An evaluation of symptom domains in the two years before pregnancy as predictors of relapse in the perinatal period in women with severe mental illness

TY - JOUR

T1 - An evaluation of symptom domains in the two years before pregnancy as predictors of relapse in the perinatal period in women with severe mental illness

AU - Khapre , Sharvari Khapre

AU - Stewart, Robert

AU - Taylor, Clare

PY - 2021/3/8

Y1 - 2021/3/8

N2 - Background: Symptoms may be more useful prognostic markers for mental illness than diagnoses. We sought to investigate symptom domains in women with pre-existing severe mental illness (SMI; psychotic and bipolar disorder) as predictors of relapse risk during the perinatal period. Method: Data were obtained from electronic health records of 399 pregnant women with SMI diagnoses from a large south London mental healthcare provider. Symptoms within six domains characteristically associated with severe mental illness (positive, negative, disorganisation, mania, depression and catatonia) recorded in clinical notes 2 years before pregnancy were identified with natural language processing algorithms to extract data from text, and associations investigated with hospitalisation during pregnancy and three months postpartum. Results: 76 women (19%) relapsed during pregnancy and 107 (27%) relapsed postpartum. After adjusting for covariates, disorganisation symptoms showed a positive association at borderline significance with relapse during pregnancy (aOR=1.36; 95% CI=0.99-1.87) per unit increase in number of symptoms) and depressive symptoms negatively with relapse postpartum (0.78; 0.62-0.98). Restricting the sample to women with at least one recorded symptom in any given domain, higher disorganisation (1.84; 1.22–2.76), positive (1.50; 1.07–2.11) and manic (1.48; 1.03–2.11) symptoms were associated with relapse during pregnancy, and disorganisation (1.54; 1.08–2.20) symptom domains were associated with relapse postpartum. Conclusion: Positive, disorganisation and manic symptoms recorded in the two years before pregnancy were associated with increased risk of relapse during pregnancy and postpartum. The characterisation of routine health records from text fields is relatively transferrable and could help inform predictive risk modelling.

AB - Background: Symptoms may be more useful prognostic markers for mental illness than diagnoses. We sought to investigate symptom domains in women with pre-existing severe mental illness (SMI; psychotic and bipolar disorder) as predictors of relapse risk during the perinatal period. Method: Data were obtained from electronic health records of 399 pregnant women with SMI diagnoses from a large south London mental healthcare provider. Symptoms within six domains characteristically associated with severe mental illness (positive, negative, disorganisation, mania, depression and catatonia) recorded in clinical notes 2 years before pregnancy were identified with natural language processing algorithms to extract data from text, and associations investigated with hospitalisation during pregnancy and three months postpartum. Results: 76 women (19%) relapsed during pregnancy and 107 (27%) relapsed postpartum. After adjusting for covariates, disorganisation symptoms showed a positive association at borderline significance with relapse during pregnancy (aOR=1.36; 95% CI=0.99-1.87) per unit increase in number of symptoms) and depressive symptoms negatively with relapse postpartum (0.78; 0.62-0.98). Restricting the sample to women with at least one recorded symptom in any given domain, higher disorganisation (1.84; 1.22–2.76), positive (1.50; 1.07–2.11) and manic (1.48; 1.03–2.11) symptoms were associated with relapse during pregnancy, and disorganisation (1.54; 1.08–2.20) symptom domains were associated with relapse postpartum. Conclusion: Positive, disorganisation and manic symptoms recorded in the two years before pregnancy were associated with increased risk of relapse during pregnancy and postpartum. The characterisation of routine health records from text fields is relatively transferrable and could help inform predictive risk modelling.

KW - perinatal

KW - severe mental illness

KW - relapse

KW - cohort

M3 - Article

SN - 0213-6163

JO - European Journal of Psychiatry

JF - European Journal of Psychiatry

ER -