Elsevier

General Hospital Psychiatry

Volume 34, Issue 2, March–April 2012, Pages 139-145
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
Mental health, substance use and intimate partner problems among pregnant and postpartum suicide victims in the National Violent Death Reporting System,☆☆

https://doi.org/10.1016/j.genhosppsych.2011.09.017Get rights and content

Abstract

Objectives

Suicide during pregnancy and postpartum is a tragic event for the victim and profoundly impacts the baby, the family and the community. Prior efforts to study risks for pregnancy-associated suicide have been hampered by the lack of data sources which capture pregnancy and delivery status of victims. Introduction of the United States National Violent Death Reporting System (NVDRS) offers new insights into violent deaths by linking multiple data sources and allowing better examination of psychosocial risk factors.

Methods

The analysis used data from 17 states reporting to the NVDRS from 2003 to 2007 to evaluate suicide patterns among pregnant, postpartum, and nonpregnant or postpartum women. Demographic factors, mental health status, substance use, precipitating circumstances, intimate partner problems and suicide methods were compared among groups.

Results

The 2083 female suicide victims of reproductive age demonstrated high prevalence of existing mental health diagnosis and current depressed mood, with depressed mood significantly higher among postpartum women. Substance use and presence of other precipitating factors were high and similar among groups. Intimate partner problems were higher among pregnant and postpartum victims. Postpartum women were more likely to die via asphyxia as cause of death compared to poisoning or firearms.

Conclusions

These findings describe important mental health, substance use and intimate partner problems seen with pregnancy-associated suicide. The study highlights mental health risk factors which could potentially be targeted for intervention in this vulnerable population.

Introduction

Suicide during pregnancy and postpartum is an important public health problem with profound impacts on the baby, the family and the community. The perinatal period is a vulnerable time for maternal mental health, with major depression affecting 13%–20% of pregnant and postpartum women and anxiety disorders affecting 10%–12% [1], [2], [3], [4]. Suicidal ideation is common during pregnancy and postpartum, although suicide completion is lower, suggesting that this period may offer some protective effect [4], [5]. However, perinatal suicide is still a potentially preventable public health issue and a devastating event for families when it occurs. As these women have frequent interaction with the health care system, there may be greater opportunity for providers to intervene if risk factors for self-harm can be better defined.

Unfortunately, efforts to study risks for pregnancy-associated suicide have been hampered by the lack of data sources which capture pregnancy and delivery status of victims [5], [6], [7]. Previous suicide surveillance efforts had very limited access to psychiatric status, psychiatric history and current stressors for the victim, which made it difficult to evaluate potential areas of intervention, treatment or prevention. Introduction of the United States National Violent Death Reporting System (NVDRS) in 2003 has provided new insights into violent deaths [8]. The data set allows close examination of pregnancy-associated suicides across multiple states [9]. The NVDRS is unique in its linkage of data from multiple sources. This permits exploration of demographic information and mode of death but also provides critical details about pregnancy and postpartum status, mental health, substance use and precipitating circumstances to create a more complete picture of victim characteristics.

We utilized the NVDRS to examine victims of suicides during pregnancy, suicides up to 1 year postpartum and non-pregnancy-associated suicides and to compare psychiatric history, substance use, methods of suicide, intimate partner problems and precipitating circumstances among these groups.

Section snippets

NVDRS sample

The NVDRS combines information from multiple sources: death certificates, coroner and medical examiner information, toxicology data and law enforcement reports [9]. We abstracted data from the NVDRS for the years 2003–2007 for 17 states. Sixteen of these states collect statewide data (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin), and one (California) gathers

Demographics

We limited the NVDRS data to reproductive-age female suicides among the 17 reporting states, which gave a sample size of 2083 victims. Of these, 48 (2%) were pregnant at the time of death, 65 (3%) were within 1 year postpartum, and 1970 (95%) were not pregnant or postpartum. Race was combined into three categories — white, nonwhite and missing — due to small cell size for pregnant and postpartum victims. Groups did not vary by these racial categories (Table 1). However, pregnant and postpartum

Discussion

Several findings stand out from this analysis. First, mental health disorders and substance abuse are equally prevalent in pregnant and nonpregnant women who commit suicide, and providers should be alert to these risk factors. Second, postpartum women were more likely to have been identified as having depressed mood in the 2 weeks prior to suicide than other women. Both pregnant and postpartum women were more frequently reported as having problems with a current or former intimate partner.

Conclusions

This analysis of mental health, substance, IPV and recent stressors associated with suicides during pregnancy and postpartum provides rich data on comorbidities and risk factors. Since mothers and infants in the childbearing years are likely to have frequent contacts with the health system, we urge providers to ask their patients about mental health diagnosis, current depressed mood and conflict with intimate partners. Women disclosing such issues may signal higher risk for suicide and may need

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    Financial support: Dr. Gold received salary support from this study from a National Institute of Mental Health K-23 grant and Dr. Palladino received salary support from the Robert Wood Johnson Clinical Scholars Program. The funders had no role in study design, data collection or analysis, or interpretation of results.

    ☆☆

    Recommended disclaimer for manuscripts using NVDRS data: This research uses data from NVDRS, a surveillance system designed by the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control. The findings are based, in part, on the contributions of the 17 funded states that collected violent death data and the contributions of the states' partners, including personnel from law enforcement, vital records, medical examiners/coroners and crime laboratories. The analyses, results and conclusions presented here represent those of the authors and not necessarily those of CDC. Persons interested in obtaining data files from NVDRS should contact CDC's National Center for Injury Prevention and Control, 4770 Buford Hwy, NE, MS F-63, Atlanta, GA 30341-3717, (800) CDC-INFO (232-4636).

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