Long-term outcomes of first episode affective psychosis in postpartum women

Outcomes of first episode postpartum psychosis and their distinction from outcomes of non-postpartum psychosis are poorly characterised.

To characterise the disease course and outcomes of first episode postpartum psychosis, compared with first episode non-postpartum psychosis.

This is a retrospective cohort study. Group demographics and subsequent outcomes were compared between groups unadjusted and adjusted for prior psychiatric illness. Outcome trajectories within the postpartum psychosis group were analysed via k-means clustering, and multivariable outcome prediction models calculated.

Women in the postpartum group (n = 408) had lower parity (0.4 vs 0.6, t = -4.3, p < 0,001) and more prior psychiatric admissions (0.8 vs 0.1, t = 12.8, p < 0.001) than those experiencing non-postpartum psychosis (n = 1011). During follow-up, women with postpartum psychosis had fewer subsequent births and an increased risk of readmission during subsequent postpartum periods (0.55 admissions/delivery). Mortality in the postpartum group (871/100,000/year) was c. 11.3x local population norm. Clustering identified two distinct clinical trajectories following first episode postpartum psychosis, one of higher future morbidity and one of lower future morbidity.

Small but significant differences in baseline characteristics and later prognosis were observed between individuals experiencing first episode postpartum psychosis and first episode non-postpartum psychosis in this single centre sample. Excess mortality was observed in both groups.