Dalla Lana School of Public Health, 7938University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Can J Psychiatry. 2020 Dec;65(12):854-864. doi: 10.1177/0706743720931231.
To examine the relationship between prepregnancy chronic medical conditions (CMCs) and the risk of acute perinatal psychiatric health-care encounters (i.e., psychiatric emergency department visits, hospitalizations) among refugees, nonrefugee immigrants, and long-term residents in Ontario.
We conducted a population-based study of 15- to 49-year-old refugees ( = 29,189), nonrefugee immigrants ( = 187,430), and long-term residents ( = 641,385) with and without CMC in Ontario, Canada, with a singleton live birth in 2005 to 2015 and no treatment for mental illness in the 2 years before pregnancy. Modified Poisson regression was used to estimate the relative risk of a psychiatric emergency department visit or hospitalization from conception until 1 year postpartum among women with versus without CMC, stratified by migrant status. An unstratified model with an interaction term between CMC and migrant status was used to test for multiplicativity of effects.
The association between CMC and risk of a psychiatric emergency department visit or hospitalization was stronger among refugees (adjusted relative risk [aRR] = 1.87; 95% confidence interval [CI], 1.36 to 2.58) compared to long-term residents (aRR = 1.39; 95% CI, 1.30 to 1.48; interaction = 0.047). The strength of the association was no different in nonrefugee immigrants (aRR = 1.26; 95% CI, 1.05 to 1.51) compared to long-term residents (interaction = 0.45).
Our study identifies refugee women with CMC as a high-risk group for acute psychiatric health care in the perinatal period. Preventive psychosocial interventions may be warranted to enhance supportive resources for all women with CMC and, in particular refugee women, to reduce the risk of acute psychiatric health care in the perinatal period.
探讨妊娠前慢性疾病（CMCs）与安大略省难民、非难民移民和长期居民围产期急性精神保健就诊（即精神科急诊就诊、住院）风险之间的关系。
我们对加拿大安大略省 15 至 49 岁的难民（n=29189）、非难民移民（n=187430）和长期居民（n=641385）进行了一项基于人群的研究，这些人在 2005 年至 2015 年间有单胎活产，且在妊娠前 2 年内没有接受过精神疾病治疗。采用修正泊松回归估计了妊娠至产后 1 年内有 CMC 与无 CMC 的女性精神科急诊就诊或住院的相对风险，按移民身份分层。采用无分层模型和 CMC 与移民身份之间的交互项来检验效应的相乘性。
与长期居民相比（调整后的相对风险[aRR]，1.39；95%置信区间[CI]，1.30 至 1.48；交互作用 = 0.047），CMCs 与精神科急诊就诊或住院风险的关联在难民中更强（aRR，1.87；95%CI，1.36 至 2.58）。与长期居民相比（交互作用 = 0.45），非难民移民中的关联强度无差异（aRR，1.26；95%CI，1.05 至 1.51）。
我们的研究确定有 CMC 的难民女性是围产期急性精神保健的高风险群体。可能需要预防性的社会心理干预措施，为所有有 CMC 的女性，特别是难民女性，提供支持资源，以降低围产期急性精神保健的风险。
