Postpartum psychiatric emergency care visits followed up less than half the time

Fewer than half of emergency care visits for psychiatric reasons in postpartum women were accompanied by follow-up within 30 days, according to a study published in Lancet Psychiatry.

“Given the high risk nature of mental illness in the post-partum period, both for the childbearing parents and their infants, rapid follow-up after post-partum psychiatric emergency department attendance is essential to facilitate treatment,” Lucy C. Barker, MD, of the department of psychiatry at the University of Toronto, and colleagues wrote.

Barker and colleagues sought to examine outpatient mental health care follow-up by medical professionals 30 days after an initial postpartum psychiatric visit to emergency care, and to ascertain how social determinants affect those who receive treatment.

The population-based cohort study included health data from Ontario, accessed through ICES, a nonprofit health information database, and collected between April 1, 2008, and March 10, 2020. The search identified 12,158 people (mean age, 26.9 years) who had attended the ED for a psychiatric reason in the postpartum period, whose sex was listed as female on their health card.

Primary outcome was the proportion of individuals with any outpatient physician visit for a mental health reason within 30 days of the initial emergency visit. Associations between social determinants of health — age, neighborhood income and ethnic diversity, community size, immigration — and who received an outpatient mental health visit were also examined.

Barker and colleagues used modified Poisson regression in adjusting for social determinants of health, clinical and health services characteristics to examine independent associations with follow-up, and conditional inference trees to explore how social determinants of health intersect with each other and with clinical and health services characteristics in relation to follow-up.

Data showed that 9,848 individuals lived in an urban area. Among these 1,518 (15.5%) were immigrants, 2,587 (26.3%) lived in areas with high ethnic diversity and 2,318 lived in rural communities.

A total of 5,442 individuals (44.8%) received 30-day follow-up, 4,622 in the urban sub-cohort and 820 in the rural sub-cohort. In addition, 66.3% of individuals reported having a family physician, yet only 10% reported using a psychiatrist regularly. Regression models revealed that younger age, lower relative neighborhood income, smaller community size and immigrant status were the chief social determinants associated with lower likelihood of follow-up care.

“Ongoing equity-oriented, intersectionality-informed research and service implementation are needed to identify and address social determinants of health-related gaps in postpartum mental health care,” Barker and colleagues wrote.