Psychiatric–Medical ComorbidityMental health, substance use and intimate partner problems among pregnant and postpartum suicide victims in the National Violent Death Reporting System☆,☆☆
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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Cited by (55)
Precipitating Circumstances Associated With Intimate Partner Problem–Related Suicides
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2021, Aggression and Violent BehaviorRelationship between trait neuroticism and suicidal ideation among postpartum women in China: Testing a mediation model
2019, Journal of Affective DisordersCitation Excerpt :According to a recent survey in the US, suicide was found to be one of the leading causes of death for reproductive aged-women (Ballesteros et al., 2017). Postpartum women were found to have a relatively higher risk of suicide, which has a great negative effect on the baby's growth and development, as well as the emotional burden on their families (Gold et al., 2011). Suicidal ideation is one of the major risk factors predicting suicide (Chen et al., 2018; Lindahl et al., 2005), and is a common phenomenon among postpartum women around the world.
Screening and diagnosis of peripartum depression and related disorders
2023, Counseling for Peripartum Depression: A Strengths-Based Approach to Conceptualization and Treatment
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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.
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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).