Johannsen Benedicte Marie Winther, Larsen Janne Tidselbak, Laursen Thomas Munk, Bergink Veerle, Meltzer-Brody Samantha, Munk-Olsen Trine
From the National Center for Register-Based Research and the Center for Integrated Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark; the Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands; and the Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill.
Am J Psychiatry. 2016 Jun 1;173(6):635-42. doi: 10.1176/appi.ajp.2015.14121510. Epub 2016 Mar 4.
The postpartum period is associated with a high risk of psychiatric episodes. The authors studied mortality in women with first-onset severe psychiatric disorders following childbirth and compared their mortality rates with those in women from the background population including other female psychiatric patients (mothers and childless women).
In a register-based cohort study with linked information from Danish population registers, the authors identified women with first psychiatric inpatient or outpatient contacts 0-3 months postpartum. The main outcome measure was mortality rate ratios (MRRs): deaths from natural causes (diseases and medical conditions) or unnatural causes (suicides, accidents, and homicides). The cohort included 1,545,857 women representing 68,473,423 person-years at risk.
In total, 2,699 women had first-onset psychiatric disorders 0-3 months postpartum, and 96 of these died during follow-up. Women with postpartum psychiatric disorders had a higher MRR (3.74; 95% CI=3.06-4.57) than non-postpartum-onset mothers (MRR=2.73; 95% CI=2.67-2.79) when compared with mothers with no psychiatric history. However, childless women with psychiatric diagnoses had the highest MRR (6.15; 95% CI=5.94-6.38). Unnatural cause of death represented 40.6% of fatalities among women with postpartum psychiatric disorders, and within the first year after diagnosis, suicide risk was drastically increased (MRR=289.42; 95% CI=144.02-581.62) when compared with mothers with no psychiatric history.
Women with severe postpartum psychiatric disorders had increased MRRs compared with mothers without psychiatric diagnoses, and the first year after diagnosis represents a time of particularly high relative risk for suicide in this vulnerable group.
产后时期与精神疾病发作的高风险相关。作者研究了产后首次发作严重精神疾病的女性的死亡率，并将她们的死亡率与包括其他女性精神病患者（有子女和无子女的女性）在内的背景人群中的女性死亡率进行了比较。
在一项基于登记册的队列研究中，作者利用丹麦人口登记册的相关信息，确定了产后0至3个月首次有精神科住院或门诊记录的女性。主要结局指标是死亡率比（MRRs）：自然原因（疾病和医疗状况）或非自然原因（自杀、事故和杀人）导致的死亡。该队列包括1,545,857名女性，代表68,473,423人年的风险期。
共有2,699名女性在产后0至3个月首次发作精神疾病，其中96人在随访期间死亡。与无精神病史的母亲相比，产后精神疾病女性的死亡率比（MRR = 3.74；95% CI = 3.06 - 4.57）高于非产后发作的母亲（MRR = 2.73；95% CI = 2.67 - 2.79）。然而，有精神疾病诊断的无子女女性的死亡率比最高（MRR = 6.15；95% CI = 5.94 - 6.38）。在产后精神疾病女性中，非自然死亡原因占死亡总数的40.6%，与无精神病史的母亲相比，在诊断后的第一年内，自杀风险急剧增加（MRR = 289.42；95% CI = 144.02 - 581.62）。
与无精神疾病诊断的母亲相比，患有严重产后精神疾病的女性死亡率比增加，在该脆弱群体中，诊断后的第一年是自杀相对风险特别高的时期。
