Skip to main content

Advertisement

SpringerLink
Log in

Suicide Risk and Mood Disorders in Women in the Postpartum Period: a Longitudinal Study

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

Suicide associated with severe psychiatric illnesses is considered the leading cause of maternal deaths. We aimed to assess the suicide risk in women who experienced depressive or mixed episodes of mood change during the postpartum period and to determine which disorder is more related to suicide risk in the same period. We conducted a longitudinal study with 706 women whose children were born from April 2007 to May 2008 in a southern city in Brazil, and received prenatal care by the Brazilian National System of Public Health. The first assessment occurred during the prenatal period and the second within 30 to 60 days postpartum. The incidence of suicide risk was 10.9%. The odds of postpartum suicide risk were 6.50 (95% CI: 2.73; 15.48) higher in mothers with postpartum depression and 41.50 (95% CI: 12.11; 142.16) higher in those with mixed episodes than those who did not suffer from any mood disorder. Women with chronic episodes (who had depressive or mixed episodes during pregnancy and postpartum) were at increased odds of 4.94 (95% CI: 1.46; 16.69) of a postpartum suicide risk. The postpartum seems to be a critical period in the women’s mental health. The impact of mental disorders in this period, especially mixed episodes, can increase the odds of a suicide risk onset. A good psychiatric evaluation and support during the prenatal and postpartum care may prevent the subsequent risk of suicide.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rihmer Z. Can better recognition and treatment of depression reduce suicide rates? A brief review. European psychiatry : the journal of the Association of European Psychiatrists. 2001;16(7):406–9.

    Article  CAS  Google Scholar 

  2. Kapczinski F, Quevedo J, Rosa AR, Santin A, Peuker ACWB, Kleinman A, et al. Transtorno bipolar: teoria e clínica. 1 ed. ed. Artmed: Porto Alegre; 2009.

    Google Scholar 

  3. Balazs J, Benazzi F, Rihmer Z, Rihmer A, Akiskal KK, Akiskal HS. The close link between suicide attempts and mixed (bipolar) depression: implications for suicide prevention. J Affect Disord. 2006;91(2–3):133–8. https://doi.org/10.1016/j.jad.2005.12.049.

    Article  PubMed  Google Scholar 

  4. Kar N. Profile of risk factors associated with suicide attempts: a study from Orissa. India Indian Journal of Psychiatry. 2010;52(1):48–56. https://doi.org/10.4103/0019-5545.58895.

    Article  PubMed  Google Scholar 

  5. Oquendo MA, Galfalvy H, Russo S, Ellis SP, Grunebaum MF, Burke A, et al. Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder. Am J Psychiatry. 2004;161(8):1433–41. https://doi.org/10.1176/appi.ajp.161.8.1433.

    Article  PubMed  Google Scholar 

  6. Hawton K, van Heeringen K. Suicide. Lancet. 2009;373(9672):1372–81. https://doi.org/10.1016/S0140-6736(09)60372-X.

    Article  PubMed  Google Scholar 

  7. Valtonen HM, Suominen K, Haukka J, Mantere O, Leppamaki S, Arvilommi P, et al. Differences in incidence of suicide attempts during phases of bipolar I and II disorders. Bipolar Disord. 2008;10(5):588–96. https://doi.org/10.1111/j.1399-5618.2007.00553.x.

    Article  PubMed  Google Scholar 

  8. Nepon J, Belik SL, Bolton J, Sareen J. The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on alcohol and related conditions. Depress Anxiety. 2010;27(9):791–8. https://doi.org/10.1002/da.20674.

    Article  PubMed  PubMed Central  Google Scholar 

  9. INSERM Collective Expertise Centre. INSERM Collective expert reports [internet]. Institut national de la santé et de la recherche médicale, Paris. 2000. https://www.ncbi.nlm.nih.gov/books/NBK7127/.

  10. Isometsa ET. Psychological autopsy studies: a review. European psychiatry : the journal of the Association of European Psychiatrists. 2001;16(7):379–85.

    Article  CAS  Google Scholar 

  11. Nock MK, Dempsey CL, Aliaga PA, Brent DA, Heeringa SG, Kessler RC, et al. Psychological autopsy study comparing suicide decedents, suicide ideators, and propensity score matched controls: results from the study to assess risk and resilience in service members (Army STARRS). Psychol Med. 2017;47(15):2663–74. https://doi.org/10.1017/S0033291717001179.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Van Orden K, Conwell Y. Suicides in Late Life. Curr Psychiatry Rep. 2011;13(3):234–41. https://doi.org/10.1007/s11920-011-0193-3.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Yoshimasu K, Kiyohara C, Miyashita K. The stress research Group of the Japanese Society for H. suicidal risk factors and completed suicide: meta-analyses based on psychological autopsy studies. Environ Health Prev Med. 2008;13(5):243–56. https://doi.org/10.1007/s12199-008-0037-x.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Appleby L, Mortensen PB, Faragher EB. Suicide and other causes of mortality after post-partum psychiatric admission. The British journal of psychiatry : the journal of mental science. 1998;173:209–11.

    Article  CAS  Google Scholar 

  15. Oates M. Suicide: the leading cause of maternal death. Br J Psychiatry. 2003;183(4):279–81. https://doi.org/10.1192/bjp.183.4.279.

    Article  PubMed  Google Scholar 

  16. Gressier F, Guillard V, Cazas O, Falissard B, Glangeaud-Freudenthal NMC, Sutter-Dallay A-L. Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. J Psychiatr Res. 2017;84:284–91. https://doi.org/10.1016/j.jpsychires.2016.10.009.

    Article  PubMed  Google Scholar 

  17. Lysell H, Dahlin M, Viktorin A, Ljungberg E, D'onofrio BM, Dickman P, et al. Maternal suicide–register based study of all suicides occurring after delivery in Sweden 1974–2009. PLoS One. 2018;13(1):e0190133.

    Article  Google Scholar 

  18. Austin MP, Kildea S, Sullivan E. Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting. Med J Aust. 2007;186(7):364–7.

    Article  Google Scholar 

  19. Lewis G, Drife JO, Clutton-Brock T. Why mothers die: 2000–2002: the sixth report of the confidential enquiries into maternal deaths in the United Kingdom. London: RCOG Press; 2004.

    Google Scholar 

  20. Oates M. Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. Br Med Bull. 2003;67:219–29.

    Article  Google Scholar 

  21. Gissler M, Hemminki E, Lönnqvist J. Suicides after pregnancy in Finland, 1987-94: register linkage study. BMJ : British Medical Journal. 1996;313(7070):1431–4.

    Article  CAS  Google Scholar 

  22. Andersen BR, Westergaard HB, Bodker B, Weber T, Moller M, Sorensen JL. Maternal mortality in Denmark, 1985-1994. Eur J Obstet Gynecol Reprod Biol. 2009;142(2):124–8. https://doi.org/10.1016/j.ejogrb.2008.10.009.

    Article  PubMed  Google Scholar 

  23. Pinheiro RT, da Silva RA, Magalhaes PV, Horta BL, Pinheiro KA. Two studies on suicidality in the postpartum. Acta Psychiatr Scand. 2008;118(2):160–3. https://doi.org/10.1111/j.1600-0447.2008.01184.x.

    Article  CAS  PubMed  Google Scholar 

  24. Arán Barés M, Gispert R, Puig X, Freitas A, Ribas G, Puigdefàbregas A. Evolución temporal y distribución geográfica de la mortalidad por suicidio en Cataluña y España (1986-2002). Gac Sanit. 2006;20:473–80.

    Article  Google Scholar 

  25. Levi F, La Vecchia C, Lucchini F, Negri E, Saxena S, Maulik PK, et al. Trends in mortality from suicide, 1965–99. Acta Psychiatrica Scandinavica. 2003;108(5):341–9. https://doi.org/10.1034/j.1600-0447.2003.00147.x.

    Article  CAS  PubMed  Google Scholar 

  26. Pavia M, Nicotera G, Scaramuzza G, Angelillo IF. Suicide mortality in southern Italy: 1998-2002. Psychiatry Res. 2005;134(3):275–9. https://doi.org/10.1016/j.psychres.2005.02.004.

    Article  PubMed  Google Scholar 

  27. Amorim P. Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Rev Bras Psiquiatr. 2000;22:106–15.

    Article  Google Scholar 

  28. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of clinical psychiatry. 1998;59 Suppl 20:22–33;quiz 4–57.

  29. Castells MA, Furlanetto LM. Validity of the CAGE questionnaire for screening alcohol-dependent inpatients on hospital wards. Rev Bras Psiquiatr. 2005;27:54–7.

    Article  Google Scholar 

  30. Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica no Brasil. 2009.

  31. Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26(1):224–7.

    Article  CAS  Google Scholar 

  32. Heron J, Craddock N, Jones I. Postnatal euphoria: are 'the highs' an indicator of bipolarity? Bipolar Disord. 2005;7(2):103–10. https://doi.org/10.1111/j.1399-5618.2005.00185.x.

    Article  PubMed  Google Scholar 

  33. Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet (London, England). 2014;384(9956):1789–99. https://doi.org/10.1016/s0140-6736(14)61278-2.

    Article  Google Scholar 

  34. Akiskal HS, Benazzi F, Perugi G, Rihmer Z. Agitated "unipolar" depression re-conceptualized as a depressive mixed state: implications for the antidepressant-suicide controversy. J Affect Disord. 2005;85(3):245–58. https://doi.org/10.1016/j.jad.2004.12.004.

    Article  PubMed  Google Scholar 

  35. Persons JE, Coryell WH, Solomon DA, Keller MB, Endicott J, Fiedorowicz JG. Mixed state and suicide: Is the effect of mixed state on suicidal behavior more than the sum of its parts? Bipolar disorders. 2018;20(1):35–41. https://doi.org/10.1111/bdi.12538.

    Article  PubMed  Google Scholar 

  36. Perugi G, Akiskal HS, Micheli C, Toni C, Madaro D. Clinical characterization of depressive mixed state in bipolar-I patients: Pisa-san Diego collaboration. J Affect Disord. 2001;67(1–3):105–14.

    Article  CAS  Google Scholar 

  37. Moreno DH, Moreno RA. Mixed states and rapid cycling in bipolar disorder. Archives of Clinical Psychiatry (São Paulo). 2005;32:56–62.

    Article  Google Scholar 

  38. Silva R, Jansen K, Souza L, Quevedo L, Barbosa L, Moraes I et al. Sociodemographic risk factors of perinatal depression: a cohort study in the public health care system. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2012;34(2):143–8.

  39. Pinheiro RT, Magalhaes PV, Horta BL, Pinheiro KA, da Silva RA, Pinto RH. Is paternal postpartum depression associated with maternal postpartum depression? Population-based study in Brazil. Acta Psychiatr Scand. 2006;113(3):230–2. https://doi.org/10.1111/j.1600-0447.2005.00708.x.

    Article  CAS  PubMed  Google Scholar 

  40. Chen YW, Dilsaver SC. Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders. Biol Psychiatry. 1996;39(10):896–9. https://doi.org/10.1016/0006-3223(95)00295-2.

    Article  CAS  PubMed  Google Scholar 

  41. Smith DJ, Ghaemi N. Is underdiagnosis the main pitfall when diagnosing bipolar disorder? Yes BMJ. 2010;340:c854. https://doi.org/10.1136/bmj.c854.

    Article  PubMed  Google Scholar 

  42. Ganz D, Braquehais MD, Sher L. Secondary prevention of suicide. PLoS Med. 2010;7(6):e1000271. https://doi.org/10.1371/journal.pmed.1000271.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) that allowed this study to happen and the families who kindly participated.

Funding

This study was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) [grant no. 409670/2006–5].

Author information

Authors and Affiliations

  1. Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C, Pelotas, RS, 96015-560, Brazil

    Luciana de Avila Quevedo, Carolina Coelho Scholl, Mariana Bonati de Matos, Ricardo Azevedo da Silva & Ricardo Tavares Pinheiro

  2. Faculty of Medicine, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil

    Fábio Monteiro da Cunha Coelho

  3. Faculty of Medicine, University of Rio Grande Foundation (FURG), Rio Grande, RS, Brazil

    Karen Amaral Tavares Pinheiro

Authors
  1. Luciana de Avila Quevedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carolina Coelho Scholl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariana Bonati de Matos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ricardo Azevedo da Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fábio Monteiro da Cunha Coelho
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karen Amaral Tavares Pinheiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ricardo Tavares Pinheiro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Luciana de Avila Quevedo: conceptualization, formal analysis, investigation, writing – original draft. Carolina Coelho Scholl: writing – review and editing. Mariana Bonati de Matos: investigation, visualization. Ricardo Azevedo da Silva: conceptualization, methodology, project administration, resources. Fábio Monteiro da Cunha Coelho: conceptualization, investigation. Karen Amaral Tavares Pinheiro: investigation. Ricardo Tavares Pinheiro: project administration, resources, funding acquisition, supervision, formal analysis, writing – review and editing.

Corresponding author

Correspondence to Luciana de Avila Quevedo.

Ethics declarations

Conflict of Interest

The authors declare that there is no conflict of interest.

Ethics Approval

All participants gave written informed consent for the analysis and anonymous publication of the research findings. The study was approved by the Research Ethics Committee in accordance with existing regulations (CONEP-Res196/96) and the latest version of the Helsinki Declaration.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Avila Quevedo, L., Scholl, C.C., de Matos, M.B. et al. Suicide Risk and Mood Disorders in Women in the Postpartum Period: a Longitudinal Study. Psychiatr Q 92, 513–522 (2021). https://doi.org/10.1007/s11126-020-09823-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-020-09823-5

Keywords

Search

Navigation