Severe maternal morbidity and mental health-related hospitalizations or emergency department visits after delivery: A nation-wide study in Canada
Notice bibliographique
Résumé
Background: Severe maternal morbidity (SMM) is a composite of near-fatal events occurring during pregnancy or the puerperium. SMM is known to cause significant physical and emotional trauma, resulting in both short-term and long-term health complications. Short term psychological complications of SMM range from depressive symptoms to psychiatric admission or prescription medication for mental illness. SMM subtypes like severe pre-eclampsia have been associated with long term outcomes of severe mental illness, including psychiatric admission for depression. It is plausible that composite SMM is also associated with long-term severe mental health outcomes, including mental-health related hospitalization or emergency department visits. Objectives and hypotheses: The primary objective is to assess for an association between any SMM in the first recorded birth, with hospitalization or ED visit for mental illness up to 13 years after the index birth hospitalization, as compared to no SMM in the first recorded birth. Methods: Using data from the Canadian Institute of Health Information Discharge Abstract Database (DAD) and the National Ambulatory Care Reporting System (NACRS) we performed a longitudinal cohort study of 2,112,518 Canadian postpartum individuals aged 18-55 years with a first recorded hospital birth between April 1, 2008 and March 31, 2021. The primary study outcome was a composite of mental health-related hospitalization and/or ED visits occurring 43 days or more after the index birth hospitalization. The composite was defined by an ICD-10-CA code for a mood or anxiety disorder, substance-related or addictive disorder, schizophrenia spectrum or other psychotic disorder, or suicidality or self-harm event We used univariable and multivariable Cox regression models to generate crude and adjusted hazard ratios (HRs).Results: A total of 2,112,518 individuals gave birth over the study period; after exclusions, our analytic cohort included 35,825 SMM-affected individuals and 1,543,567 were non SMM-affected individuals (mean age 29.7±5.4 and 30.7 ±6.0, respectively). SMM-affected individuals were more likely to be older, to deliver pre-term, to have a stillbirth, to have a cesearean section, and to have experienced a non-severe hypertensive disorder of pregnancy or gestational diabetes compared with individuals who did not have an SMM. Overall, 43,066 individuals had a mental health-related hospitalization or ED visit (73.2 per 10 000); among these, 1287 had a recorded SMM (96.1 per 1000), and 41 779 did not (72.7 per 1000) (crude HR 1.31 [95% CI 1.24-1.39]). After adjustment for delivery year, comorbidity, maternal age, urban or rural residential status and income quintile, the adjusted HR was 1.26 (95% 1.19-1.34.Conclusion: Results from this study suggest a relationship between composite SMM and long-term mental health-related hospitalization or ED visit. As pregnancy complications become increasingly prevalent in Canada, it is increasingly crucial to understand the association between these events and adverse mental health outcomes. Given the disruptive nature of severe obstetric complications, and the potential for long-term mental health complications, it is important to extend clinical monitoring for these conditions among postpartum individuals beyond the first year postpartum
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,008 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».