General medical conditions and mortality in women with postpartum psychiatric disorders

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BACKGROUND: Psychiatric patients have an increased risk of general medical conditions and mortality, but no study has systematically explored these outcomes among women with mental disorders following childbirth (postpartum psychiatric disorders: PPD). Therefore, we aimed to investigate the risk of subsequent general medical conditions and mortality in women with a broad spectrum of PPD.

METHODS: This register-based cohort study followed all Danish women born after Jan. 1st, 1960, until Jan. 1st, 2016. The exposure of interest was 1) mild-moderate PPD: first-ever prescription of psychotropic medication (ATC codes: N03-N07) and 2) severe PPD: first-ever in- or outpatient contact to a psychiatric facility, both within six months postpartum. Outcomes of interest were 1) hospital-registered chronic medical conditions and 2) mortality from natural and unnatural causes. We included 1,841,949 women representing 22,615,310 person-years at risk.

RESULTS: Among 15,852 women with mild-moderate PPD and 4,266 women with severe PPD, we found a higher risk of any subsequent general medical condition (mild-moderate PPD: IRR 1.25; 95%CI 1.20-1.31 and severe PPD: IRR 1.35; 95%CI: 1.24-1.48) when compared to the female background population. Mortality from both natural and unnatural causes was higher in both groups: Mild-moderate PPD: natural causes MRR 1.37; 95%CI: 1.17-1.61; unnatural causes MRR 1.52; 95%CI: 1.10-2.11, severe PPD: natural causes MRR 1.42; 95%CI 1.02-2.00, and unnatural causes MRR 5.05; 95%CI: 3.40-7.51.

CONCLUSIONS: This first overview of general medical prognosis in PPD shows that women at either end of the spectrum are at increased risk of subsequent chronic medical conditions and overall mortality.

TidsskriftActa Psychiatrica Scandinavica
StatusE-pub ahead of print - 11 sep. 2020

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