Many women heading to ER for postpartum mood disorders

A new study from the Institute for Clinical Evaluative Sciences (ICES) and Women’s College Hospital shows that many Ontario women who experience mood disorders in the first year after giving birth go to their local emergency room for mental healthcare instead of visiting their family doctor or community mental health clinics. The researchers say the risk is highest for women from marginalized or rural communities.

The first year postpartum is a high-risk period for the development and recurrence of mental illness in women. Postpartum mood disorders can have serious consequences for women and their children.

“Our study highlights some important missed opportunities, since we know that all women do come into contact with healthcare services at various points during pregnancy and delivery,” says Simone Vigod, the senior author of the paper who is an adjunct scientist at ICES, a scientist at Women's College Research Institute and a staff psychiatrist at Women's College Hospital. “If care providers know how to effectively screen and link women at risk for postpartum mood disorders to appropriate mental health supports, we can help to prevent the sort of crisis that might later bring these women to the ER.”

Vigod and her team looked at the records for nearly 9,000 Ontario women who made an unplanned visit to the ER for a psychiatric reason (including psychotic disorders, depression, anxiety, bipolar disorder, alcohol or substance-related disorders, personality disorder, other psychiatric diagnoses or self-harm) during the first year after giving birth between 2006 and 2012. This represents a little more than 1 per cent of the roughly 800,000 women giving birth in the province during this time. They found that for 60 per cent of these women, the ER visit was the first mental health contact in the postpartum period, and only 14 per cent resulted in hospitalization, indicating that the mental health needs of these women could have been more appropriately met in places other than the ER.

Vigod notes that the study also shows that socioeconomic factors appear to be barriers in accessing postpartum mental health supports. Women from socioeconomically marginalized communities were nearly twice as likely to seek care in the ER, and women from marginalized ethnic groups were more than twice as likely. Women who are homeless or housing insecure were six times as likely to receive their first postpartum mental healthcare in the ER.

“By better understanding what the barriers are, we can work to improve them,” says Vigod. “For example, we can use well-baby visits or public health nursing services to ensure that marginalized postpartum women are screened for mental illness and linked to appropriate care. We can also target women’s mental health services in low-income neighborhoods. Because women are already accessing healthcare supports during the course of pregnancy and birth, we have a great starting place from which we can effectively address these barriers and meet the needs of the most vulnerable women and their babies.”

“Postpartum psychiatric emergency visits: a nested case-control study” was published today in the journal Archives of Women’s Mental Health.

Author block: Lucy Church Barker, Paul Kurdyak, Kinwah Fung, Flora I Matheson, Simone Vigod.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

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