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Perinatal mental illness among women with disabilities: a population-based cohort study

Abstract

Purpose

To examine the risk of perinatal mental illness, including new-onset disorders and recurrent or ongoing use of mental health care, comparing women with physical, sensory, intellectual/developmental, and multiple disabilities to those without a disability.

Methods

From all women aged 15–49 years with a singleton birth in Ontario, Canada (2003–2018), those with physical (n = 144,972), sensory (n = 45,249), intellectual/developmental (n = 2,227), and ≥ 2 of these disabilities (“multiple disabilities”; n = 8,883), were compared to 1,601,363 without a disability on risk of healthcare system contact for mental illness from conception to 365 days postpartum. The cohort was stratified into: (1) no pre-pregnancy mental illness (to identify new-onset illness), (2) distal mental illness (> 2 years pre-pregnancy, to identify recurrent illness), and (3) recent mental illness (0–2 years pre-pregnancy, to identify ongoing contact). Modified Poisson regression generated relative risks (aRR), adjusted for age, parity, income quintile, and rural residence.

Results

About 14.7, 26.5, and 56.6% of women with no disabilities had new-onset, recurrent, and ongoing contact for mental illness, respectively, perinatally. Risks were elevated across disability groups for new-onset (physical: aRR 1.18, 95% CI 1.16–1.20; sensory: 1.11, 1.08–1.15; intellectual/developmental: 1.38, 1.17–1.62; multiple: 1.24, 1.15–1.33), recurrent (physical: 1.10, 1.08–1.12; sensory 1.06, 1.02–1.09; intellectual/developmental: 1.24, 1.11–1.37; multiple: 1.16, 1.09–1.23), and ongoing contact (physical: 1.09, 1.08–1.10; sensory: 1.08, 1.06–1.10; intellectual/developmental: 1.31, 1.26–1.37; multiple: 1.20, 1.16–1.23).

Conclusion

The heightened use of new, recurrent, and ongoing mental health care across disability groups in the perinatal period suggests that adapted screening and intervention approaches are critical to optimize perinatal mental health in this population.

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Acknowledgements

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under award # 5R01HD092326. This research was undertaken, in part, thanks to funding from the Canada Research Chairs Program to Dr. Hilary K. Brown. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding; no endorsement is intended or should be inferred.

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Correspondence to Hilary K. Brown.

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Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI. Parts of this report are based on Ontario Registrar General (ORG) information on deaths, the original source of which is ServiceOntario. The views expressed therein are those of the author and do not necessarily reflect those of ORG or the Ministry of Government Services. Dr. Vigod receives royalties from UpToDate Inc for authorship of materials related to depression and pregnancy.

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Brown, H.K., Vigod, S.N., Fung, K. et al. Perinatal mental illness among women with disabilities: a population-based cohort study. Soc Psychiatry Psychiatr Epidemiol (2022). https://doi.org/10.1007/s00127-022-02347-2

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  • DOI: https://doi.org/10.1007/s00127-022-02347-2

Keywords

  • Disability
  • Mental health
  • Pregnancy
  • Postpartum period