Abstract
Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed to do in the present study. We designed a descriptive prospective study and included information from Danish population registers to study first-time ever and recurrent psychiatric episodes during the perinatal period, including treatment at psychiatric facilities and general practitioners (GPs). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods across moderate and severe perinatal psychiatric episodes.
Highlights
Psychiatric episodes during pregnancy and following childbirth are complex, as the well-being of both the mother and infant must be considered in all treatment decisions
They are often characterized by severe depression with suicidal ideation,[7] or as postpartum psychosis that has been closely associated with bipolar affective disorders,[8] it does not have a specific diagnoses.[9,10]
Antidepressant use in the perinatal period has increased over time,[12,13] as it has for depression outside the perinatal period
Summary
Psychiatric episodes during pregnancy and following childbirth are complex, as the well-being of both the mother and infant must be considered in all treatment decisions. Episodes requiring psychiatric hospitalization and specialist treatment in secondary and tertiary health-care systems are thought to be on the severe end of the spectrum. They are often characterized by severe depression with suicidal ideation,[7] or as postpartum psychosis that has been closely associated with bipolar affective disorders,[8] it does not have a specific diagnoses.[9,10] Adding to this, a proportion of more moderate postpartum psychiatric episodes will be treated in primary care with prescription drugs. Evidence suggests that some perinatal psychiatric episodes will be unnoticed and untreated,[16,17,18] with one recent study highlighting that pharmacological treatment is less likely to be prescribed in perinatal illnesses compared with other time points.[19]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
