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Early discharge and risk for postnatal depression
A R Hickey1, P M Boyce, D Ellwood
1Department of Psychological Medicine, Nepean Hospital, Penrith, NSW.
Objective:
To determine whether early discharge (< 72 hours) after childbirth increased the risk for women developing postnatal depression.
Design:
Prospective cohort design consisting of an initial interview, and six-weekly assessments for 24 weeks using a self-report questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Women discharged within 72 hours were compared with the remaining women.
Setting:
Tertiary referral hospital in western Sydney, New South Wales, 1993.
Participants:
All 749 women delivering over a three-month period were recruited. Of the 522 participants, 425 women completed the study.
Main Outcome Measures:
Women scoring > 13 on the EPDS on two or more occasions were considered potential "cases" of postnatal depression. The diagnosis was confirmed using the Structured Clinical Interview for DSM-III-R disorders (SCID).
Results:
Of the 153 women (36%) discharged early, 22 women (14.4%) developed postnatal depression over the study period compared with 20 of the 272 women (7.4%) who had standard length of stay. Women who were discharged within 72 hours had a significantly increased risk for developing postnatal depression (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.07-4.21). This risk persisted when other sociodemographic, obstetric and psychosocial risk factors were controlled for in a logistic regression analysis (OR, 3.06; 95% CI, 1.22-7.69).
Conclusion:
Women planning early discharge after childbirth should be carefully assessed before discharge and follow-up should be rigorous. The potential to develop postnatal depression should be considered in all women choosing early discharge from hospital.