The effect of obstetric and perinatal events on risk of mental illness in women of childbearing age.

Abstract

A study of mental illness among women of childbearing age in Hamilton County, Ohio, in 1957-1958 compared relative incidence at various stages of womanhood. Rates for pregnant women were substantially lower than for new mothers. Rates for the first 6 months post partum approximated those ior non-chUdbearing parous women, but were characterized by an explosive peak in the first month following delivery. Obstetric, perinatal, and social factors were studied in parapartum mental illness patients and normal mothers for the period 1940-1958. Patients and controls were similar in sociocultural indices such as occupation of spouse, residence, mobility pattern, and legitimacy of offspring. Sharp differences were observed in obstetric and perinatal variables, distinguishing prepartum from postpartum mental illness patients and both from normal mothers. As compared with normal mothers, the prepartum mental illness patients were older, more parous, and included fewer priraiparae. The patients had had a longer interval since their last viable pregnancy. Postpartum mental illness patients also were older and had a delayed latest pregnancy as compared with normal women, but differed further in including more primiparae and in having fewer children, shorter gestation, more dystocia, lighter infants, and higher perinatal mortality. Half of the parapartum mental Ulness patients who became pregnant again suffered recurrence in one-third of their subsequent pregnancies, each mental illness repeating in the same category as the original attack, prepartum or postpartum. Occurrence of a prior mental illness unassociated with pregnancy also predisposed to parapartum breakdown.