An investigation into puerperal psychoses in black women admitted to Baragwanath Hospital

Abstract

Objectives: Puerperal psychosis was studied in black African women at Baragwanath Hospital in Johannesburg.

Design: A retrospective study analysed the clinical notes of 314 cases of puerperal psychosis seen over previous years. A prospective study researched 67 cases of puerperal psychosis referred during a full calendar year. A control group of 98 patients was matched with the prospective study patients for age, marital status, parity and month of delivery.

Results: The incidence (2-3 cases per 1,000 births), onset and pattern of illness are all remarkably similar to that described in the international literature. Confirmed risk factors were a primiparous patient; a family history of psychiatric illness; and a personal psychiatric history, particularly a history of mania. Additional risk factors found in this study were substance dependence; a medical illness; the season of the year; a male child; and psychosocial stress including need for intensive medical care for the baby or death of the baby.

Conclusion: The conclusion reached is that the puerperal psychoses are undifferentiated psychoses, usually mood disorders, showing some special symptomatology, and are precipitated in constitutionally predisposed patients by the physiological factors of the involutionary period.