Divorce or Separation Following Postpartum Psychiatric Episodes: A Population-Based Cohort Study

Benedicte M. W. Johannsen, MD^a ; Merete L. Mægbæk, MSc^a ; Bodil H. Bech, PhD^b ; Thomas M. Laursen, PhD^a,c ; Trine Munk-Olsen, PhD^a

J Clin Psychiatry 2021;82(3):20m13555

ABSTRACT

Objective: Psychiatric disorders are an established risk factor for divorce or separation. Despite the fact that 10%–15% of new mothers experience postpartum psychiatric episodes (PPEs), no previous studies have investigated the effects of PPEs on the probability of divorce in these new families. Therefore, this study aimed to investigate and quantify the probability of subsequent divorce/separation among women with either mild/moderate or severe PPE compared to mothers without PPE.

Methods: This cohort study based on the national Danish registers included all cohabitating, primiparous women without previous psychiatric history who gave birth from 1996 through 2014. At 6 months postpartum, each woman’s PPE status was evaluated and categorized as follows: (1) mild/moderate PPE (prescription of psychotropic medication—Anatomical Therapeutic Chemical Classification codes N03–N07), (2) severe PPE (psychiatric inpatient or outpatient treatment—International Classification of Disease, 10th Edition codes F00–F99, excluding codes for organic mental disorders, substance abuse, and mental retardation), and (3) no PPE (reference group). Subsequently, the status of cohabitation was assessed a maximum of 5 times (every January 1).

Results: A total of 266,771 new mothers were included; 4,442 had a first mild/moderate PPE and 1,141 had a first severe PPE within 6 months postpartum. Compared to mothers without PPE, women with mild/moderate PPE had a significantly higher probability of later divorce (adjusted hazard ratio [HR] = 1.23; 95% CI, 1.15–1.31); for women with severe PPE, the probability was even greater (adjusted HR = 1.64; 95% CI, 1.45–1.85).

Conclusions: Women experiencing their first-ever PPE following childbirth have a higher probability of divorce in the years following their diagnosis than mothers without PPE. Further, this study showed a dose-response relationship between the severity of PPE and the probability of divorce.

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