Archives of Women's Mental Health

, Volume 15, Issue 5, pp 333–341 | Cite as

Major depressive disorder in the perinatal period: using data linkage to inform perinatal mental health policy

  • Fenglian Xu
  • Marie-Paule Austin
  • Nicole Reilly
  • Lisa Hilder
  • Elizabeth A. Sullivan
Original Article

Abstract

This study aims to investigate hospital admission of major depressive disorders (MDD) before and after birth. Population data for all primiparous women admitted to the hospital with depressive disorders before and after birth were used. The comparison group consisted of 10 % of primiparous women not admitted to the hospital with a diagnosis of a psychiatric disorder or substance use. A total of 728 women had a first admission with depressive disorders (501 in the first postpartum year). The rate of first hospital admission for depressive disorders decreased during pregnancy and increased markedly in the first three months after birth (peaking in the second month with a rate of 10.74/1,000 person year and rate ratio of 12.56) compared with the 6 months prior to pregnancy. Admission remained elevated in the second postpartum year. Older maternal age, smoking, elective caesarian section and admission to a neonatal intensive care unit or special care nursery were associated with a higher rate of admission. Women born outside Australia and those most socioeconomically disadvantaged were less likely to be admitted to the hospital in the first postpartum year. Overall risk of hospital admission with depressive disorders rose significantly across the entire first postpartum year. This has significant implications for policy and service planning for women with mood disorders in the perinatal period.

Keywords

Depressive disorder Postpartum Data linkage 

References

  1. Adhikari P (2006) Socio-economic indexes for areas: Introduction, use and future directions. Australian Bureau of Statistics, CanberraGoogle Scholar
  2. Almond P (2009) Postnatal depression: a global public health perspective. Perspectives in Public Health 129(5):221–227PubMedCrossRefGoogle Scholar
  3. Austin M-P (2006) To treat or not to treat: maternal depression, SSRI use in pregnancy and adverse neonatal effects. Psychol Med 36(12):1663–1670PubMedCrossRefGoogle Scholar
  4. Austin MP, Leader L (2000) Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms. Aust N Z J Obstet Gynaecol 40(3):331–337PubMedCrossRefGoogle Scholar
  5. Austin MP, Priest SR (2005) Clinical issues in perinatal mental health: new developments in the detection and treatment of perinatal mood and anxiety disorders. Acta Psychiatr Scand 112(2):97–104PubMedCrossRefGoogle Scholar
  6. Austin M-P, Hadzi-Pavlovic D et al (2010) Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection? Arch Women's Ment Health 13(5):395–401CrossRefGoogle Scholar
  7. Austin M-P, Highet N, et al. (2011a) The beyondblue clinical practice guidelines for depression and related disorders—anxiety, bipolar disorder and puerperal psychosis—in the perinatal period. A Guideline for Primary Care Health Professionals Providing Care in the Perinatal Period. beyondblue: the national depression initiative, MelbourneGoogle Scholar
  8. Austin M-P, Colton J, et al. (2011b) The Antenatal Risk Questionnaire (ANRQ): acceptability and use for psychosocial risk assessment in the maternity setting. Women Birth. doi:10.1016/j.wombi.2011.06.002
  9. Australian Institute of Health and Welfare (2010) Mental health services in Australia 2007–08. Mental Health Series No. 12., Cat. No. HSE 88. AIHW, CanberraGoogle Scholar
  10. Cliffe S, Black D et al (2008) Maternal deaths in New South Wales, Australia: a data linkage project. Aust N Z J Obstet Gynaecol 48(3):255–260PubMedCrossRefGoogle Scholar
  11. Cox JL, Murray D et al (1993) A controlled study of the onset, duration and prevalence of postnatal depression. Br J Psychiatry 163:27–31PubMedCrossRefGoogle Scholar
  12. Dayan J, Creveuil C et al (2006) Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a prospective cohort study among women with early and regular care. Psychosom Med 68(6):938–946PubMedCrossRefGoogle Scholar
  13. Dudek-Shriber L (2004) Parent stress in the neonatal intensive care unit and the influence of parent and infant characteristics. Am J Occup Ther 58(5):509–520PubMedCrossRefGoogle Scholar
  14. Gaynes BN, Gavin N et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep/Technol Assess 118:1–225Google Scholar
  15. Kendell RE, Rennie D et al (1981) The social and obstetric correlates of psychiatric admission in the puerperium. Psychol Med 11(2):341–350PubMedCrossRefGoogle Scholar
  16. Kendell RE, Chalmers JC et al (1987) Epidemiology of puerperal psychoses. Br J Psychiatry 150:662–673PubMedCrossRefGoogle Scholar
  17. Lasser K, Boyd JW et al (2000) Smoking and mental illness: a population-based prevalence study. JAMA 284(20):2606–2610PubMedCrossRefGoogle Scholar
  18. Martins C, Gaffan EA (2000) Effects of early maternal depression on patterns of infant–mother attachment: a meta-analytic investigation. J Child Psychol Psychiatry 41(6):737–746PubMedCrossRefGoogle Scholar
  19. Milgrom J, Westley D et al (2004) The mediating role of maternal responsiveness in some longer term effects of postnatal depression on infant development. Infant Behav Dev 27(4):443–454CrossRefGoogle Scholar
  20. Mracog RK, Jenkins GJ et al (1992) The influence of maternal age on caesarean section rates. Aust N Z J Obstet Gynaecol 32(3):206–207CrossRefGoogle Scholar
  21. Munk-Olsen T, Laursen TM et al (2006) New parents and mental disorders: a population-based register study. JAMA 296(21):2582–2589PubMedCrossRefGoogle Scholar
  22. Murray L, Arteche A et al (2011) Maternal postnatal depression and the development of depression in offspring up to 16 years of age. J Am Acad Child Adolesc Psychiatr 50(5):460–470CrossRefGoogle Scholar
  23. National Centre for Classification in Health (1999) The international statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM). National Centre for Classification in Health, SydneyGoogle Scholar
  24. National Institute for Health and Clinical Excellence (NICE) (2007) Antenatal and postnatal mental health: The NICE guidelines on clinical management and service guidance CG45. The British Psychological Society & the Royal College of Psychiatrists, National Collaborating Centre for Mental Health, LondonGoogle Scholar
  25. O'Hara MW, Swain AM (1996) Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatr 8(1):37–54CrossRefGoogle Scholar
  26. Pawlby S, Sharp D et al (2008) Postnatal depression and child outcome at 11 years: the importance of accurate diagnosis. J Affect Disord 197:241–245CrossRefGoogle Scholar
  27. Rahman A, Bunn J et al (2007) Maternal depression increases infant risk of diarrhoeal illness: a cohort study. Arch Dis Child 92(1):24–28PubMedCrossRefGoogle Scholar
  28. Ratnarajah D, Schofield MJ (2007) Parental suicide and its aftermath: a review. J Fam Stud 13(1):78–93CrossRefGoogle Scholar
  29. Savitz DA, Stein CR et al (2011) The Epidemiology of hospitalized postpartum depression in New York State, 1995–2004. Ann Epidemiol 21(6):399–406PubMedCrossRefGoogle Scholar
  30. Schneider B, Philipp M et al (2001) Psychopathological predictors of suicide in patients with major depression during a 5-year follow-up. Eur Psychiatr 16(5):283–288CrossRefGoogle Scholar
  31. Scottish Intercollegiate Guidelines Network (SIGN) (2007) SIGN 60. Postnatal depression and puerperal psychosis: A national clinical guideline. 2007 review. Royal College of Physicians, EdinburghGoogle Scholar
  32. Wurmser H, Rieger M et al (2006) Association between life stress during pregnancy and infant crying in the first six months postpartum: a prospective longitudinal study. Early Hum Dev 82(5):341–349PubMedCrossRefGoogle Scholar
  33. Yang S-N, Shen L-J et al (2011) The delivery mode and seasonal variation are associated with the development of postpartum depression. J Affect Disord 132(1–2):158–164PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Fenglian Xu
    • 1
  • Marie-Paule Austin
    • 2
  • Nicole Reilly
    • 2
  • Lisa Hilder
    • 1
  • Elizabeth A. Sullivan
    • 1
  1. 1.Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s HealthUniversity of New South WalesSydneyAustralia
  2. 2.Perinatal and Women’s Mental Health Unit, St John of God Health Care and School of PsychiatryUniversity of New South WalesSydneyAustralia

Personalised recommendations