Table 2

Definitions of mental disorders exposure/outcome variables

VariableTime frameDatabaseOperation definition/ICD codes
Diagnosis of a psychiatric disorder3 years prior to the birth of the index childPhysician claims
Hospital abstracts
Prescription claims
A woman was considered to have a psychiatric disorder if she had one of the following (see specific definitions below): substance abuse disorder, personality disorder, mood and anxiety disorder, schizophrenia or prenatal psychological distress
Substance abuse
disorder
3 years prior to the birth of the index childPhysician claims
Hospital
Abstracts
Prescription claims
A woman was considered to have a substance use disorder if 5 years prior to the birth of the child she had:
  1. One or more hospitalisations with a diagnosis for alcohol or drug psychoses, alcohol or drug dependence, or non-dependent abuse of drugs (ICD-9-CM codes 291, 292, 303, 304, 305, ICD-10-CM codes: F10-F19 and F55) OR

  2. One or more physician visits with a diagnosis for alcohol or drug psychoses, alcohol or drug dependence, or non-dependent abuse of drugs using the same ICD-9-CM codes listed above

Personality disorder3 years prior to the birth of the index childPhysician claims
Hospital abstracts
Prescription claims
A women was considered to have a personality disorders if in the 5 years prior to giving birth to the child she had the following:
  1. One or more hospitalisations with a diagnosis of personality disorder (ICD-9-CM code 301 or ICD-10- CA codes F34.0, F60, F61, F62, F68.1, F68.8, or F69) OR

  2. One or more physician visits with a diagnosis of personality disorder: (ICD-9-CM code 301)

Mood and anxiety disorder3 years prior to the birth of the index childPhysician claims
Hospital abstracts
Prescription claims
A women was considered to have mood or anxiety disorder if in the 5 years prior to giving birth to the child she had the following:
  1. One or more hospitalisations with a diagnosis for depressive disorder, affective psychoses, neurotic depression or adjustment reaction: ICD-9-CM codes 296.1-296.8, 300.4, 309 or 311; ICD-10-CA codes F31, F32, F33, F34.1, F38.0, F38.1, F41.2, F43.1, F43.2, F43.8, F53.0, F93.0 or with a diagnosis for an anxiety state, phobic disorders or obsessive–compulsive disorders: ICD-9-CM codes 300.0, 300.2, 300.3, 300.7; ICD-10-CA codes F40, F41.0, F41.1, F41.3, F41.8, F41.9, F42, F45.2; OR

  2. F48, F68.0, or F99 AND one or more prescriptions for an antidepressant or mood stabiliser, including medications with the ATC codes N05AN01, N05BA, N06A; OR

  3. One or more physician visits with a diagnosis for depressive disorder or affective psychoses: ICD-9-CM codes 296, 311; OR

  4. One or more physician visits with a diagnosis for anxiety disorders: ICD-9-CM code 300 AND one or more prescriptions for an antidepressant or mood stabiliser, including medications with the ATC codes N05AN01, N05BA, N06A; OR

  5. Three or more physician visits with a diagnosis for anxiety disorders or adjustment reaction: ICD-9-CM code 300, 309

Schizophrenia3 years prior to the birth of the index childPhysician claims
Hospital abstracts
Prescription claims
A women was considered to have schizophrenia if in the 5 years prior to giving birth to the child had the following:
  1. One or more hospitalisations or physician visits with a diagnosis of schizophrenia: ICD-9-CM code 295 or ICD-10-CA codes F20, F21, F23.2, F25; OR

  2. One or more physician visits with a diagnosis of schizophrenia: ICD-9-CM code 295.

Prenatal psychological distress8 months prior to the birth of the index childPhysician claims
Hospital abstracts
Prescription claims
A woman was considered to have prenatal psychological distress if in the 8 months prior to giving birth she had:
  1. One or more hospitalisations with a diagnosis for depressive disorder, affective psychoses, neurotic depression, or adjustment reaction (ICD-9-CM codes 296.2–296.8, 300.4, 309, 311; ICD–10–CA codes F31, F32, F33, F341, F38.0, F38.1, F41.2, F43.1, F43.2, F43.8,F53.0, F93.0) OR

  2. One or more physician visits with a diagnosis for depressive disorder, affective psychoses, neurotic depression, or adjustment reaction (ICD-9-CM codes 296, 309 or 311) OR

  3. One or more hospitalisations with a diagnosis for anxiety disorders (ICD-9-CM code 300l ICD-10-CD codes F32.0, F34.1, F40, F41, F42, F44, F45.0, F451, F452, F48, F68.0, F99) OR

  4. One or more prescriptions for an antidepressant or mood stabiliser (ATC codes N03AB02, N03AB52, N03AF01, N05AN01, N06A) OR

  5. One or more physician visits with a diagnosis of anxiety disorders one or more physician visits with a diagnosis for anxiety disorders (ICD-9-CM code 300) and one or more prescriptions for an antidepressant or mood stabiliser (ATC codes N03AB02, N03AB52, N03AF01, N05AN01, N06A) OR

  6. One or more hospitalisations with a diagnosis for anxiety states, phobic disorders, or obsessive–compulsive disorders (ICD-9-CM codes 300.0, 300.2, 300.3; ICD-10-CA codes F40, F41.0, F41.1, F41.3, F41.8, F41.9, F42) OR

  7. Two or more physician visits with a diagnosis for anxiety disorders (ICD—CM code 300)

Postnatal psychological distress12 months after the the birth of the index childPhysician claims
Hospital abstracts
Prescription claims
A woman was considered to have postnatal psychological distress if in the 12 months prior to giving birth she had:
  1. One or more hospitalisations with a diagnosis for depressive disorder, affective psychoses, neurotic depression or adjustment reaction (ICD-9-CM codes 296.2–296.8, 300.4, 309, 311; ICD-10-CA codes F31, F32, F33, F341, F38.0, F38.1, F41.2, F43.1, F43.2, F43.8,F53.0, F93.0) OR

  2. One or more physician visits with a diagnosis for depressive disorder, affective psychoses, neurotic depression or adjustment reaction (ICD-9-CM codes 296, 309 or 311) OR

  3. One or more hospitalisations with a diagnosis for anxiety disorders (ICD-9-CM code 300l ICD-10-CD codes F32.0, F34.1, F40, F41, F42, F44, F45.0, F451, F452, F48, F68.0, F99) OR

  4. One or more prescriptions for an antidepressant or mood stabiliser (ATC codes N03AB02, N03AB52, N03AF01, N05AN01, N06A) OR

  5. One or more physician visits with a diagnosis of anxiety disorders one or more physician visits with a diagnosis for anxiety disorders (ICD-9-CM code 300) and one or more prescriptions for an antidepressant or mood stabiliser (ATC codes N03AB02, N03AB52, N03AF01, N05AN01, N06A) OR

  6. One or more hospitalisations with a diagnosis for anxiety states, phobic disorders, or obsessive–compulsive disorders (ICD-9-CM codes 300.0, 300.2, 300.3; ICD-10-CA codes F40, F41.0, F41.1, F41.3, F41.8, F41.9, F42) OR

  7. Two or more physician visits with a diagnosis for anxiety disorders (ICD—CM code 300)