Nager Anna, Szulkin Robert, Johansson Sven-Erik, Johansson Leena-Maria, Sundquist Kristina
Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden.
Nord J Psychiatry. 2013 Feb;67(1):53-8. doi: 10.3109/08039488.2012.675590. Epub 2012 May 8.
The relapse rate for psychiatric disorders after postpartum psychosis is high. Apart from subsequent puerperal periods, previous studies have not examined when relapses in psychiatric disorders occur. In addition, little is known about the impact of certain individual factors on the risk of non-puerperal readmission among women with previous postpartum psychosis.
The first aim was to examine the association between non-puerperal readmission due to psychiatric disorders and years of follow-up (in total, 30 years) in women with postpartum psychosis. The second aim was to examine the impact of age, type of psychosis, previous hospitalization for psychiatric disorders and level of education on the risk of non-puerperal readmission due to psychiatric disorders.
All Swedish women aged 20-44 with postpartum psychosis (n =3140) were followed between 1975 and 2004 for non-puerperal readmission due to psychiatric disorders. A Cox frailty regression model was used to estimate hazard ratios for non-puerperal readmission.
The risk of non-puerperal readmission, although gradually decreasing with time, remained high many years after the postpartum psychosis. The risk of non-puerperal readmission was significantly higher among women with schizophrenia, lower levels of education and previous psychiatric hospitalization.
Postpartum psychosis is often part of a lifelong recurrent psychiatric disorder. Women with schizophrenia, lower levels of education and hospitalization due to a psychiatric disorder prior to postpartum psychosis have a higher risk of non-puerperal readmission.
The findings constitute important knowledge for all healthcare workers encountering women with a previous postpartum psychosis.
产后精神病发作后精神疾病的复发率很高。除了随后的产褥期外，以往的研究并未考察精神疾病复发的时间。此外，对于某些个体因素对既往有产后精神病的女性非产褥期再次入院风险的影响知之甚少。
第一个目的是研究产后精神病女性因精神疾病导致的非产褥期再次入院与随访年限（共30年）之间的关联。第二个目的是研究年龄、精神病类型、既往因精神疾病住院情况以及教育程度对因精神疾病导致的非产褥期再次入院风险的影响。
对1975年至2004年间所有年龄在20 - 44岁且患有产后精神病的瑞典女性（n = 3140）进行随访，观察其因精神疾病导致的非产褥期再次入院情况。采用Cox脆弱回归模型估计非产褥期再次入院的风险比。
产后精神病发作后，非产褥期再次入院的风险虽随时间逐渐降低，但多年后仍居高不下。精神分裂症女性、教育程度较低以及既往有精神科住院史的女性非产褥期再次入院的风险显著更高。
产后精神病往往是一种终身复发性精神疾病的一部分。患有精神分裂症、教育程度较低以及在产后精神病发作前因精神疾病住院的女性非产褥期再次入院的风险更高。
这些发现为所有接触过有既往产后精神病女性的医护人员提供了重要知识。
