Maternal bereavement shortly before or during pregnancy and risk of postpartum psychotic illness: a population-based study from Denmark and Sweden
Authors Warselius P, Cnattingius S, Li J, Wei D, Valdimarsdottir UA, Kosidou K, Reutfors J, Olsen J, Vestergaard M, Obel C, László KD
Received 26 November 2018
Accepted for publication 27 February 2019
Published 24 April 2019 Volume 2019:11 Pages 285—298
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Professor Henrik Toft Sørensen
Pauline Warselius,1 Sven Cnattingius,1 Jiong Li,2 Dang Wei,3 Unnur Anna Valdimarsdottir,4,5 Kyriaki Kosidou,3,6 Johan Reutfors,1 Jørn Olsen,2,7 Mogens Vestergaard,8,9 Carsten Obel,8,9 Krisztina D László3
1Department of Medicine Solna, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; 2Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; 3Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 5Faculty of Medicine, University of Iceland, Reykjavik, Iceland; 6Centre for Epidemiology and Community Medicine, Stockholm County’s Health Care District, Stockholm, Sweden; 7Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA; 8Department of Public Health, Aarhus University, Aarhus, Denmark; 9Research Unit and Section for General Practice, Department of Public Health, University of Aarhus, Aarhus, Denmark
Purpose: Postpartum psychosis is a rare but severe complication following childbirth, with unknown etiology. This study investigated whether the death of a close family member — a source of severe stress — the year before or during pregnancy was associated with an increased risk of psychotic illness in the postpartum period among women without and with a history of psychiatric disorder.
Methods: We studied live births in Denmark during 1978–2008 and births in Sweden during 1973–2006 (n=5,246,978). Information on death of women’s relatives and partners and sociodemographic, health-, and pregnancy-related factors was obtained through linkage with nationwide registries.
Results: The death of a close relative the year before or during pregnancy was not associated with psychotic illness during the first 90 days postpartum among women without (adjusted HR 1.02, 95% CI 0.76–1.37) or with a history of psychiatric disorder (HR 0.96, 95% CI 0.74–1.25). Similarly, there was no association between bereavement and risk of postpartum psychosis according to the timing of the loss (the year before or during pregnancy), the relative’s cause of death (natural or unnatural), or the woman’s relationship to the deceased (parent/sibling or partner/older child).
Conclusions: Death of a close relative, one of the most severe sources of stress, before or during pregnancy was not associated with postpartum psychosis. Therefore, these data do not support the hypothesis that severely stressful life events, such as bereavement around the time of pregnancy, are associated with postpartum psychosis.
Keywords: postpartum, psychosis, bereavement, stress, pregnancy, cohort study
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