General medical conditions and mortality in women with postpartum psychiatric disorders
General medical conditions and mortality in women with postpartum psychiatric disorders
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DOI：
10.1111/acps.13232
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发表时间：
2020-09-25
影响因子：
6.7
通讯作者：
Munk-Olsen, T.
中科院分区：
文献类型：
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作者：
Johannsen, B. M. W.;Laursen, T. M.;Munk-Olsen, T.
背景精神病患者的一般医疗条件和死亡率的风险增加，但没有研究系统地探讨这些结果的妇女与精神障碍分娩后（产后精神障碍：PPD）。因此，我们的目的是调查随后的一般医疗条件和死亡率的妇女与广泛的PPD的风险。这项基于登记的队列研究跟踪了1960年1月1日之后出生的所有丹麦女性，直到2016年1月1日。关注的暴露为（i）轻度-中度PPD：首次处方精神药物（ATC代码：N 03-N 07）和（ii）重度PPD：首次住院或门诊接触精神病机构，均在产后6个月内。关注的结果是（i）医院登记的慢性疾病和（ii）自然和非自然原因导致的死亡率。我们纳入了1 841 949名妇女，代表22 615 310人年的风险。结果在15852例轻中度PPD患者和4266例重度PPD患者中，我们发现与女性背景人群相比，轻中度PPD患者发生任何后续全身疾病的风险更高（IRR 1.25; 95% CI 1.20-1.31和重度PPD患者IRR 1.35; 95% CI 1.24-1.48）。两组中自然和非自然原因的死亡率均较高：轻度-中度PPD：自然原因MRR 1.37; 95% CI：1.17-1.61;非自然原因MRR 1.52; 95% CI：1.10-2.11，重度PPD：自然原因MRR 1.42; 95% CI 1.02-2.00，非自然原因MRR 5.05; 95% CI：3.40-7.51.结论：首次对PPD患者的一般医疗预后进行了概述，结果表明，处于疾病谱两端的女性发生后续慢性疾病和总体死亡率的风险增加。
Background Psychiatric patients have an increased risk of general medical conditions and mortality, but no study has systematically explored these outcomes among women with mental disorders following childbirth (postpartum psychiatric disorders: PPD). Therefore, we aimed to investigate the risk of subsequent general medical conditions and mortality in women with a broad spectrum of PPD. Methods This register-based cohort study followed all Danish women born after January 1, 1960, until January 1, 2016. The exposure of interest was (i) mild-moderate PPD: first-ever prescription of psychotropic medication (ATC codes: N03-N07) and (ii) severe PPD: first-ever in- or out-patient contact to a psychiatric facility, both within six months postpartum. Outcomes of interest were (i) hospital-registered chronic medical conditions and (ii) mortality from natural and unnatural causes. We included 1 841 949 women representing 22 615 310 person-years at risk. Results Among 15 852 women with mild-moderate PPD and 4266 women with severe PPD, we found a higher risk of any subsequent general medical condition (mild-moderate PPD: IRR 1.25; 95% CI 1.20-1.31 and severe PPD: IRR 1.35; 95% CI: 1.24-1.48) when compared to the female background population. Mortality from both natural and unnatural causes was higher in both groups: Mild-moderate PPD: natural causes MRR 1.37; 95% CI: 1.17-1.61; unnatural causes MRR 1.52; 95% CI: 1.10-2.11, andsevere PPD: natural causes MRR 1.42; 95% CI 1.02-2.00, and unnatural causes MRR 5.05; 95% CI: 3.40-7.51. Conclusions This first overview of general medical prognosis in PPD shows that women at either end of the spectrum are at increased risk of subsequent chronic medical conditions and overall mortality.