Epidemiology of Puerperal Psychoses

TLDR

The study linked obstetric and psychiatric registers in a 470,000‑person cohort over 12 years to examine psychiatric admissions within 90 days of childbirth, identifying 120 admissions among 54,087 births. The analysis revealed a markedly elevated risk of psychiatric admission within 30 days postpartum—especially among primiparous women—attributable to metabolic and psychological factors, with women having prior manic‑depressive illness at greatest risk and most admissions meeting criteria for manic or depressive disorders, suggesting puerperal psychoses are primarily manic‑depressive rather than schizophrenic.

Abstract

Computer linkage of an obstetric register and a psychiatric case register made it possible to investigate the temporal relationship between childbirth and psychiatric contact in a population of 470 000 people over a 12-year period resulted in 54 087 births: 120 psychiatric admissions within 90 days of parturition. The ‘relative risk’ of admission to a psychiatric hospital with a psychotic illness was extremely high in the first 30 days after childbirth, particularly in primiparae, suggesting that metabolic factors are involved in the genesis of puerperal psychoses. However, being unmarried, having a first baby, Caesarian section and perinatal death were all associated with an increased risk of psychiatric admission or contact, or both, suggesting that psychological stresses also contribute to this high psychiatric morbidity. Women with a history of manic depressive illness, manic or depressive, had a much higher risk of psychiatric admission in the puerperium than those with a history of schizophrenia or depressive neuroses, and the majority of puerperal admissions met Research Diagnostic Criteria for manic or depressive disorder. Probably, therefore, puerperal psychoses are manic depressive illnesses and unrelated to schizophrenia.