Critical Period, High-acuity Illness, Inequitable Access: Understanding Outcomes following Postpartum Psychiatric Emergency Visits, and the Role of Social Determinants of Health
Bibliographic record
Abstract
Within the year following childbirth, approximately 1 in 100 postpartum individuals visit an emergency department (ED) for a psychiatric reason. Postpartum psychiatric ED visits are an indication of acute need for mental health care, and an opportunity to coordinate services. This thesis aimed to fill gaps in knowledge about the outcomes of postpartum individuals following psychiatric ED visits, and specifically understand how individual and intersecting social determinants of health relate (1) to inpatient hospital admission from the ED, and for discharged individuals, (2) to outpatient physician follow-up within 30 days, and (3) to subsequent psychiatric admission within 365 days. The thesis is comprised of three projects, all of which use Ontario health administrative data to examine a cohort of postpartum individuals with psychiatric ED visits (2008 to 2020). In each project, social determinants were examined independently, then in intersection using three distinct methods. In Project 1, 16.0% of individuals were admitted to hospital from the initial ED visit and, of the examined social determinants of health, only Chinese ethnicity was associated with an increased risk of admission after adjusting for clinical and other factors. Additive interaction to evaluate for synergistic or antagonistic effects between social determinants was non-significant. In Project 2, 44.8% of discharged individuals saw a physician for mental health care in the 30 days following the ED visit, with less follow-up in younger individuals, those in low-income and rural areas, and immigrants. Conditional inference trees used to examine social determinants in intersection identified patterns not evident from traditional regression (e.g., neighbourhoods diversity related to follow-up only among those aged ≤25 years). In Project 3, 9.5% of those discharged had a subsequent psychiatric admission, with a lower likelihood of admission among younger and immigrant individuals. Latent class analysis identified 4 socially distinct subgroups, which had differing risk of admission. Taken together, this thesis identified gaps in both inpatient and outpatient mental health care in a high-acuity postpartum population. Complexity in the relationships between social determinants and health service access underscore the need for intersectionality-informed approaches to improve equitable postpartum mental health service delivery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".