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.
Similar content being viewed by others
References
Alegria M, Canino G, Rios R, Vera M, Calderon J, Rusch D, Ortega A (2002) Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatr Serv 53:1547–1555
Bost N, Crilly J, Wallen K (2014) Characteristics and process outcomes of patients presenting to an Australian emergency department for mental health and non-mental health diagnoses. Int Emerg Nurs 22(3):146–152
Byatt N, Levin LL, Ziedonis D, Moore S, Allison J (2015) Enhancing participation in depression care in outpatient perinatal care settings. obstet gynecol 126(5):1
Canadian Institute for Health Information (2008) CIHI Data Quality Study of Ontario Emergency Department Visits for Fiscal Year 2004–2005: Volume II of IV—main study findings. Canadian Institute for Health Information, Ottawa
Catalano R, McConnell W, Forster P, McFarland B, Thorton D (2003) Psychiatric emergency services and the system of care. Psychiatr Serv 54(3):351–355
Clark SL, Belfort M, Dildy G, Englebright J, Meints L, Meyers J, Frye D, Perlin J (2010) Emergency department use during the postpartum period: implications for current management of the puerperium. Am J Obstet Gynecol 203:38.e1–6
Clarke DE, Dusome D, Hughes L (2007) Emergency department from the mental health client’s perspective. Int J Ment Health Nurs 16(2):126–131
Cleary M, Horsfall J, Escott P (2014) Marginalization and associated concepts and processes in relation to mental health/illness. Issues Ment Health Nurs 35:224–226
Costa D, Matanov A, Canavan R et al (2014) Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries. BMC Health Serv Res 14:49
Dennis C-L, Chung-Lee L (2006) Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth 33(4):323–331
Dolja-Gore X, Loxton DJ, D’Este CA, Byles J (2014) Mental health service use: is there a difference between rural and non-rural women in service uptake? Aust J Rural Health 22(3):92–100
Durbin A, Bondy SJ, Durbin J (2012) The association between income source and met need among community mental health service users in Ontario, Canada. Community Ment Health J 48:662–672
Escarce JJ, Morales LS, Rumbaut RG (2006) The health status and health behaviors of Hispanics. In: Tienda M, Mitchell F (eds) Hispanics and the future of America. The National Academies Press, Washington, DC, pp 362–409
Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083
Goel V, Williams JI, Anderson GM, Blackstein-Hirsch P, Fooks C, Naylor CD (eds) (1996) Patterns of health care in Ontario. The ICES practice atlas, 2nd edn. Canadian Medical Association, Ottawa, http://www.ices.on.ca/~/media/files/atlases-reports/1996/patterns-of-health-care-in-ontario-2nd-edition/Full%20report.ashx. Accessed September 12, 2014
Health Services Research & Development Center at The John Hopkins University (2009) The Johns Hopkins ACG System Technical Reference Guide, Version 9.0. Baltimore: The John Hopkins University. https://www.healthpartners.com/files/57460.pdf. Accessed October 12, 2014.
Hutton EK, Reitsma AH, Kaufman K (2009) Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth 36:180–189
Joseph KS, Fahey J (2009) Validation of perinatal data in the Discharge Abstract Database of the Canadian Institute for Health Information. Chronic Dis Can 29(3):96–100
Joseph KS, Liu S, Rouleau J, Kirby R, Kramer M, Sauve R (2010) Severe maternal morbidity in Canada, 2003 to 2007: surveillance using routine hospitalization data and ICD-10CA codes. J Obstet Gynaecol Can 32(9):837–846
Juurlink D, Preyra C, Croxford R, Chong A, Austin P, Tu J, Laupacis A (2006) Canadian Institute for Health Information Discharge Abstract Database: a validation study. Institute for Clinical Evaluative Sciences, Toronto, http://www.ices.on.ca/~/media/Files/Atlases-Reports/2006/CIHI-DAD-a-validation-study/Full%20report.ashx. Accessed September 30, 2014
Katon W, Russo J, Gavin A (2014) Predictors of postpartum depression. J Women’s Heal 23(9):753–759
Kurtz Landy C, Sword W, Ciliska D (2008) Urban women’s socioeconomic status, health service needs and utilization in the four weeks after postpartum hospital discharge: findings of a Canadian cross-sectional survey. BMC Health Serv Res 8:203
Matheson FI, Dunn JR, Smith KLW, Moineddin R, Glazier RH (2012) ON-Marg Ontario Marginalization Index user guide version 1.0. Toronto: Centre for Research on Inner City Health. http://www.torontohealthprofiles.ca/onmarg/userguide_data/ON-Marg_user_guide_1.0_FINAL_MAY2012.pdf. Accessed September 12, 2014
McEwan K, Goldner E (2001) Performance indicators for mental health services and supports. A resource kit prepared for the Federal/Provincial/Territorial Advisory Network on Mental Health. Health Canada, Ottawa, http://www.multiculturalmentalhealth.ca/wp-content/uploads/2013/10/accountability_and_performance_measures_for_mental_health_services_and_supports.pdf. Accessed October 20, 2014
Ministry of Health and Long-Term Care (2013) 2011 Annual report of the Chief Medical Officer of Health of Ontario to the Legislative Assembly of Ontario: maintaining the gains, moving the yardstick. Ontario Health Status Report. Toronto: Queen’s Printer for Ontario. http://www.health.gov.on.ca/en/common/ministry/publications/reports/cmoh_13/cmoh_13.pdf. Accessed January 8, 2015
Oates M (2003) Suicide: the leading cause of maternal death. Br J Psychiatry 183:279–281
O’Hara MW, Wisner KL (2014) Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol 28(1):3–12
Paschetta E, Berrisford G, Coccia F, Whitemore J, Wood A, Pretlove S, Ismail KMK (2014) Perinatal psychiatric disorders: an overview. Am J Obstet Gynecol 210(6):501–509.e6
Price SK, Proctor EK (2009) A rural perspective on perinatal depression: prevalence, correlates, and implications for help-seeking among low-income women. J Rural Health 25(2):158–166
Priebe S, Matanov A, Schor R et al (2012) Good practice in mental health care for socially marginalised groups in Europe: a qualitative study of expert views in 14 countries. BMC Public Health 12:248
Robertson E, Grace S, Wallington T, Stewart D (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26:289–295
SAS Institute Inc (2011) SAS® 9.3 System Options: reference, 2nd edn. SAS Institute Inc., Cary, NC, http://support.sas.com/documentation/cdl/en/lesysoptsref/64892/PDF/default/lesysoptsref.pdf. Accessed March 5, 2015
Song D, Sands RG, Wong YI (2014) Utilization of mental health services by low-income pregnant and postpartum women on medical assistance. Women Health 39(1):37–41
Spinelli MG (2004) Maternal infanticide associated with mental illness: prevention and the promise of saved lives. Am J Psychiatry 161(9):1548–1057
Statistics Canada (2011) Population, urban and rural, by province and territory (Ontario). http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo62g-eng.htm. Accessed November 22, 2015
Steele L, Dewa C, Lee K (2007) Socioeconomic status and self-reported barriers to mental health service use. Can J Psychiatry 52:201–206
Steele LS, Glazier RH, Lin E, Evans M (2004) Using administrative data to measure ambulatory mental health service provision in primary care. Med Care 42(10):960–965
Stein A, Pearson RM, Goodman SH et al (2014) Effects of perinatal mental disorders on the fetus and child. Lancet 384:1800–1819
Wisner KL, Moses-Kolko EL, Sit DKY (2010) Postpartum depression: a disorder in search of a definition. Arch Womens Ment Health 13:37–40
Zeman L, Arfken CL (2006) Decreasing unnecessary care in a psychiatric emergency service. Psychiatr Serv 57(1):137–138
Zuijdwijk CS, Cuerden M, Mahmud FH (2013) Social determinants of health on glycemic control in pediatric type 1 diabetes. J Pediatr 162(4):730–735
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. No small cells are contained in the data and therefore no details that might disclose the identity of a subject are present.
Funding
This study was supported by a grant from the Canadian Institutes of Health Research (CIHR). It was also supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of CIHI.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Barker, L.C., Kurdyak, P., Fung, K. et al. Postpartum psychiatric emergency visits: a nested case-control study. Arch Womens Ment Health 19, 1019–1027 (2016). https://doi.org/10.1007/s00737-016-0651-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-016-0651-3