Emergency Psychiatry

Journal Article Annotations
2016, 3rd Quarter

Emergency Psychiatry

Annotations by Scott A. Simpson MD MPH
October 2016

  1. Postpartum psychiatric emergency visits: a nested case-control study

Also of interest:

PUBLICATION #1 — Emergency Psychiatry
Postpartum psychiatric emergency visits: a nested case-control study
Barker LC, Kurdyak P, Fung K, Matheson FI, Vigod S
Arch Womens Ment Health 2016 Aug 11 [Epub ahead of print]

The finding: More than 1% of women will present to an emergency department (ED) for a mental health complaint in the postpartum period. The investigators studied all women (n=8728) in a Canadian province who had an emergency psychiatric visit in the year after giving birth. The ED was the first episode of postpartum psychiatric care for 60% of women; compared to women who had an outpatient visit as their first mental health visit, first presenters were less likely to have a prior psychiatric diagnosis (51% versus 74% of patients) or outpatient psychiatric care prior to delivery (11% versus 29%). Reasons for presentation were roughly similar in both groups, but inpatient psychiatric hospitalization was not common (14% versus 20%). The median time to first visit was 5 months, and only about 25% of ED visits occur prior to 2 months postpartum. The authors found that patients receiving their first episode of care in the ED were more likely to be economically marginalized and postulate that barriers to accessing outpatient care precipitate unnecessary ED visits.

Strength and weaknesses: The authors provide a rich description of an understudied patient population. The authors estimate they capture over 98% of births. The authors are most interested in the effect of economic marginalization on patients’ utilization; however, it is unclear which barriers complicate access to care for patients in a system where outpatient mental health is freely available. The authors posit that these barriers include access to psychological treatments and “limited acceptability of drug treatments for depression and anxiety.” However, the study’s methodology cannot prove this, and it remains unclear why most women in the study used the ED for care.

Relevance: Most postpartum women in need of mental health care will first seek treatment through an emergency department. Emergency psychiatrists must be familiar with psychiatric management in the postpartum period.