(173) Mental Health Outcomes Following Cesarean Hysterectomy

Objective:
To determine rates of postpartum depression (PPD) and post-traumatic stress disorder (PTSD) following cesarean hysterectomy (c-hyst). While PTSD risk is known to increase after emergent c-hyst, it remains unclear whether this is due to the urgency of the procedure, cesarean delivery itself, or the psychological effects of hysterectomy and loss of fertility. This study compares rates of PPD and PTSD among patients undergoing cesarean—with and without postpartum hemorrhage (PPH)—and c-hyst—with and without PPH—to assess the independent contribution of hysterectomy to adverse mental health outcomes.

Study Design:
This retrospective cohort study used the TriNetX research network. Patients who underwent cesarean or c-hyst between 2015 and June 2025 were identified. A total of 556,584 patients were included: 529,254 cesarean without PPH, 24,480 cesarean with PPH, 1,821 c-hyst without PPH, and 1,029 c-hyst with PPH. Patients were 1:1 matched by age, race, preterm delivery, intrauterine fetal demise, and mental health history. SSRI initiation within 6 months postpartum was also examined.

Results:
PPD and PTSD rates were 3.8% and 1.1% after cesarean without PPH and 4.7% and 1.6% with PPH (PPD RR 1.24, [1.14–1.35], PTSD RR 1.38, [1.18–1.61]. C-hyst without PPH was associated with PPD and PTSD rates of 4.3% and 1.7% (PPD RR 1.15, [0.78–1.69], PTSD RR 3.09, [1.58–6.07]). With PPH, c-hyst was associated with PPD and PTSD rates of 5.7% and 5.0% (PPD RR 1.04, [0.81–1.35], PTSD RR 1.92, [1.45–2.55]; p < 0.0001). SSRI initiation was 11.8% after cesarean without PPH vs. 12.9% with PPH (RR 1.10, [1.05–1.16]). C-hyst without PPH had higher SSRI use (14.2%) vs. cesarean without PPH (RR 1.25, CI 1.04–1.49). No difference in SSRI use was found between hysterectomy groups.

Conclusion:
Cesarean hysterectomy, particularly with PPH, is associated with increased PTSD risk. While PPH modestly increases PPD and SSRI use, hysterectomy appears to independently elevate PTSD risk. These findings highlight the psychological burden of hysterectomy and support the need for targeted mental health screening in this population.