Long-term outcome of offspring after maternal severe puerperal disorder.

OBJECTIVE: To study adult mental health in offspring of mothers who experienced severe puerperal disorder. METHOD: Mothers, followed up a mean of 23 years after puerperal disorder requiring hospitalization, were interviewed regarding adult psychiatric illness, childhood neurotic symptoms and conduct problems of 48 offspring of the index episode and 62 additional siblings. RESULTS: In these predominantly young adults the lifetime rate of ICD-10 adult psychiatric illness was 26%, and was higher in offspring of puerperal episodes (35% vs. 15%, P = 0.07). There were also high rates of childhood symptoms and problems. CONCLUSION: There are high lifetime rates of adult psychiatric illness in young adult offspring of mothers with puerperal disorder, which are likely to increase further with time, and warrant special attention.

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 puerperal psychiatric illness, few have been very long-term. METHODS: Sixty-four subjects from 85 (75.3%) in an unselected sample of women admitted to a psychiatric hospital within 6 months of childbirth were successfully followed up a mean of 23 years (range 17-28) later. Most subjects were interviewed in detail, with further information obtained from general practice and hospital records. Data included subsequent illnesses and diagnoses, subsequent childbirth, longitudinal social function, current symptoms and social function. RESULTS: Seventy-five per cent of subjects had further psychiatric illnesses, most of them unrelated to childbirth, and 37% had at least three subsequent episodes. The risk of puerperal psychiatric illness was 29% in subsequent pregnancies. At outcome interview the majority of subjects were well, with satisfactory social adjustment. Diagnoses in subsequent psychiatric illnesses showed considerable consistency with index diagnoses, with some shift to bipolar disorder. Further illnesses were less likely to occur where the index illness occurred with first child, onset was within 1 month of delivery, and where the index diagnosis was unipolar depression. CONCLUSIONS: There is a high risk of subsequent non-puerperal recurrences following severe puerperal psychotic illness, showing considerable diagnostic consistency with the index episode, but with good functional outcome. Puerperal illnesses showed strong continuities with non-puerperal illnesses in these women.