Early discharge and risk for postnatal depression

Objective: To determine whether early discharge (< 72 hours) after childbirth increased the risk for women developing postnatal depression. Design: Prospective cohort design consisting of an initial interview, and six-weekly assessments for 24 weeks using a self-report questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Women discharged within 72 hours were compared with the remaining women. Setting: Tertiary referral hospital in western Sydney, New South Wales, 1993. Participants: All 749 women delivering over a three-month period were recruited. Of the 522 participants, 425 women completed the study. Main outcome measures: Women scoring > 13 on the EPDS on two or more occasions were considered potential ''cases'' of postnatal depression. The diagnosis was confirmed using the Structured Clinical Interview for DSM-III-R disorders (SCID). Results: Of the 153 women (36%) discharged early, 22 women (14.4%) developed postnatal depression over the study period compared with 20 of the 272 women (7.4%) who had standard length of stay. Women who were discharged within 72 hours had a significantly increased risk for developing postnatal depression (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.07-4.21). This risk persisted when other sociodemographic, obstetric and psychosocial risk factors were controlled for in a logistic regression analysis (OR, 3.06; 95% CI, 1.22-7.69). Conclusion: Women planning early discharge after childbirth should be carefully assessed before discharge and follow-up should be rigorous. The potential to develop postnatal depression should be considered in all women choosing early discharge from hospital.