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Epidemiology of Puerperal Psychoses

  • R. E. Kendell (a1), J. C. Chalmers (a2) and C. Platz (a3)


Computer linkage of an obstetric register and a psychiatric case register made it possible to investigate the temporal relationship between childbirth and psychiatric contact in a population of 470 000 people over a 12-year period resulted in 54 087 births: 120 psychiatric admissions within 90 days of parturition. The ‘relative risk’ of admission to a psychiatric hospital with a psychotic illness was extremely high in the first 30 days after childbirth, particularly in primiparae, suggesting that metabolic factors are involved in the genesis of puerperal psychoses. However, being unmarried, having a first baby, Caesarian section and perinatal death were all associated with an increased risk of psychiatric admission or contact, or both, suggesting that psychological stresses also contribute to this high psychiatric morbidity. Women with a history of manic depressive illness, manic or depressive, had a much higher risk of psychiatric admission in the puerperium than those with a history of schizophrenia or depressive neuroses, and the majority of puerperal admissions met Research Diagnostic Criteria for manic or depressive disorder. Probably, therefore, puerperal psychoses are manic depressive illnesses and unrelated to schizophrenia.


Corresponding author

University Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh EH10 5HF


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Bratfos, O. & Haug, J. O. (1966) Puerperal mental disorders in manic depressive females. Acta Psychiatrica Scandinavica, 42, 285294.
Brockington, I. F., Winokur, G. & Dean, C. (1982) Puerperal psychoses. In Motherhood and Mental Illness (eds L. F. Brockington & R. Kumar). London: Academic Press.
Dean, C. & Kendell, R. E. (1981) The symptomatology of puerperal illnesses. British Journal of Psychiatry, 139, 128133.
Esquirol, E. (1845) Mental Maladies: a Treatise on Insanity. (trans. Hunt, E. K.). Philadelphia: Lea & Blanchard.
Heasman, M. A. & Clarke, J. A. (1979) Medical record linkage in Scotland. Health Bulletin, 37, 97103.
Kendell, R. E. (1985) Emotional and physical factors in the genesis of puerperal mental disorders. Journal of Psychosomatic Research, 29, 311.
Kendell, R. E., Wainwright, S., Hailey, A. & Shannon, B. (1976) The influence of childbirth on psychiatric morbidity. Psychological Medicine, 6, 297302.
Kendell, R. E. McGuire, R. J., Connor, Y. & Cox, J. L. (1981a) Mood changes in the first three months after childbirth. Journal of Affective Disorders, 3, 317326.
Kendell, R. E., Rennie, D., Clarke, J. A. & Dean, C. (1981b) The social and obstetric correlates of psychiatric admission in the puerperium. Psychological Medicine, 11, 341350.
Kumar, R. & Robson, K. M. (1984) A prospective study of emotional disorders in childbearing women. British Journal of Psychiatry, 144, 3547.
Paffenbarcer, R. S. (1964) Epidemiological aspects of parapartum mental illness. British Journal of Preventive and Social Medicine, 18, 189195.
Paykel, E. S. (1978) Contribution of life events to causation of psychiatric illness. Psychological Medicine, 8, 245253.
Kendell, R. E., Prusoff, B. A. & Myers, J. K. (1975) Suicide attempts and recent life events: a controlled comparison. Archives of General Psychiatry, 32, 327333.
Perris, C. & Brockington, I. F. (1981) Cycloid psychoses and their relation to the major psychoses. In Biological Psychiatry 1981 (eds C. Perris, G. Struwe & B. Jansson). Amsterdam: Elsevier/North Holland Biomedical Press.
Pugh, T. F., Jerath, B. K., Schmidt, W. M. & Reed, R. B. (1963) Rates of mental disease related to childbearing. New England Journal of Medicine, 268, 12241228.
Reich, T. & Winokur, G. (1970) Postpartum psychoses in patients with manic depressive disease. Journal of Nervous and Mental Disease, 151, 6068.
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research Diagnostic Criteria for a Selected Group of Functional Disorders, 3rd edn. New York State Psychiatric Institute.
Surtees, P. G., Dean, C., Ingham, J. G., Kreitman, N. B., Miller, P. Mc C. & Sashidharan, S. P. (1983) Psychiatric disorder in women from an Edinburgh community: associations with demographic factors. British Journal of Psychiatry, 142, 238246.
Surtees, P. G., Miller, P.Mc C., Ingham, J. G., Kreitman, N. B., Rennie, D. & Sashidharan, S. P. (1986) Life events and the onset of affective disorder. Journal of Affective Disorders, 10, 3750.
Tetlow, C. (1955) Psychoses of childbearing. Journal of Mental Science, 101, 629639.
Vislie, H. (1956) Puerperal mental disorders. Acta Psychiatrica et Neurologica Scandinavica, suppl. 111.
Whalley, L. J., Roberts, D. F., Wentzel, J. & Wright, A. F. (1982) Genetic factors in puerperal affective psychoses. Acta Psychiatrica Scandinavica, 65, 180193.


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Epidemiology of Puerperal Psychoses

  • R. E. Kendell (a1), J. C. Chalmers (a2) and C. Platz (a3)
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