Hilary K Brown1,2,3,4,5, Simone N Vigod6,7,8, Kinwah Fung7, Simon Chen7, Astrid Guttmann7,9,10,11, Susan M Havercamp12, Susan L Parish13, Joel G Ray7,14, Yona Lunsky6,7,15. 1. Department of Health & Society, University of Toronto Scarborough, Toronto, Canada. hk.brown@utoronto.ca. 2. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. hk.brown@utoronto.ca. 3. Department of Psychiatry, University of Toronto, Toronto, Canada. hk.brown@utoronto.ca. 4. ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada. hk.brown@utoronto.ca. 5. Women's College Research Institute, Women's College Hospital, Toronto, Canada. hk.brown@utoronto.ca. 6. Department of Psychiatry, University of Toronto, Toronto, Canada. 7. ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada. 8. Women's College Research Institute, Women's College Hospital, Toronto, Canada. 9. Hospital for Sick Children, Toronto, Canada. 10. Edwin HS Leong Centre for Healthy Children, University of Toronto, Toronto, Canada. 11. Department of Pediatrics, University of Toronto, Toronto, Canada. 12. Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, USA. 13. College of Health Professions, Virginia Commonwealth University, Richmond, USA. 14. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. 15. Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Canada.
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.
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.
Authors: Hilary K Brown; Simon Chen; Astrid Guttmann; Susan M Havercamp; Susan Parish; Joel G Ray; Lesley A Tarasoff; Simone N Vigod; Adele Carty; Yona Lunsky Journal: Am J Obstet Gynecol Date: 2019-11-02 Impact factor: 8.661