preventive Health Care Among Children of Women With Schizophrenia: A Population-Based Cohort Study. J Clin Psychiatry 2023; 84. [PMID: 36856526 DOI: 10.4088/jcp.22m14497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Objective: To compare well-baby visit and vaccination schedule adherence up to age 24 months in children of mothers with versus without schizophrenia. Methods: Using administrative health data on births in Ontario, Canada (2012-2016), children of mothers with schizophrenia (ICD-9: 295; ICD-10: F20/F25; DSM-IV schizophrenia or schizoaffective disorder) (n = 1,275) were compared to children without maternal schizophrenia (n = 520,831) on (1) well-baby visit attendance, including an enhanced well-baby visit at age 18 months, and (2) vaccine schedule adherence for diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B (DTaP-IPV-Hib), and measles, mumps, rubella (MMR). Cox proportional hazard regression models were adjusted for each of maternal sociodemographics, maternal health, and child health characteristics in blocks and all together in a fully adjusted model. Results: About 50.3% of children with maternal schizophrenia had an enhanced 18-month well-baby visit versus 58.6% of those without, corresponding to 29.0 versus 33.9 visits/100 person-years (PY), a hazard ratio (HR) of 0.82 (95% CI, 0.76-0.89). The association was dampened after adjustment for maternal sociodemographics, maternal health, and child health factors in blocks and overall, with a fully adjusted HR of 0.91 (95% CI, 0.84-0.98). Full vaccine schedule adherence occurred in 40.0% of children with maternal schizophrenia versus 46.0% of those without (22.6 vs 25.9/100 PY), yielding a HR of 0.86 (95% CI, 0.78-0.94). The association was dampened when adjusted for maternal sociodemographics and child health characteristics and became nonsignificant when adjusted for maternal health characteristics. The fully adjusted HR was 0.95 (95% CI, 0.87-1.04). Conclusions: Increased efforts to ensure that children with maternal schizophrenia receive key early preventive health care services are warranted.
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Affiliation(s)
- Clare L Taylor
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Hilary K Brown
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Health & Society, University of Toronto, Scarborough, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Natasha R Saunders
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lucy C Barker
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Eyal Cohen
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,St Michael's Hospital, Toronto, Ontario, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Joel G Ray
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada.,St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Simone N Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Corresponding author: Simone N. Vigod, MD, MSc, FRCPC, Department of Psychiatry, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2 Canada
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Barker LC, Hussain-Shamsy N, Rajendra KL, Bronskill SE, Brown HK, Kurdyak P, Vigod SN. The use of key social determinants of health variables in psychiatric research using routinely collected health data: a systematic analysis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:183-191. [PMID: 36149450 DOI: 10.1007/s00127-022-02368-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Social determinants of health (SDoH) impact psychiatric conditions. Routinely collected health data are frequently used to evaluate important psychiatric clinical and health services outcomes. This study explored how key SDoH are used in psychiatric research employing routinely collected health data. METHODS A search was conducted in PubMed for English-language articles published in 2019 that used routinely collected health data to study psychiatric conditions. Studies (n = 19,513) were randomly ordered for title/abstract review; the first 150 meeting criteria progressed to full-text review. Three key SDoH categories were assessed: (1) gender and sex, (2) race and ethnicity, and (3) socioeconomic status. Within each category, data were extracted on how variables were included, defined, and used in study design and analysis. RESULTS All studies (n = 103) reported on at least one of the key SDoH variables; 102 (99.0%) studies included a gender and/or sex variable, 30 (29.1%) included a race and/or ethnicity variable, and 55 (53.4%) included a socioeconomic status variable. No studies explicitly differentiated between gender and sex, and SDoH were often defined only as binary variables. SDoH were used to define the target population in 14 (13.6%) studies. Within analysis, SDoH were most often included as confounders (n = 65, 63.1%), exposures or predictors (n = 23, 22.3%), and effect modifiers (n = 14, 13.6%). Only 21 studies (20.4%) disaggregated results by SDoH and 7 (6.8%) considered intersections between SDoH. CONCLUSIONS Results suggest improvements are needed in how key SDoH are used in routinely collected health data-based psychiatric research, to ensure relevance to diverse populations and improve equity-oriented research.
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Affiliation(s)
- Lucy C Barker
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON, G1 06M4N 3M5, Canada.,Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Neesha Hussain-Shamsy
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.,Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | | | - Susan E Bronskill
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON, G1 06M4N 3M5, Canada.,Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Hilary K Brown
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON, G1 06M4N 3M5, Canada.,Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON, M1C 1A4, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON, G1 06M4N 3M5, Canada.,Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada. .,ICES, 2075 Bayview Avenue, Toronto, ON, G1 06M4N 3M5, Canada. .,Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
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Potter E, Sivagurunathan M, Armstrong K, Barker LC, Du Mont J, Lorello GR, Millman A, Urbach DR, Krakowsky Y. Patient reported symptoms and adverse outcomes seen in Canada's first vaginoplasty postoperative care clinic. Neurourol Urodyn 2023; 42:523-529. [PMID: 36630152 DOI: 10.1002/nau.25132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Vaginoplasty is a relatively common gender-affirming surgery with approximately 200 Ontarians seeking this surgery annually. Although Ontario now offers vaginoplasty in province, the capacity is not meeting demand; the majority of trans and gender-diverse patients continue to seek vaginoplasty out of province. Out-of-province surgery presents a barrier to accessing postsurgical follow-up care leaving most patients to seek support from their primary care providers or providers with little experience in gender-affirming surgery. OBJECTIVE To provide an account of the common postoperative care needs and neovaginal concerns of Ontarians who underwent penile inversion vaginoplasty out of province and presented for care at a gender-affirming surgery postoperative care clinic. DESIGN, SETTINGS, AND PARTICIPANTS A retrospective chart review of the first 80 patients presenting to a gender-affirming surgery postoperative care clinic who had undergone vaginoplasty at an outside surgical center was performed. Descriptive analyses were performed for all variables. RESULTS The sample consisted of 80 individuals with the mean age of 39 years (19-73). Most patients had surgery at another surgical center in Canada (76.3%). Many patients (22.5%) accessed care in the first 3 months after surgery, with the majority (55%) seeking care within the first perioperative year. Most patients (61.3%) were seen for more than one visit and presented with more than two symptoms or concerns. Common patient-reported symptoms during clinical visit included pain (53.8%), dilation concerns (46.3%), and surgical site/vaginal bleeding (42.5%). Sexual function concerns were also common (33.8%) with anorgasmia (11.3%) and dyspareunia (11.3%) being the most frequent complications. The most common adverse outcomes identified by health care providers included hypergranulation (38.8%), urinary dysfunction (18.8%), and wound healing issues (12.5%). CONCLUSIONS AND RELEVANCE Findings from chart review offer valuable insights into the postoperative needs and neovaginal concerns of Ontarians who have had vaginoplasty out of province. This study demonstrates the need for routine postoperative care in patients undergoing vaginoplasty. Patients experience numerous symptoms and concerns that often correlate with clinical findings and require multiple follow-up appointments. Health care providers may benefit from further education on the more common nonsurgical issues identified in this study.
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Affiliation(s)
- Emery Potter
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Kathleen Armstrong
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Lucy C Barker
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gianni R Lorello
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada.,The Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Alexandra Millman
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Transition Related Surgery Program, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David R Urbach
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Transition Related Surgery Program, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - Yonah Krakowsky
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Transition Related Surgery Program, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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14
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Vigod SN, Ray JG, Cohen E, Wilton AS, Saunders NR, Barker LC, Berard A, Dennis CL, Holloway AC, Morrison K, Oberlander TF, Hanley G, Tu K, Brown HK. Maternal Schizophrenia and the Risk of a Childhood Chronic Condition. Schizophr Bull 2022; 48:1252-1262. [PMID: 35900007 PMCID: PMC9673258 DOI: 10.1093/schbul/sbac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Maternal schizophrenia heightens the risk for certain perinatal complications, yet it is not known to what degree future childhood chronic health conditions (Childhood-CC) might arise. STUDY DESIGN This population-based cohort study using health administrative data from Ontario, Canada (1995-2018) compared 5066 children of mothers with schizophrenia to 25 324 children of mothers without schizophrenia, propensity-matched on birth-year, maternal age, parity, immigrant status, income, region of residence, and maternal medical and psychiatric conditions other than schizophrenia. Cox proportional hazard models generated hazard ratios (HR) and 95% confidence intervals (CI) for incident Childhood-CCs, and all-cause mortality, up to age 19 years. STUDY RESULTS Six hundred and fifty-six children exposed to maternal schizophrenia developed a Childhood-CC (20.5/1000 person-years) vs. 2872 unexposed children (17.1/1000 person-years)-an HR of 1.18, 95% CI 1.08-1.28. Corresponding rates were 3.3 vs. 1.9/1000 person-years (1.77, 1.44-2.18) for mental health Childhood-CC, and 18.0 vs. 15.7/1000 person-years (1.13, 1.04-1.24) for non-mental health Childhood-CC. All-cause mortality rates were 1.2 vs. 0.8/1000 person-years (1.34, 0.96-1.89). Risk for children exposed to maternal schizophrenia was similar whether or not children were discharged to social service care. From age 1 year, risk was greater for children whose mothers were diagnosed with schizophrenia prior to pregnancy than for children whose mothers were diagnosed with schizophrenia postnatally. CONCLUSIONS A child exposed to maternal schizophrenia is at elevated risk of chronic health conditions including mental and physical subtypes. Future research should examine what explains the increased risk particularly for physical health conditions, and what preventive and treatment efforts are needed for these children.
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Affiliation(s)
- Simone N Vigod
- To whom correspondence should be addressed; Department of Psychiatry, Women’s College Hospital, 76 Grenville Street, Toronto, ON, Canada; tel: 416-323-6400, ext. 4080, e-mail:
| | - Joel G Ray
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,St. Michael’s Hospital, Toronto, ON, Canada,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Edwin S.H. Leong Centre for Healthy Children, Hospital for Sick Children, Toronto, ON, Canada,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Natasha R Saunders
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Edwin S.H. Leong Centre for Healthy Children, Hospital for Sick Children, Toronto, ON, Canada,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lucy C Barker
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Anick Berard
- Universite de Montreal, Faculty of Pharmacy, Montreal, QC, Canada,CHU Ste-Justine, Montreal, QC, Canada
| | - Cindy-Lee Dennis
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Lawrence S. BloombergFaculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Alison C Holloway
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | | | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Gillian Hanley
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Karen Tu
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, North York General Hospital, Toronto Western Hospital Family Health Team-UHN, Toronto, ON, Canada
| | - Hilary K Brown
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Department of Health and Society, University of Toronto, Scarborough, Toronto, ON, Canada
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15
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Barker LC, Brown HK, Bronskill SE, Kurdyak P, Austin PC, Hussain-Shamsy N, Fung K, Vigod SN. Follow-up after post-partum psychiatric emergency department visits: an equity-focused population-based study in Canada. Lancet Psychiatry 2022; 9:389-401. [PMID: 35430003 DOI: 10.1016/s2215-0366(22)00099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Emergency department visits for a psychiatric reason in the post-partum period represent an acute need for mental health care at a crucial time, but little is known about the extent of timely outpatient follow-up after these visits or how individual and intersecting social determinants of health influence this outcome. This study aimed to examine outpatient mental health care follow-up by a physician in the 30 days after an individual attended the emergency department for a psychiatric reason in the post-partum period and understand how social determinants of health affect who receives follow-up care. METHODS In this population-based cohort study, routinely collected health data from Ontario, Canada were accessed through ICES to identify all post-partum individuals whose sex was listed as female on their health card and who had attended an emergency department in Ontario before the COVID-19 pandemic for a psychiatric reason. Individuals admitted to hospital at the time of the emergency department visit, who died during the visit, or who left without being seen were excluded from the study. Ethnicity data for individuals were not collected. The primary outcome was the proportion of individuals with any outpatient physician (psychiatrist or family physician) visit for a mental health reason within 30 days of the index emergency department visit. Family physician mental health visits were identified using a validated algorithm for Ontario Health Insurance Plan-billed visits and mental health diagnostic codes for community health centre visits. We examined the associations between social determinants of health (age, neighbourhood income, community size, immigration, neighbourhood ethnic diversity) and who received an outpatient mental health visit. We used modified Poisson regression adjusting for the other social determinants of health, clinical, and health services characteristics to examine independent associations with follow-up, and conditional inference trees to explore how social determinants of health intersect with each other and with clinical and health services characteristics in relation to follow-up. FINDINGS We analysed data collected between April 1, 2008, and March 10, 2020, after exclusions we identified 12 158 people who had attended the emergency department for a psychiatric reason in the post-partum period (mean age 26·9 years [SD 6·2]; range 13-47); 9848 individuals lived in an urban area, among these 1518 (15·5%) were immigrants and 2587 (26·3%) lived in areas with high ethnic diversity. 5442 (44·8%) of 12 158 individuals received 30-day follow-up. In modified Poisson regression models, younger age, lower neighbourhood income, smaller community size, and being an immigrant were associated with a lower likelihood of follow-up. In the CTREE, similar variables were important, with several intersections between social determinants of health and between social determinants of health and other variables. INTERPRETATION Fewer than half of emergency department visits for a psychiatric reason in the post-partum period were followed by timely outpatient care, with social-determinants-of-health-based disparities in access to care. Improvements in equitable access to post-emergency department mental health care are urgently needed in this high-risk post-partum population. FUNDING Department of Psychiatry, University of Toronto; Canadian Institutes of Health Research.
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Affiliation(s)
- Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - Hilary K Brown
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Scarborough Campus, Department of Health & Society, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - Susan E Bronskill
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Neesha Hussain-Shamsy
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | | | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada.
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16
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Toufeili A, Cohen E, Ray JG, Wilton AS, Brown HK, Saunders NR, Dennis CL, Holloway AC, Morrison KM, Hanley GE, Oberlander TF, Bérard A, Tu K, Barker LC, Vigod SN. Complex chronic conditions among children born to women with schizophrenia. Schizophr Res 2022; 241:24-35. [PMID: 35074529 DOI: 10.1016/j.schres.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 09/28/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Maternal schizophrenia is linked to complications in offspring near the time of birth. Whether there is also a higher future risk of the child having a complex chronic condition (CCC) - a pediatric condition affecting any bodily system expected to last at least 12 months that is severe enough to require specialty care and/or a period of hospitalization - is not known. METHODS In this population-based health administrative data cohort study (Ontario, Canada, 1995-2018), the risk for CCC was compared in 5066 children of women with schizophrenia (the exposed) vs. 2,939,320 unexposed children. Adjusted hazard ratios (aHR) were generated for occurrence of any CCC, by CCC category, and stratified by child sex, and child prematurity. RESULTS CCC was more frequent in the exposed (7.7 per 1000 person-years [268 children]) than unexposed (4.2 per 100 person-years [124,452 children]) - an aHR of 1.25 (95% CI 1.10-1.41). aHRs were notably higher in 5 of 9 CCC categories: neuromuscular (1.73, 1.28-2.33), cardiovascular (1.94, 1.64-2.29), respiratory (1.83, 1.32-2.54), hematology/immunodeficiency (2.24, 1.24-4.05) and other congenital or genetic defect (1.59, 1.16-2.17). The aHR for CCC was more pronounced among boys (1.32, 1.13-1.55) than girls (1.16, 0.96-1.40), and of similar magnitude in term (1.22, 1.05-1.42) and preterm infants (1.18, 0.95-1.46). CONCLUSIONS The risk for a CCC appears to be higher in children born to women with schizophrenia. This finding introduces opportunities for targeted preconception counselling, optimization of maternal risk factors, and intervention to support a vulnerable parent population who will experience unique challenges caring for a child with CCCs.
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Affiliation(s)
- A Toufeili
- Dept. of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - E Cohen
- Dept. of Pediatrics and Edwin S.H. Leong Centre for Healthy Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - J G Ray
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - H K Brown
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Women's College Hospital and Research Institute, Toronto, Ontario, Canada
| | - N R Saunders
- Dept. of Pediatrics and Edwin S.H. Leong Centre for Healthy Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - C L Dennis
- St. Michael's Hospital, Toronto, Ontario, Canada; Women's College Hospital and Research Institute, Toronto, Ontario, Canada; Faculty of Nursing, Toronto, Ontario, Canada
| | - A C Holloway
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - K M Morrison
- Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
| | - G E Hanley
- Women's College Hospital and Research Institute, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - T F Oberlander
- University of British Columbia, Vancouver, British Columbia, Canada
| | - A Bérard
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Quebec, Canada; Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - K Tu
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada; North York General Hospital, Toronto, Ontario, Canada; Toronto Western Hospital Family Health Team-University Health Network, Toronto, Ontario, Canada
| | - L C Barker
- Dept. of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital and Research Institute, Toronto, Ontario, Canada
| | - S N Vigod
- Dept. of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital and Research Institute, Toronto, Ontario, Canada.
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17
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Kirubarajan A, Barker LC, Leung S, Ross LE, Zaheer J, Park B, Abramovich A, Yudin MH, Lam JSH. LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review. BJOG 2022; 129:1630-1643. [PMID: 35048502 DOI: 10.1111/1471-0528.17103] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND The perinatal period may uniquely impact the mental health and wellbeing of lesbian, gay, bisexual, transgender, queer, and Two-Spirit (LGBTQ2S+) childbearing individuals. OBJECTIVES To characterise and synthesise the experiences of LGBTQ2S+ childbearing individuals regarding perinatal mental health, including symptomatology, access to care and care-seeking. SEARCH STRATEGY We conducted and reported a systematic review following PRISMA guidelines of eight databases (EMBASE, MEDLINE-OVID, CINAHL, Scopus, Web of Science: Core Collection, Sociological Abstracts, Social Work Abstract, and PsycINFO) from inception to 1 March 2021. SELECTION CRITERIA Original, peer-reviewed research related to LGBTQ2S+ mental health was eligible for inclusion if the study was specific to the perinatal period (defined as pregnancy planning, conception, pregnancy, childbirth, and first year postpartum; includes miscarriages, fertility treatments and surrogacy). DATA COLLECTION AND ANALYSIS Findings were synthesised qualitatively via meta-aggregation using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI), and the ConQual approach. MAIN RESULTS Our systematic search included 26 eligible studies encompassing 1199 LGBTQ2S+ childbearing participants. Using the JBI SUMARI approach, we reported 65 results, which we synthesised as six key findings. The studies described unique considerations for LGBTQ2S+ individuals' perinatal mental health, including heteronormativity, cisnormativity, isolation, exclusion from traditional pregnancy care, stigma, and distressing situations from the gendered nature of pregnancy. Many participants described a lack of knowledge from healthcare providers related to care for LGBTQ2S+ individuals. In addition, LGBTQ2S+ individuals described barriers to accessing mental healthcare and gaps in health systems. Strategies to improve care include provider education, avoidance of gendered language, documentation of correct pronouns, trauma-informed practices, cultural humility training and tailored care for LGBTQ2S+ people. CONCLUSIONS Pregnancy, postpartum, and the perinatal period uniquely impacts the mental health and wellbeing of LGBTQ2S+individuals, largely due to systems-level inequities and exclusion from perinatal care. Healthcare providers should implement the identified strategies to improve perinatal care and address inequities.
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Affiliation(s)
- Abirami Kirubarajan
- University of Toronto Faculty of Medicine, Toronto, ON, Canada.,University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada
| | - Lucy C Barker
- University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada.,University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada
| | - Shannon Leung
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Lori E Ross
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Juveria Zaheer
- University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Bomi Park
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Alex Abramovich
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Mark H Yudin
- University of Toronto Department of Obstetrics and Gynaecology, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, Unity Health, St Michael's Hospital, Toronto, ON, Canada
| | - June Sing Hong Lam
- University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada.,University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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18
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Shakeri A, Chu C, Stamenova V, Fang J, Barker LC, Vigod SN, Bhatia RS, Tadrous M. Comparison of Healthcare Utilization Between Telemedicine and Standard Care: A Propensity-Score Matched Cohort Study Among Individuals With Chronic Psychotic Disorders in Ontario, Canada. Schizophrenia Bulletin Open 2022; 3:sgac046. [PMID: 35996531 PMCID: PMC9384485 DOI: 10.1093/schizbullopen/sgac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Telemedicine adoption has grown significantly due to the coronavirus of 2019 pandemic; however, it remains unclear what the impact of widespread telemedicine use is on healthcare utilization among individuals with psychosis. Objectives To investigate the impact of telemedicine use on changes in healthcare utilization among patients with chronic psychotic disorders (CPDs). Study Design We conducted a population-based, retrospective propensity-matched cohort study using healthcare administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14, 2020 and September 30, 2020 and a CPD diagnosis any time before March 14, 2020. Telemedicine users (2+ virtual visits after March 14, 2020) were propensity score-matched 1:1 with standard care users (minimum of 1 in-person or virtual ambulatory visit and maximum of 1 virtual visit after March 14, 2020) based on several baseline characteristics. Monthly use of various healthcare services was compared between the two groups from 12 months before to 3 months after their index in-person or virtual ambulatory visit after March 14, 2020 using generalized estimating equations (eg, hospitalizations, emergency department [ED] visits, and outpatient physician visits). The slope of change over the study period (ie, rate ratio) as well as a ratio of slopes, were calculated for both telemedicine and standard care groups for each outcome. Study Results A total of 18 333 pairs of telemedicine and standard care patients were identified after matching (60.8% male, mean [SD] age 45.4 [16.3] years). There was a significantly greater decline across time in the telemedicine group compared to the standard care group for ED visits due to any psychiatric conditions (ratio of slopes for telemedicine vs standard care (95% CI), 0.98 (0.98 to 0.99)). However, declines in primary care visit rates (ratio of slopes for telemedicine vs standard care (1.01 (1.01 to 1.02)), mental health outpatient visits with primary care (1.03 (1.03 to 1.04)), and all-cause outpatient visits with primary care (1.01 (1.01 to 1.02)), were steeper among the standard care group than telemedicine group. Conclusions Overall, patients with CPDs appeared to benefit from telemedicine as evidenced by increased outpatient healthcare utilization and reductions in ED visits due to psychiatric conditions. This suggests that telemedicine may have allowed this patient group to have better access and continuity of care during the initial waves of the pandemic.
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Affiliation(s)
- Ahmad Shakeri
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, ON , Canada
| | - Cherry Chu
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
| | - Vess Stamenova
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
| | | | - Lucy C Barker
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
- ICES , Toronto, ON , Canada
- Department of Psychiatry, University of Toronto , Toronto, ON , Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, ON , Canada
| | - Simone N Vigod
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
- ICES , Toronto, ON , Canada
- Department of Psychiatry, University of Toronto , Toronto, ON , Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, ON , Canada
| | - R Sacha Bhatia
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
- ICES , Toronto, ON , Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, ON , Canada
| | - Mina Tadrous
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, ON , Canada
- ICES , Toronto, ON , Canada
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19
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Bogler T, Hussain-Shamsy N, Schuler A, Pirmohamed J, Shore EM, Wijayasinghe S, Dennis CL, Vigod SN, Barker LC. Key concerns among pregnant individuals during the pandemic: Online cross-sectional survey. Can Fam Physician 2021; 67:e257-e268. [PMID: 34521722 DOI: 10.46747/cfp.6709e257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine common sources of concern among pregnant individuals during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN A cross-sectional, open, online electronic survey from May 9, 2020, to June 14, 2020. SETTING Electronic survey open internationally and advertised through Canadian-based social media platforms. PARTICIPANTS Eligible participants understood English and had been pregnant during the COVID-19 pandemic (ie, were pregnant at the time of survey completion or had delivered an infant on or after March 11, 2020). MAIN OUTCOME MEASURES Potential sources of concern related to the pandemic, calculated as the proportion of participants who endorsed each concern among those for whom the concern was relevant. Differences in the proportion of individuals endorsing each concern were compared by parity using modified Poisson regression. Frequency of concerns was examined in terms of level of distress, as per the Kessler Psychological Distress Scale (K6), using multivariable linear regression. RESULTS Out of 1477 participants, 87.3% were Canadian. Top concerns included the following: hospital policies related to support persons during labour (80.9%), not being able to introduce the baby to family and friends (80.1%), and developing COVID-19 while pregnant (79.2%). Primiparous participants were more likely than multiparous participants to be concerned about accessing in-person prenatal classes (51.5% vs 13.3%; relative risk = 3.88; 95% CI 2.02 to 4.98) and cancellation of hospital tours (35.0% vs 5.6%, relative risk = 6.26; 95% CI 4.25 to 9.20), among other concerns. The mean (SD) K6 score was 6.7 (3.8) within the moderate to high distress range. Number of concerns reported was associated with K6 score in both primiparous (β = 0.24; 95% CI 0.20 to 0.29; P < .0001) and multiparous (β = 0.30; 95% CI 0.24 to 0.36; P < .0001) individuals. CONCLUSION Pregnant individuals have unique concerns during the COVID-19 pandemic and the findings indicate the importance of targeted support strategies to meet the particular needs of both primiparous and multiparous pregnant individuals.
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Affiliation(s)
- Tali Bogler
- Family physician and Chair of Family Medicine Obstetrics at St Michael's Hospital (SMH) Academic Family Health Team in Toronto, Ont, Investigator at the Li Ka Shing Knowledge Institute at SMH, and Assistant Professor in the Department o Family and Community Medicine at the University of Toronto (UofT)
| | - Neesha Hussain-Shamsy
- PhD Candidate in Health Services Research at the Institute for Health Policy, Management and Evaluation (IHPME) at UofT
| | - Andrée Schuler
- Research Associate in the Department of Family and Community Medicine at UofT and MAP Centre for Urban Health Solutions at SMH
| | - Jenna Pirmohamed
- Knowledge Broker at the Innovation Office in the Centre for Aging + Brain Health Innovation at Baycrest Health Sciences in Toronto
| | - Eliane M Shore
- Obstetrician and gynecologist at SMH, Investigator at th Li Ka Shing Knowledge Institute, and Assistant Professor in the Department of Obstetrics and Gynaecology at UofT
| | - Sheila Wijayasinghe
- Family physician at SMH, Medical Director of primary care outreach at Women's College Hospital (WCH) in Toronto, and Lecturer at UofT
| | - Cindy-Lee Dennis
- Professor in the Lawrence S. Bloomberg Faculty of Nursing and in the Department of Psychiatry in the Faculty of Medicine at UofT
| | - Simone N Vigod
- Professor in the Department of Psychiatry and the IHPME at UofT, and is Chief of the Department of Psychiatry and the Shirley A. Brown Memorial Chair in Women's Mental Health Research at WCH
| | - Lucy C Barker
- PhD student at the IHPM at UofT, a fellow at Women's College Research Institute and in the Department of Psychiatry at UofT, and a psychiatrist at WCH
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Taylor CL, Brown HK, Saunders NR, Barker LC, Chen S, Cohen E, Dennis CL, Ray JG, Vigod SN. Maternal Schizophrenia, Skin-to-Skin Contact, and Infant Feeding Initiation. Schizophr Bull 2021; 48:145-153. [PMID: 34308961 PMCID: PMC8781380 DOI: 10.1093/schbul/sbab085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The World Health Organization recommends mothers and infants be in direct skin-to-skin contact immediately after birth and initiate breastfeeding as soon as possible. Little is known in women with schizophrenia. METHODS We conducted a population-based cohort study using administrative health data from Ontario, Canada (2012-2014), comparing women with (n = 471) and without schizophrenia (n = 218 435), and their infants, on the primary outcomes of any skin-to-skin contact and opportunity to initiate breastfeeding within the first 2 h after birth. For dyads with available data, secondary outcomes of intention to breastfeed, breastfeeding support, any breastmilk, and exclusive breastmilk at discharge were assessed. Modified Poisson regression was used to generate relative risks (aRR) and 95% confidence intervals (CI), adjusted for maternal age, parity, neighbourhood income, region of residence, smoking in pregnancy, and maternal medical and non-psychotic psychiatric comorbidity for all outcomes. RESULTS Maternal schizophrenia was associated with lower likelihood of skin-to-skin contact (65.2% vs 78.1%; aRR 0.88, 95% CI: 0.82-0.94), and breastfeeding initiation post-delivery (38.9% vs 52.6% aRR 0.80, CI: 0.71-0.90) compared to dyads unexposed to maternal schizophrenia. Secondary outcomes followed a similar pattern. The magnitude of the effect was slightly less when restricting the cohort to full-term, vaginal deliveries, not admitted to NICU, and infant not discharged to social services. CONCLUSIONS Reduced maternal-infant skin-to-skin contact and breastfeeding initiation immediately after birth may significantly impact maternal-child bonding and the establishment breastfeeding in this population. Mothers with schizophrenia may require individualized support to promote these WHO recommended hospital practices in the early post-natal period.
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Affiliation(s)
- Clare L Taylor
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Hilary K Brown
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Department of Health & Society, University of Toronto, Scarborough, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Natasha R Saunders
- The Hospital for Sick Children, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Lucy C Barker
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Eyal Cohen
- The Hospital for Sick Children, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- St Michael’s Hospital, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Joel G Ray
- St Michael’s Hospital, Toronto, ON, Canada,The Hospital for Sick Children, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Simone N Vigod
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,To whom correspondence should be addressed; Women’s College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada; tel: +416-323-6400, fax: +416-323-6356, e-mail:
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21
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Vigod SN, Brown HK, Huang A, Fung K, Barker LC, Hussain-Shamsy N, Wright E, Dennis CL, Grigoriadis S, Gozdyra P, Corsi D, Walker M, Moineddin R. Postpartum mental illness during the COVID-19 pandemic: a population-based, repeated cross-sectional study. CMAJ 2021; 193:E835-E843. [PMID: 34099467 PMCID: PMC8203259 DOI: 10.1503/cmaj.210151] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND: It is unclear whether the clinical burden of postpartum mental illness has increased during the COVID-19 pandemic. We sought to compare physician visit rates for postpartum mental illness in Ontario, Canada, during the pandemic with rates expected based on prepandemic patterns. METHODS: In this population-based, repeated cross-sectional study using linked health administrative databases in Ontario, Canada, we used negative binomial regression to model expected visit rates per 1000 postpartum people for March–November 2020 based on prepandemic data (January 2016–February 2020). We compared observed visit rates to expected visit rates for each month of the pandemic period, generating absolute rate differences, incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). The primary outcome was a visit to a primary care physician or a psychiatrist for any mental disorder. We stratified analyses by maternal sociodemographic characteristics. RESULTS: In March 2020, the visit rate was 43.5/1000, with a rate difference of 3.11/1000 (95% CI 1.25–4.89) and an IRR of 1.08 (95% CI 1.03–1.13) compared with the expected rate. In April, the rate difference (10.9/1000, 95% CI 9.14–12.6) and IRR (1.30, 95% CI 1.24–1.36) were higher; this level was generally sustained through November 2020. From April–November, we observed elevated visit rates across provider types and for diagnoses of anxiety, depressive and alcohol or substance use disorders. Observed increases from expected visit rates were greater for people 0–90 days postpartum compared with 91–365 days postpartum; increases were small among people living in low-income neighbourhoods. Public health units in the northern areas of the province did not see sustained elevations in visit rates after July; southern health units had elevated rates through to November. INTERPRETATION: Increased visits for mental health conditions among postpartum people during the first 9 months of the COVID-19 pandemic suggest an increased need for effective and accessible mental health care for this population as the pandemic progresses.
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Affiliation(s)
- Simone N Vigod
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Hilary K Brown
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Anjie Huang
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Kinwah Fung
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Lucy C Barker
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Neesha Hussain-Shamsy
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Elisabeth Wright
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Cindy-Lee Dennis
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Sophie Grigoriadis
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Peter Gozdyra
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Daniel Corsi
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Mark Walker
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Rahim Moineddin
- Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont
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22
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Taylor CL, Brown HK, Saunders NR, Barker LC, Chen S, Cohen E, Dennis CL, Ray JG, Vigod SN. Accidental injury, self-injury, and assault among children of women with schizophrenia: a population-based cohort study. Acta Psychiatr Scand 2021; 143:406-417. [PMID: 33502768 DOI: 10.1111/acps.13281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/17/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aimed to compare the risk for injury overall and by intent (accidental injury, self-injury, and assault) among children born to women with versus without schizophrenia. METHODS Using health administrative data from Ontario, Canada, children born from 2003 to 2017 to mothers with (n = 3769) and without (n = 1,830,054) schizophrenia diagnosed prior to their birth were compared on their risk for child injury, captured via emergency department, hospitalization, and vital statistics databases up to age 15 years. Cox proportional hazard models generated hazard ratios for time to first injury event (overall and by intent), adjusted for potential confounders (aHR). We stratified by child sex and age at follow-up: 0-1 (infancy), 2-5 (pre-school), 6-9 (primary school), and 10-15 (early adolescence) planning to collapse age categories as needed to obtain stable and reportable estimates. RESULTS Maternal schizophrenia was associated with elevated risk for child injury overall (105.4 vs. 89.4/1000 person-years (py), aHR 1.08, 95% CI 1.03-1.14), accidental injury (104.7 vs. 88.1/1000py, 1.08, 1.03-1.14), for self-injury (0.4 vs. 0.2/1000py, 2.14 1.18-3.85), and assault (1.0 vs. 0.3/1000py, 2.29, 1.45-3.62). By child sex, point estimates were of similar magnitude and direction, though not all remained statistically significant. For accidental injury and self-injury, the risk associated with maternal schizophrenia was most elevated in 10-15-year-olds. For assault, the risk associated with maternal schizophrenia was most elevated among children in the 0-1 and 2-5-year-old age groups. CONCLUSION The elevated risk of child injury associated with maternal schizophrenia, especially for self-injury and assault, suggests that targeted monitoring and preventive interventions are warranted.
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Affiliation(s)
- Clare L Taylor
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Hilary K Brown
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Interdisciplinary Centre for Health & Society, University of Toronto, Scarborough, ON, Canada
| | - Natasha R Saunders
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Lucy C Barker
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Eyal Cohen
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,St Michael's Hospital, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Joel G Ray
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,St Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Simone N Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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23
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Barker LC, Sunderji N, Kurdyak P, Stergiopoulos V, Gonzalez A, Kopp A, Vigod SN. Urgent Outpatient Care Following Mental Health ED Visits: A Population-Based Study. Psychiatr Serv 2020; 71:616-619. [PMID: 32089079 DOI: 10.1176/appi.ps.201900466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Follow-up after psychiatric emergency department (ED) contact is key to optimizing outcomes for vulnerable patients. We aimed to quantify the likelihood of receiving outpatient mental health care after psychiatric ED visits in a population-level sample. METHODS Among individuals who presented for a psychiatric ED visit in Ontario, Canada (2010-2012) and were not admitted to hospital (N=143,662), the authors estimated the likelihood of outpatient physician mental health care within 14 days post-ED visit and compared this across presenting diagnoses. RESULTS About 40.2% (N=57,797) had a follow-up mental health visit within 14 days post-ED. Follow-up was lower among individuals presenting with substance use disorders (25.2%) than among those presenting with disorders not primarily related to substance use (44.5%) (χ2=3,784.7, df=1, p<0.001). Follow-up differed among those presenting with schizophrenia (46.4%), bipolar disorder (56.1%), and major depressive disorder (51.1%) (χ2=61.7, df=2, p<0.001). CONCLUSIONS Post-ED outpatient mental health follow-up is low. Systemwide coordination is needed to connect these high-acuity patients with care, especially those with presentations related to substance use.
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Affiliation(s)
- Lucy C Barker
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Nadiya Sunderji
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Paul Kurdyak
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Vicky Stergiopoulos
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Alejandro Gonzalez
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Alexander Kopp
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
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Vigod SN, Fung K, Amartey A, Bartsch E, Felemban R, Saunders N, Guttmann A, Chiu M, Barker LC, Kurdyak P, Brown HK. Maternal schizophrenia and adverse birth outcomes: what mediates the risk? Soc Psychiatry Psychiatr Epidemiol 2020; 55:561-570. [PMID: 31811316 DOI: 10.1007/s00127-019-01814-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 11/28/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Maternal schizophrenia is associated with adverse birth outcomes, but the reasons for this remain unclear. In a population-based cohort of infants born to women with schizophrenia, we determined the occurrence of key perinatal outcomes and explored whether factors identifiable in our datasets explained any elevated risk. METHODS Using population-level health administrative data linked to clinical birth-registry data in Ontario, Canada (2006-2011), we examined the relative risk (RR) of preterm birth (< 37 weeks), small for gestational age (SGA), and Apgar scores < 8 in infants of women with schizophrenia (n = 4279) versus infants of unaffected women (n = 286,147). Generalized estimating equations determined whether reproductive history, maternal health conditions, pregnancy exposures, and complications explained elevated RRs. RESULTS Among infants of women with schizophrenia, risk was higher for prematurity (11.4% vs. 6.9%, aRR 1.64, 95% CI 1.51-1.79), SGA (3.5% vs. 2.5%, aRR 1.40, 95% CI 1.20-1.64), and Apgar score < 8 at 1 (19.0% vs. 12.8%, aRR 1.49, 95% CI 1.40-1.59) and 5 min (5.6% vs. 3.0%, aRR 1.90, 95% CI 1.68-2.16). Smoking, fourfold more common among women with schizophrenia, was the variable that explained the greatest proportion of the elevated aRR for prematurity (9.9%), SGA (28.7%), and Apgar < 8 at 1 and 5 min (9.8%, 5.6%). Illicit substance use, certain reproductive history variables, and pregnancy complications also contributed to the elevated aRR for preterm birth. CONCLUSIONS Elevated risks of preterm birth, SGA, and low Apgar scores in infants of women with schizophrenia are partly explained by potentially modifiable factors such as smoking and illicit drug use, suggesting opportunities for targeted intervention.
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Affiliation(s)
- Simone N Vigod
- Women's College Hospital and Research Institute, 76 Grenville Street Rm. 6336, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada.
| | | | | | | | | | - Natasha Saunders
- University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Hospital for Sick Children, Toronto, ON, Canada
| | - Astrid Guttmann
- University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Hospital for Sick Children, Toronto, ON, Canada
| | - Maria Chiu
- University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Lucy C Barker
- Women's College Hospital and Research Institute, 76 Grenville Street Rm. 6336, Toronto, ON, M5S 1B2, Canada.,University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Paul Kurdyak
- University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Hilary K Brown
- Women's College Hospital and Research Institute, 76 Grenville Street Rm. 6336, Toronto, ON, M5S 1B2, Canada.,University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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25
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Abstract
Women with schizophrenia experience low rates of sexual satisfaction and high rates of sexual dysfunction. They are at high risk for adverse sexual health outcomes including unplanned pregnancies, induced abortions, and human immunodeficiency virus (HIV), and face higher rates of sexual violence and various forms of intimate partner violence. This review explores the complex and intersecting biopsychosocial risk factors that explain these outcomes among women with schizophrenia, including factors related to the illness itself, antipsychotic medications, medical and psychiatric comorbidities, stigma, childhood trauma, and social determinants of health including poverty and housing instability. Sexual health interventions designed to help women with schizophrenia achieve pleasurable and safe sexual experiences, free of coercion, discrimination and violence are few and far between, suggesting opportunities for future development in this area.
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Affiliation(s)
- Lucy C Barker
- Women's College Hospital and Research Institute, 76 Grenville St, Toronto, Ontario M5S 1B2, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada
| | - Simone N Vigod
- Women's College Hospital and Research Institute, 76 Grenville St, Toronto, Ontario M5S 1B2, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada.
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26
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Faulkner MR, Barker LC, Vigod SN, Dennis CL, Brown HK. Collective impact of chronic medical conditions and poverty on perinatal mental illness: population-based cohort study. J Epidemiol Community Health 2019; 74:158-163. [PMID: 31678966 DOI: 10.1136/jech-2019-212714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/15/2019] [Accepted: 10/19/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic medical conditions (CMCs) and poverty commonly co-occur and, while both have been shown to independently increase the risk of perinatal mental illness, their collective impact has not been examined. METHODS This population-based study included 853 433 Ontario (Canada) women with a singleton live birth and no recent mental healthcare. CMCs were identified using validated algorithms and disease registries, and poverty was ascertained using neighbourhood income quintile. Perinatal mental illness was defined as a healthcare encounter for a mental health or substance use disorder in pregnancy or the first year postpartum. Modified Poisson regression was used to test the independent impacts of CMC and poverty on perinatal mental illness risk, adjusted for covariates, and additive interaction between the two exposures was assessed using the relative excess risk due to interaction (RERI) and synergy index (SI). RESULTS CMC and poverty were each independently associated with increased risk of perinatal mental illness (CMC vs no CMC exposure: 19.8% vs 15.6%, adjusted relative risk (aRR) 1.21, 95% CI (CI) 1.20 to 1.23; poverty vs no poverty exposure: 16.7% vs 15.5%, aRR 1.06, 95% CI 1.05 to 1.07). However, measures of additive interaction for the collective impact of both exposures on perinatal mental illness risk were not statistically significant (RERI 0.02, 95% CI -0.01 to 0.06; SI 1.09, 95% CI 0.95 to 1.24). CONCLUSION CMC and poverty are independent risk factors for perinatal mental illness and should be assessed as part of a comprehensive management programme that includes prevention strategies and effective screening and treatment pathways.
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Affiliation(s)
- Mary-Rose Faulkner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Lucy C Barker
- ICES, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Simone N Vigod
- ICES, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hilary K Brown
- ICES, Toronto, Ontario, Canada .,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
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27
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Gupta R, Brown HK, Barker LC, Dennis CL, Vigod SN. Rapid repeat pregnancy in women with schizophrenia. Schizophr Res 2019; 212:86-91. [PMID: 31420202 DOI: 10.1016/j.schres.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 01/14/2023]
Abstract
AIM Women with schizophrenia are vulnerable to adverse reproductive health outcomes. Short inter-pregnancy interval, or rapid repeat pregnancy, is associated with maternal and infant complications, and may be preventable. Whether women with schizophrenia are at disproportionate risk for rapid repeat pregnancy is unknown. METHODS This population-based cohort study in Ontario, Canada (2002-2013) compared women with and without schizophrenia on their risk of rapid repeat pregnancy, defined as pregnancy within 12 months of an index live birth. Among women with public drug coverage, those with and without schizophrenia were compared on their use of non-barrier contraception (hormonal and surgical) post-delivery. RESULTS Women with schizophrenia (n = 1565) were at higher risk for rapid repeat pregnancy than women without schizophrenia (n = 924,657) (6.3% vs. 3.9%, adjusted relative risk, aRR 1.31, 95% confidence interval, CI, 1.07-1.59). They had more rapid repeat pregnancies resulting in live births (aRR 1.85, 95% CI 1.26-2.72), but not pregnancy losses (aRR 1.50, 95% CI 0.99-2.29) or induced abortions (aRR 1.07, 95% CI 0.81-1.42). Post-delivery non-barrier contraception use was similar between groups (43.7% vs. 43.6%, aRR 1.06, 95% CI 0.93-1.20), although women with schizophrenia were more likely to use injectable contraception (14.1% vs. 10.1%, aRR 1.67, 95% CI 1.35-2.07). DISCUSSION Women with schizophrenia are at higher risk than their peers for rapid repeat pregnancy, but use non-barrier contraception at similar rates. The postnatal period is an opportune time to initiate targeted interventions designed to optimize planning for any future pregnancies, and contribute to improving maternal and child health in this vulnerable group.
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Affiliation(s)
- Renu Gupta
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hilary K Brown
- ICES, Toronto, Canada; Dalla Lana School of Public Health, Interdisciplinary Centre for Health & Society, University of Toronto, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Lucy C Barker
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Faculty of Nursing, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Barker LC, Brand IR, Crawford SM. Sustained effect of the aromatase inhibitors anastrozole and letrozole on endometrial thickness in patients with endometrial hyperplasia and endometrial carcinoma. Curr Med Res Opin 2009; 25:1105-9. [PMID: 19301987 DOI: 10.1185/03007990902860549] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate whether there may be a role for aromatase inhibitors (AIs) in the treatment of endometrial hyperplasia (EH) and endometrial adenocarcinoma (EA) in postmenopausal women, a retrospective study on the effect of aromatase inhibitors (anastrozole or letrozole) was conducted for 16 patients who were not amenable to surgical treatment. MAIN OUTCOME MEASURE Resolution of endometrial thickening measured by transvaginal ultrasound at 3-month intervals; the response of metastases was assessed by standard oncological criteria. RESULTS In all, 16 patients were studied. The BMI of 13 of the 16 patients was known and ranged from 20.7 to 47.7 (mean 34.5) kg/m(2). During treatment with AIs, mean endometrial thickness in the eight patients with EH decreased progressively by 81.7% from 14.7 mm at the start of treatment to 2.7 mm following 36 months of treatment. A greater original mean endometrial thickness of 17 mm was seen in the four patients with localised EA, this fell progressively by 67.1% to 5.6 mm following 36 months of treatment. No responses were seen in four patients with metastatic disease. CONCLUSION Our results indicate that treatment of EH with anastrozole or letrozole can reduce endometrial thickness as seen ultrasonically, and that in some cases AI treatment can reduce endometrial thickness in patients with localised EA. We found no evidence to indicate that AI treatment prevents disease progression in patients with metastatic EA. Further investigations will be necessary to validate our findings from this small retrospective study and to compare AI inhibitor treatment with topical progestogen therapy.
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Affiliation(s)
- L C Barker
- Oncology Department, Airedale General Hospital, Steeton, UK
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29
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Abstract
A consultant-led day hospital in a district general hospital (DGH) was compared with general practitioner-controlled day hospitals in community hospitals (CHs). CHs were more generously provided for their populations, 3.87 compared with 1.38 places per 1000, but less well staffed at 70% of the DGH levels. Patients were similar demographically and in dependence, but differed in some diagnoses; 33% of CH patients were referred for social reasons alone, compared with 2% in the DGH. CH patients received fewer treatment sessions each day, 2.11 compared with 2.55 in the DGH and the difference was mainly in medical input. Median duration of attendance was 332 days in the CH and 92 days in the DGH; the 6-month discharge rate was 67% in the CH and 35% in the DGH, with 48% of patients attending for more than a year in the CH compared with 24% in the DGH. This study suggests that while the DGH unit provides an active service the CH units offer supportive care which largely duplicates that which could be provided more cheaply in day centres.
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Affiliation(s)
- L C Barker
- Department of Geriatric Medicine, Radcliffe Infirmary, Oxford
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Abstract
A case of agranulocytosis during malaria prophylaxis with Maloprim (pyrimethamine and dapsone) is described. At the recommended dose of one tablet weekly this is apparently a rare occurrence but highlights one of the hazards in a changing climate of malarial prophylaxis in which the use of Maloprim is increasing.
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