Hostname: page-component-7c8c6479df-p566r Total loading time: 0 Render date: 2024-03-27T19:21:52.846Z Has data issue: false hasContentIssue false

Epidemiology of Puerperal Psychoses

Published online by Cambridge University Press:  02 January 2018

R. E. Kendell*
Affiliation:
Edinburgh University Department of Psychiatry
J. C. Chalmers
Affiliation:
Medical Statistics Unit, University of Edinburgh
C. Platz
Affiliation:
Royal Edinburgh Hospital
*
University Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh EH10 5HF

Abstract

Computer linkage of an obstetric register and a psychiatric case register made it possible to investigate the temporal relationship between childbirth and psychiatric contact in a population of 470 000 people over a 12-year period resulted in 54 087 births: 120 psychiatric admissions within 90 days of parturition. The ‘relative risk’ of admission to a psychiatric hospital with a psychotic illness was extremely high in the first 30 days after childbirth, particularly in primiparae, suggesting that metabolic factors are involved in the genesis of puerperal psychoses. However, being unmarried, having a first baby, Caesarian section and perinatal death were all associated with an increased risk of psychiatric admission or contact, or both, suggesting that psychological stresses also contribute to this high psychiatric morbidity. Women with a history of manic depressive illness, manic or depressive, had a much higher risk of psychiatric admission in the puerperium than those with a history of schizophrenia or depressive neuroses, and the majority of puerperal admissions met Research Diagnostic Criteria for manic or depressive disorder. Probably, therefore, puerperal psychoses are manic depressive illnesses and unrelated to schizophrenia.

Type
Research Article
Copyright
Copyright © 1987 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bratfos, O. & Haug, J. O. (1966) Puerperal mental disorders in manic depressive females. Acta Psychiatrica Scandinavica, 42, 285294.CrossRefGoogle ScholarPubMed
Brockington, I. F., Winokur, G. & Dean, C. (1982) Puerperal psychoses. In Motherhood and Mental Illness (eds L. F. Brockington & R. Kumar). London: Academic Press.Google Scholar
Dean, C. & Kendell, R. E. (1981) The symptomatology of puerperal illnesses. British Journal of Psychiatry, 139, 128133.CrossRefGoogle ScholarPubMed
Esquirol, E. (1845) Mental Maladies: a Treatise on Insanity. (trans. Hunt, E. K.). Philadelphia: Lea & Blanchard.Google Scholar
Heasman, M. A. & Clarke, J. A. (1979) Medical record linkage in Scotland. Health Bulletin, 37, 97103.Google ScholarPubMed
Kendell, R. E. (1985) Emotional and physical factors in the genesis of puerperal mental disorders. Journal of Psychosomatic Research, 29, 311.CrossRefGoogle ScholarPubMed
Kendell, R. E., Wainwright, S., Hailey, A. & Shannon, B. (1976) The influence of childbirth on psychiatric morbidity. Psychological Medicine, 6, 297302.CrossRefGoogle ScholarPubMed
Kendell, R. E. McGuire, R. J., Connor, Y. & Cox, J. L. (1981a) Mood changes in the first three months after childbirth. Journal of Affective Disorders, 3, 317326.CrossRefGoogle Scholar
Kendell, R. E., Rennie, D., Clarke, J. A. & Dean, C. (1981b) The social and obstetric correlates of psychiatric admission in the puerperium. Psychological Medicine, 11, 341350.CrossRefGoogle ScholarPubMed
Kumar, R. & Robson, K. M. (1984) A prospective study of emotional disorders in childbearing women. British Journal of Psychiatry, 144, 3547.CrossRefGoogle ScholarPubMed
Paffenbarcer, R. S. (1964) Epidemiological aspects of parapartum mental illness. British Journal of Preventive and Social Medicine, 18, 189195.Google Scholar
Paykel, E. S. (1978) Contribution of life events to causation of psychiatric illness. Psychological Medicine, 8, 245253.CrossRefGoogle ScholarPubMed
Kendell, R. E., Prusoff, B. A. & Myers, J. K. (1975) Suicide attempts and recent life events: a controlled comparison. Archives of General Psychiatry, 32, 327333.Google Scholar
Perris, C. & Brockington, I. F. (1981) Cycloid psychoses and their relation to the major psychoses. In Biological Psychiatry 1981 (eds C. Perris, G. Struwe & B. Jansson). Amsterdam: Elsevier/North Holland Biomedical Press.Google Scholar
Pugh, T. F., Jerath, B. K., Schmidt, W. M. & Reed, R. B. (1963) Rates of mental disease related to childbearing. New England Journal of Medicine, 268, 12241228.CrossRefGoogle ScholarPubMed
Reich, T. & Winokur, G. (1970) Postpartum psychoses in patients with manic depressive disease. Journal of Nervous and Mental Disease, 151, 6068.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research Diagnostic Criteria for a Selected Group of Functional Disorders, 3rd edn. New York State Psychiatric Institute.Google Scholar
Surtees, P. G., Dean, C., Ingham, J. G., Kreitman, N. B., Miller, P. Mc C. & Sashidharan, S. P. (1983) Psychiatric disorder in women from an Edinburgh community: associations with demographic factors. British Journal of Psychiatry, 142, 238246.CrossRefGoogle ScholarPubMed
Surtees, P. G., Miller, P.Mc C., Ingham, J. G., Kreitman, N. B., Rennie, D. & Sashidharan, S. P. (1986) Life events and the onset of affective disorder. Journal of Affective Disorders, 10, 3750.CrossRefGoogle ScholarPubMed
Tetlow, C. (1955) Psychoses of childbearing. Journal of Mental Science, 101, 629639.CrossRefGoogle ScholarPubMed
Vislie, H. (1956) Puerperal mental disorders. Acta Psychiatrica et Neurologica Scandinavica, suppl. 111.Google Scholar
Whalley, L. J., Roberts, D. F., Wentzel, J. & Wright, A. F. (1982) Genetic factors in puerperal affective psychoses. Acta Psychiatrica Scandinavica, 65, 180193.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.