Predelivery concussion linked to increased risk for severe maternal mental illness

Key takeaways:

• Overall, 11.3% of individuals with a predelivery history of concussion experienced severe maternal mental illness.
• This association was strongest in those with no history of mental illness.

Individuals with a predelivery history of concussion appeared to be at increased risk for severe maternal mental illness, highlighting the importance of screening and supportive care for this high-risk group, according to researchers.

“There are several known risk factors for severe maternal mental illness, including history of mental illness, lack of social support and history of abuse or violence,” Samantha Krueger, RM, BHSc, MSc, a registered midwife and doctoral student in clinical epidemiology at McMaster University, and colleagues wrote in the Journal of Clinical Psychiatry. “However, many birthing people experience severe mental illness outcomes without these risk factors.”

As concussion is the most common traumatic brain injury and carries risk for mental illness in the general population, the researchers sought to examine the relationship between predelivery concussion history and risk for severe maternal mental illness.

Using health administration data from the Institute of Clinical Evaluative Sciences, Krueger and colleagues conducted a population-based cohort study of individuals in Ontario, Canada, with a single-child live birth between April 2007 and March 2017.

The researchers included 806,330 individuals in the analysis, of whom 18,064 (2.2%) had a history of concussion and 736,689 (91.4%) did not.

The primary outcome was incidence of severe maternal mental illness, defined as a psychiatric ED visit or hospital admission, or self-harm or suicide up to 14 years after delivery.

Krueger and colleagues used Cox proportional hazards regression to compare individuals with and without a recorded health care encounter for concussion, adjusting for sociodemographic confounding factors as well as history of interpersonal violence and mental illness.

According to the results, 11.3% of those with a predelivery history of concussion experienced severe maternal mental illness (14.7 per 1,000 person-years) vs. 6.8% of those without predelivery history of concussion (7.9 per 1,000 person-years; adjusted HR = 1.25; 95% CI, 1.2-1.31).

When stratified by a history of predelivery mental illness, the association was strongest in individuals with no mental illness history (aHR = 1.33; 95% CI, 1.23-1.44) and remained strong for those with a history of outpatient care (aHR = 1.3; 95% CI, 1.2-1.4) and acute care for mental illness (aHR = 1.14; 95% CI, 1.06-1.24).

“As a high-risk group, birthing people with a history of concussion could also benefit from ongoing screening for mental illness by their primary care provider in the months and years after childbirth,” Krueger and colleagues wrote.