title: Postpartum psychiatric emergency visits: a nested case-control study.
abstract: Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006-2012), who delivered a live born infant and had a psychiatric ED visit within 1 year postpartum (n = 8728). We compared those whose ED visit was the first physician mental health contact since delivery to those who had accessed mental health services on specific indicators of marginalization hypothesized to be associated with lower likelihood of mental health contact prior to the ED visit. For 60.4 % of women, this was the first physician mental health contact since delivery. The majority were presenting with a mood or anxiety disorder, and only 13.6 % required hospital admission. These women were more likely to have material deprivation and residential instability than women with contact (Q5 vs. Q1 aORs 1.30, 95 % CI 1.12-1.50; 1.17, 95 % CI 1.01-1.36), to live in rural vs. urban areas (aOR 1.58, 95 % CI 1.38-1.80), and to be low vs. high income quintile (aOR 1.18, 95 % CI 1.01-1.38). The frequent use of ED services as the first point of contact for mental health concerns suggests that interventions to improve timely and equitable access to effective outpatient postpartum mental health care are needed. Marginalized women are at particularly high risk of not having accessed outpatient services prior to an ED visit, and therefore, future research and interventions will specifically need to consider the needs of this group.
authors: Department of Psychiatry, University of Toronto, Toronto, Canada.
authors: Lucy Church
authors: LC
authors: Barker
authors: Department of Psychiatry, University of Toronto, Toronto, Canada.|Centre for Addiction and Mental Health, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors: Paul
authors: P
authors: Kurdyak
authors: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Women's College Hospital and Research Institute, 76 Grenville Street, M5S 1B2, Toronto, Canada.
authors: Kinwah
authors: K
authors: Fung
authors: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Canada.
authors: Flora I
authors: FI
authors: Matheson
authors: Department of Psychiatry, University of Toronto, Toronto, Canada. simone.vigod@wchospital.ca.|Institute for Clinical Evaluative Sciences, Toronto, Canada. simone.vigod@wchospital.ca.|Women's College Hospital and Research Institute, 76 Grenville Street, M5S 1B2, Toronto, Canada. simone.vigod@wchospital.ca.
authors: Simone
authors: S
authors: Vigod
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy; D002170:Canada / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D050498:Live Birth / Q000453:epidemiology; D000068097:Maternal Health / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000706:statistics & numerical data*; D019964:Mood Disorders / Q000453:epidemiology / Q000628:therapy; D020380:Needs Assessment; D049590:Postpartum Period / Q000523:psychology; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D012307:Risk Factors; D062487:Social Marginalization / Q000523:psychology; D012959:Socioeconomic Factors
keywords: Health services; Marginalization; Maternal health; Mental health; Perinatal epidemiology