Long-term outcome of severe puerperal psychiatric illness: a 23 year follow-up study

Background. Although there have been many follow-up studies of severe puerp eral psychiatric illness, few have been very long-term. Methods. Sixty-four subjects from 85 (75.3 %) in an unselected sample of wo men admitted to a psychiatric hospital within 6 months of childbirth were s uccessfully followed up a mean of 23 years (range 17-28) later. Most subjec ts were interviewed in detail, with further information obtained from gener al practice and hospital records. Data included subsequent illnesses and di agnoses, subsequent childbirth, longitudinal social function, current sympt oms and social function. Results. Seventy-five per cent of subjects had further psychiatric illnesse s, most of them unrelated to childbirth, and 37 % had at least three subseq uent episodes. The risk of puerperal psychiatric illness was 29 % in subseq uent pregnancies. At outcome interview the majority of subjects were well, with satisfactory social adjustment. Diagnoses in subsequent psychiatric il lnesses showed considerable consistency with index diagnoses, with some shi ft to bipolar disorder. Further illnesses were less likely to occur where t he index illness occurred with first child, onset was within 1 month of del ivery, and where the index diagnosis was unipolar depression. Conclusions. There is a high risk of subsequent non-puerperal recurrences f ollowing severe puerperal psychotic illness, showing considerable diagnosti c consistency with the index episode, but with good functional outcome. Pue rperal illnesses showed strong continuities with non-puerperal illnesses in these women.