The impact of trauma exposure on outcomes in postpartum psychosis.

Post-partum psychosis is a rare but rapidly evolving psychiatric emergency which carries significant risks to the health and lives of mother and infant. Around half of affected women have no previous psychiatric history although women with bipolar disorder or a personal or family history of post-partum psychosis are at significantly greater risk. For some women, a post-partum episode is retrospectively identified as the first presentation of bipolar disorder. However, for others it will be their only episode of severe mental illness. The literature on outcomes and predictors of outcome in post-partum psychosis is surprisingly sparse and much of it is so old as to be of little use to modern psychiatry. There is an association between trauma and severe mental illness. We know that people who are exposed to trauma either in childhood or adulthood develop SMI at around 3 times the rate of the general population. In addition, 60% women who have SMI experience domestic or sexual violence in adulthood. Pregnancy is a time when women have regular contact with health professionals and domestic violence screening is a part of routine antenatal care.I intend to test the hypothesis that women with a history of trauma have poorer outcomes than controls following an episode of post-partum psychosis. Outcomes will be primarily measured by admission and readmission rates as well as social services supervision of the infants.