Abstract
Social determinants of health have the potential to influence mental health and addictions-related emergency department (ED) visits and the likelihood of admission to hospital. We aimed to determine how social determinants of health, individually and in combination, relate to the likelihood of hospital admission at the time of postpartum psychiatric ED visits. Among 10 702 postpartum individuals (female based on health card) presenting to the ED for a psychiatric reason in Ontario, Canada (2008-2017), we evaluated the relation between six social determinants of health (age, neighbourhood quintile [Q, Q1 = lowest, Q5 = highest], rurality, immigrant category, Chinese or South Asian ethnicity and neighbourhood ethnic diversity) and the likelihood of hospital admission from the ED. Poisson regression models generated relative risks (RR, 95% CI) of admission for each social determinant, crude and adjusted for clinical severity (diagnosis and acuity) and other potential confounders. Generalised estimating equations were used to explore additive interaction to understand whether the likelihood of admission depended on intersections of social determinants of health. In total, 16.0% (n = 1715) were admitted to hospital from the ED. Being young (age 19 or less v. 40 or more: RR 0.60, 95% CI 0.45-0.82), rural-dwelling (v. urban-dwelling: RR 0.75, 95% CI 0.62-0.91) and low-income (Q1 v. Q5: RR 0.81, 95% CI 0.66-0.98) were each associated with a lower likelihood of admission. Being an immigrant (non-refugee immigrant v. Canadian-born/long-term resident: RR 1.29, 95% CI 1.06-1.56), of Chinese ethnicity (v. non-Chinese/South Asian ethnicity: RR 1.88, 95% CI 1.42-2.49); and living in the most v. least ethnically diverse neighbourhoods (RR 1.24, 95% CI 1.01-1.53) were associated with a higher likelihood of admission. Only Chinese ethnicity remained significant in the fully-adjusted model (aRR 1.49, 95% CI 1.24-1.80). Additive interactions were non-significant. For the most part, whether a postpartum ED visit resulted in admission from the ED depended primarily on the clinical severity of presentation, not on individual or intersecting social determinants of health. Being of Chinese ethnicity did increase the likelihood of admission independent of clinical severity and other measured factors; the reasons for this warrant further exploration.
Highlights
Psychiatric disorders are among the most common complications of childbirth (O’Hara and Wisner, 2014)
Using population-based data from Ontario, Canada, this study explored the association between six social determinants of health and the likelihood of hospital admission at the time of a postpartum psychiatric emergency department (ED) visit
We found that immigrants, those of Chinese ethnicity, and those residing in ethnicallydiverse areas were more likely to be admitted than their counterparts who were Canadian-born or long-term residents, not Chinese or South Asian, or those living in low ethnic diversity neighbourhoods
Summary
Psychiatric disorders are among the most common complications of childbirth (O’Hara and Wisner, 2014). While most psychiatric presentations can be treated in an outpatient setting, about 1% of postpartum individuals (women and childbearing individuals of other gender identities) present to an emergency department (ED) for a psychiatric reason in the first year after delivery (Barker et al, 2016). This high-risk group comprises the most severe psychiatric presentations, with serious potential for negative maternal and child health implications outcomes (Luykx et al, 2019). It is important to ensure that admissions do not occur unnecessarily, and decisions need to consider the potential impacts of disruptions to infant care (e.g. breastfeeding) and maternal–infant bonding during admissions
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