General medical conditions and mortality in women with postpartum psychiatric disorders

Abstract

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. This register-based cohort study followed all Danish women born after January 1, 1960, until January 1, 2016. The exposure of interest was (i)mild-moderatePPD: first-ever prescription of psychotropic medication (ATC codes: N03-N07) and (ii)severePPD: first-ever in- or out-patient contact to a psychiatric facility, both within six months postpartum. Outcomes of interest were (i) hospital-registered chronic medical conditions and (ii) mortality from natural and unnatural causes. We included 1841949 women representing 22615310 person-years at risk. Among 15852 women withmild-moderatePPD and 4266 women withseverePPD, we found a higher risk of any subsequent general medical condition (mild-moderatePPD: IRR 1.25; 95% CI 1.20-1.31 andseverePPD: 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-moderatePPD: natural causes MRR 1.37; 95% CI: 1.17-1.61; unnatural causes MRR 1.52; 95% CI: 1.10-2.11, and severePPD: natural causes MRR 1.42; 95% CI 1.02-2.00, and unnatural causes MRR 5.05; 95% CI: 3.40-7.51. 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.