Women with schizophrenia less likely to use acute mental health services during pregnancy and after delivery

Women with schizophrenia use fewer acute psychiatric services during pregnancy and in the year following delivery, at about half the amount used in the year before pregnancy. This is among the findings of a new study from the Institute for Clinical Evaluative Sciences (ICES) and Women’s College Hospital that was published today in the Journal of Clinical Psychiatry.

"We saw that psychiatric hospitalizations and emergency department visits for women with schizophrenia were roughly halved during pregnancy, and aside from the first nine days after birth during which they were at much higher risk, these rates remained lower overall in the year after delivery,” says Dr. Simone Vigod, the paper’s senior author who is an adjunct scientist at ICES and a scientist at Women's College Research Institute. “As half of women with schizophrenia can expect to become pregnant, we think it will be helpful for these women and their families and care providers to understand that except for the first week after delivery, they are at relatively lower risk of requiring acute psychiatric inpatient and emergency care during pregnancy and in the year following."

Using anonymized health records held at ICES, the researchers examined healthcare use for all women diagnosed with schizophrenia in Ontario who had a live birth between 2003 and 2011. They looked at how each of the 1,433 women in the sample used healthcare in the one year before pregnancy, during pregnancy, and for one year after. About half of the women had not delivered a baby previously, and almost 60 per cent of the women lived in neighbourhoods that fall into the lowest two neighbourhood income quintiles.

Emergency department visits and hospitalizations for psychiatric and self-harm reasons were consistently lower in pregnancy and in the year following birth, compared to the year before conception.

"It may be that new mothers had more interaction with their healthcare providers and social services in the postpartum period, so symptom exacerbations were caught early and treated," explains Vigod. "It may also be—as we've seen in other studies of new mothers with schizophrenia—that having a child can increase a woman’s self-esteem and her motivation to remain stable, as well as drawing her closer to an extended network of family and social supports."

The researchers note that these lower hospitalization numbers may also reflect extra precautions on the part of women and their care providers to avoid hospitalization in the year following birth, perhaps due to concerns about potential loss of custody or a wish to avoid mother-infant separation.

The study’s findings include:

• Twenty-five per cent of the women had had at least one psychiatric hospitalization in the year before conception. During pregnancy this fell to about 12 per cent, and 19 per cent in the year after birth.
• Twenty per cent of the women had at least one psychiatric ED visit without hospitalization in the year before conception. This fell to 10 per cent during pregnancy, and 15 per cent in the year after birth.
• Self-harm related ED visits dropped sharply, with four percent of the women treated for a self-harm incident prior to conception, falling to only about 1 per cent of women both during and after pregnancy.
• The incidence rate of psychiatric hospitalizations in the year before pregnancy (50 per 100 person-years) was halved during pregnancy (25 per 100 person-years), and reduced by one third in the year following birth (33 per 100 person-years).
• While psychiatric hospitalizations were much lower over the entire one-year period postpartum, the rates were much higher in the first 9 days after birth (at three times the rates before pregnancy), waning over the first month.

The researchers say there has been little research to date on the use of psychiatric services for women with schizophrenia during or shortly after pregnancy, and no study has looked at patterns at the individual level. They say the next step will be to find ways to identify women at higher risk of requiring acute psychiatric services in the time around pregnancy.

Says Vigod, “Given that most women engage with the healthcare system for care after delivery, and that most deliver their infants in hospital, this gives us an ideal opportunity for psychiatric and social services to establish therapeutic relationships with women and their babies to ensure that they have all the supports they need to make a healthy transition to parenthood.”

The study “Hospitalizations and emergency department visits for psychiatric illness during and after pregnancy among women with schizophrenia” was published today in the Journal of Clinical Psychiatry.

Authors: Geneviève Rochon-Terry, Andrea Gruneir, Mary V. Seeman, Joel G. Ray, Paula Rochon, Cindy-Lee Dennis, Sophie Grigoriadis, Kinwah Fung, Paul A. Kurdyak and Simone N. 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

About Women’s College Hospital – For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of equitable access, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole. Women’s College Research Institute (WCRI) is tackling some of the greatest health challenges of our time. Its scientists are conducting global research that advances the health of women and improves healthcare options for all, and are then translating those discoveries to provide much-needed improvements in healthcare worldwide. For more information about how WCH and WCRI are transforming patient care, visit www.womenscollegehospital.ca and www.womensresearch.ca

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