title: Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence.
abstract: Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed to do in the present study. We designed a descriptive prospective study and included information from Danish population registers to study first-time ever and recurrent psychiatric episodes during the perinatal period, including treatment at psychiatric facilities and general practitioners (GPs). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods across moderate and severe perinatal psychiatric episodes.
authors.affiliation: Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark.|CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Munk-Olsen
authors.affiliation: Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark.
authors.forename: M L
authors.initials: ML
authors.lastname: Maegbaek
authors.affiliation: Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark.
authors.forename: B M
authors.initials: BM
authors.lastname: Johannsen
authors.affiliation: Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark.
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
authors.forename: L M
authors.initials: LM
authors.lastname: Howard
authors.affiliation: Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.|Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: A
authors.initials: A
authors.lastname: di Florio
authors.affiliation: Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark.|Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Bergink
authors.affiliation: UNC Center for Women's Mood Disorder, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Meltzer-Brody
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003718:Denmark; D005260:Female; D058006:General Practice; D006778:Hospitals, Psychiatric; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012306:Risk