Peripartum psychiatric admissions in Israel: A retrospective cohort study

• In Israel, as in other countries, psychiatric admissions peak in the first month postpartum and decline by six months, prior psychiatric admission is the strongest risk factor for postpartum admission, and 62% of postpartum admissions occur among women with no psychiatric history. • Psychotic disorders are associated with a higher admission risk than bipolar disorder or depression. • High EPDS scores are associated with high admission risk even among women without prior psychiatric admissions, and not only admissions due to depression. To characterize peripartum psychiatric admissions in Israel and identify risk factors associated with postpartum admissions. A total of 828,374 births between 2016 and 2022 were retrospectively analyzed using Israeli maternal-child health clinics’ data, representing 62% of nationwide births during the study period. Psychiatric admissions before, during and after pregnancy were identified through a national registry. Multivariable logistic regression and Cox proportional hazards models were used to examine risk factors, including: prior psychiatric admissions, Edinburgh Postnatal Depression Scale scores, occupation, marital status, and socioeconomic status. Admission rate spikes in the first month postpartum, and gradually returns to baseline levels after 6 months. Postpartum admissions were considerably more likely among women who had previous psychiatric admissions (OR = 149), and more so due to psychotic disorders (OR = 104) than bipolar disorder (OR = 5.1). However, first time admissions compose 62% of six-months postpartum admissions. Among mothers screened with EPDS a high score was associated with elevated risk for admission (OR = 5.6), especially when considering only mothers with no prior admissions (OR = 8.9). Perinatal psychiatric admissions’ characteristics in Israel resemble those reported elsewhere, both temporally and in associated risk factors. The large number of first-time admissions highlights the need and challenge in identifying mothers at risk. EPDS screening was found useful in identifying mothers at risk for admissions, even beyond those due to postpartum depression and in the postpartum period. Incorporating a more detailed clinical history is likely required to better identify mothers at risk.