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

The incidence of depressive episodes is different before, during, and after pregnancy: A population-based study

BACKGROUND

Depressive episodes during pregnancy are widely investigated but it is still unknown whether pregnancy is a high-risk period compared to the pre-pregnancy period. Therefore, we aimed to investigate the incidence and recurrence of depressive episodes before, during, and after pregnancy.

METHODS

In the current population-based registry study, we calculated monthly incidence and recurrence of psychiatric inpatient admissions and outpatient psychiatric contact for depressive episodes. We identified a population consisting of all first childbirths in Denmark from 1999 through 2015 (N = 392,287).

RESULTS

Incidence of inpatient admission during pregnancy was lower than before pregnancy. After childbirth, a significant increase in first-time and recurrent psychiatric inpatient admissions was observed, especially in the first months. In contrast, outpatient psychiatric treatment incidence and recurrence were increased both during pregnancy as well as in the postpartum period, as compared to pre-pregnancy.

LIMITATIONS

Analyses were performed on depressive episodes representing the severe end of the spectrum, questioning generalizability to milder forms of depression treated outside psychiatric specialist treatment facilities.

CONCLUSION

We found a different pattern of severe episodes of depression compared to moderate episodes before, during, and after pregnancy. In light of our findings and those of others, we suggest distinguishing between timing of onset in the classification of depression in the perinatal period: Depression with pregnancy onset OR with postpartum onset (instead of the current DSM classifier "with perinatal onset"), as well as severity of depression, which is important for both clinical and future research endeavors.

Mental health service use among pregnant and early postpartum women

PURPOSE

To explore the proportion and characteristics of women with a mental disorder who have contact with mental health services during pregnancy and the postnatal period in a maternity service in London.

METHODS

Data from the WEll-being in pregNancy stuDY (WENDY), a prospective cohort study, were used. Women were recruited at their first appointment for antenatal care and assessed for mental disorders using the Structured Clinical Interview DSM-IV Axis I/II Disorders for Research. Clinical, sociodemographic and psychosocial characteristics were collected. Mental health service use data were collected for the period from study entry to 3 months postpartum.

RESULTS

Two hundred women met diagnostic criteria for a mental disorder. Fifty-five (34%) of these had at least one contact with mental health services. Moderate depression (OR 7.44, CI 2.03-27.28, p < 0.01), severe depression (OR 10.5, CI 2.68-41.12, p < 0.01), past psychiatric hospital admission (OR 3.76, CI 1.05-13.44, p < 0.05), symptoms of anxiety (OR 3.95, CI 1.86-8.37, p < 0.001) and perceived low levels of social support (OR 0.43, CI 0.18-1.01, p = 0.05) were associated with an increased likelihood of contact with mental health services in univariate analyses. However, only moderate (OR 5.92, CI 1.31-26.78, p = 0.02) and severe depression (OR 6.04, CI 1.08-33.72, p = 0.04) remained significant in the multivariate regressions analyses.

CONCLUSION

Only a third of women with a diagnosable mental disorder at their first antenatal appointment had any contact with mental health services during pregnancy or up to 3 months postpartum. Further research is warranted to elicit perinatal women's views about the potential barriers to accessing professional mental health care.

Creating the first national linked dataset on perinatal and maternal outcomes in Australia: Methods and challenges

BACKGROUND

Data linkage offers a powerful mechanism for examining healthcare outcomes across populations and can generate substantial robust datasets using routinely collected electronic data. However, it presents methodological challenges, especially in Australia where eight separate states and territories maintain health datasets. This study used linked data to investigate perinatal and maternal outcomes in relation to place of birth. It examined data from all eight jurisdictions regarding births planned in hospitals, birth centres and at home. Data linkage enabled the first Australia-wide dataset on birth outcomes. However, jurisdictional differences in data collection created challenges in obtaining comparable cohorts of women with similar low-risk pregnancies in all birth settings. The objective of this paper is to describe the techniques for managing previously linked data, and specifically for ensuring the resulting dataset contained only low-risk pregnancies.

METHODS

This paper indicates the procedures for preparing and merging linked perinatal, inpatient and mortality data from different sources, providing technical guidance to address challenges arising in linked data study designs.

RESULTS

We combined data from eight jurisdictions linking four collections of administrative healthcare and civil registration data. The merging process ensured that variables were consistent, compatible and relevant to study aims. To generate comparable cohorts for all three birth settings, we developed increasingly complex strategies to ensure that the dataset eliminated women with pregnancies at risk of complications during labour and birth. It was then possible to compare birth outcomes for comparable samples, enabling specific examination of the impact of birth setting on maternal and infant safety across Australia.

CONCLUSIONS

Data linkage is a valuable resource to enhance knowledge about birth outcomes from different settings, notwithstanding methodological challenges. Researchers can develop and share practical techniques to address these challenges. Study findings suggest that jurisdictions develop more consistent data collections to facilitate future data linkage.

The association of Emergency Department presentations in pregnancy with hospital admissions for postnatal depression (PND): a cohort study based on linked population data

BACKGROUND

To investigate the impact of presenting to an Emergency Department (ED) during pregnancy on postnatal depression (PND) in women in New South Wales (NSW), Australia.

METHOD

An epidemiological population-based study using linked data from the NSW Emergency Department Data Collection (EDDC), the NSW Perinatal Data Collection (PDC) and the NSW Admitted Patients Data Collection (APDC) was conducted. Women who gave birth to their first child in NSW between 1 January 2006 and 31 December 2010 were followed up from pregnancy to the end of the first year after birth.

RESULTS

The study population includes 154,328 women who gave birth to their first child in NSW between 2006 and 2010. Of these, 31,764 women (20.58%) presented to ED during pregnancy (95%CI = 20.38-20.78). Women who presented to ED during pregnancy were more likely to be admitted to hospital for the diagnosis of unipolar depression (the adjusted relative risk (RR) =1.86, 95%CI = 1.49-2.31) and the diagnosis of mild mental and behavioural disorders associated with the puerperium (the adjusted RR = 1.55, 95%CI = 1.29-1.87) than those without ED presentation.

CONCLUSION

Women's hospital admissions for postnatal depression were associated with frequent ED presentations during pregnancy.

Mental disorders in new parents before and after birth: a population-based cohort study

BACKGROUND

Mental disorders of women during the postnatal period are a major public health problem. Compared with women's mental disorders, much less attention has been paid to men's mental disorders in the perinatal period. To date, there have been no reports in the literature describing secular changes of both maternal and paternal hospital admissions for mental disorders over the period covering the year before pregnancy (non-parents), during pregnancy (expectant parents) and up to the first year after birth (parents) based on linked parental data. The co-occurrences of couples' hospital admissions for mental disorders have not previously been investigated.

AIMS

To describe maternal and paternal hospital admissions for mental disorders before and after birth. To compare the co-occurrences of parents' hospital admissions for mental disorder in the perinatal period.

METHOD

This is a cohort study using paired parents' population data from the New South Wales (NSW) Perinatal Data Collection (PDC), Registry of Births, Deaths and Marriages (RBDM) and Admitted Patients Data Collection (APDC). The study included all parents (n=196 669 couples) who gave birth to their first child in NSW between 1 January 2003 and 31 December 2009.

RESULTS

The hospital admission rate for women with a principal mental disorder diagnosis in the period between the year before pregnancy and the first year after birth was significantly higher than that for men. Parents' mental disorders influenced each other. If a man was admitted to hospital with a principal mental disorder diagnosis, his wife or partner was more likely to be admitted to hospital with a principal mental disorder diagnosis compared with women whose partner had not had a hospital admission, and vice versa.

CONCLUSIONS

Mothers' mental disorders after birth increased more significantly than fathers. However, fathers' mental disorders significantly impacted the co-occurrence of mothers' mental disorders.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Following Up Crack Users after Hospital Discharge Using Record Linkage Methodology: An Alternative to Find Hidden Populations

This paper presents the probabilistic record linkage (PRL) methodology as an alternative way to find or follow up hard-to-reach population as crack users. PRL was based on secondary data from public health information systems and the strategy used from standardization; phonetic encoding and the rounds of matching data were described. A total of 293 patient records from medical database and two administrative datasets obtained from Ministry of Health Information Systems were used. Patient information from the medical database was the identifiers to the administrative datasets containing data on outpatient treatment and hospital admissions. 40% of patient records were found in the hospital database and 12% were found in the outpatient database; 95% of the patients were hospitalized up to 5 times, and only 10 out of them had outpatient information. The record linkage methodology by linking government databases may help to address research questions about the path of patients in the care network without spending time and financial resources with primary data collection.

Data Integration Protocol In Ten-steps (DIPIT): a new standard for medical researchers

INTRODUCTION

The exponential increase in data, computing power and the availability of readily accessible analytical software has allowed organisations around the world to leverage the benefits of integrating multiple heterogeneous data files for enterprise-level planning and decision making. Benefits from effective data integration to the health and medical research community include more trustworthy research, higher service quality, improved personnel efficiency, reduction of redundant tasks, facilitation of auditing and more timely, relevant and specific information. The costs of poor quality processes elevate the risk of erroneous outcomes, an erosion of confidence in the data and the organisations using these data. To date there are no documented set of standards for best practice integration of heterogeneous data files for research purposes. Therefore, the aim of this paper is to describe a set of clear protocol for data file integration (Data Integration Protocol In Ten-steps; DIPIT) translational to any field of research.

METHODS AND RESULTS

The DIPIT approach consists of a set of 10 systematic methodological steps to ensure the final data are appropriate for the analysis to meet the research objectives, legal and ethical requirements are met, and that data definitions are clear, concise, and comprehensive. This protocol is neither file specific nor software dependent, but aims to be transportable to any data-merging situation to minimise redundancy and error and translational to any field of research. DIPIT aims to generate a master data file that is of the optimal integrity to serve as the basis for research analysis.

CONCLUSION

With linking of heterogeneous data files becoming increasingly common across all fields of medicine, DIPIT provides a systematic approach to a potentially complex task of integrating a large number of files and variables. The DIPIT protocol will ensure the final integrated data is consistent and of high integrity for the research requirements, useful for practical application across all fields of medical research.

Hospital admissions for alcohol use disorders before, during, and after pregnancy: a study based on linked population data in new South Wales, Australia

BACKGROUND

Alcohol use disorders (AUD) during pregnancy can have profound lifelong effects on the baby, including fetal alcohol spectrum disorders (FASD). Hospital admission for AUD during pregnancy provides an opportunity for intervention. Characterization of women along the AUD spectrum during pregnancy aids the development of prevention strategies, policy, and clinical management guidelines aimed at this population. This study describes the hospital admission levels for AUD between the sixth month before pregnancy and the first year after birth and explores risk factors associated with the hospital admissions.

METHODS

This study was based on linked population data between 2002 and 2005 using the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC), Australia. The study subjects included primiparous mothers who were admitted to hospital in the period from the sixth month before pregnancy to 1 year after birth with at least 1 of the following diagnoses (ICD-10-AM): mental and behavioral disorders due to the use of alcohol (MBDA) (F10.0-10.9); toxic effects of alcohol (T51.0-51.9); maternal care for suspected damage to fetus from alcohol (O35.4); or alcohol rehabilitation (Z50.2).

RESULTS

A total of 175 new mothers had 287 hospital admissions with the principal or stay AUD diagnoses during the study period in NSW. Of the 287 admissions, 181 admissions (63.07%) were reported for an alcohol-related disorder as the principal diagnosis. The hospital admission rate for AUD was 1.76/1,000 person-years (PY) (95% CI: 1.45 to 2.07) during the 6 months prepregnancy. The rate decreased to 0.49/1,000 PY (95% CI: 0.36 to 0.63) during pregnancy and to 0.82/1,000 PY (95% CI: 0.67 to 0.97) in the first year after birth. Women who smoked during pregnancy, lived in a remote area and were younger than 25 years, were more likely to be admitted to hospital with AUD diagnoses. Women in the middle disadvantaged quintile and born in other countries were less likely to be admitted to hospital with AUD diagnoses.

CONCLUSIONS

Hospital admission for AUD decreased significantly in pregnancy and the first year postpartum compared to the prepregnancy period.