Maternal suicide is a leading cause of death during the pregnancy and in the months after giving birth in the United States, but many of these deaths may be preventable, University of Michigan researchers say.
The drama of maternal suicide
A new study published in JAMANetworkOpen examines the circumstances associated with maternal suicide and how those circumstances vary across the perinatal period, using data from the Centers for Disease Control and Prevention’s National Violent Death Reporting System.
The UM authors found that mental health conditions, substance use, and relationship problems were important triggers for maternal suicide.
The study used data from more than 1,100 women who died during pregnancy or within a year of giving birth and whose deaths were listed as suicide or from undetermined causes. Researchers compared the individuals’ data to more than 17,600 women ages 10 to 50 who had not become pregnant in the past year.
“We should be doing everything we can to prevent these suicides. We owe it to these women and their families,” said lead author Kara Zivin, a professor of psychiatry and obstetrics and gynecology at the UM Medical School and a professor of health management and policy at the UM School of Public Health.
![Prenatal genetic testing, cesarean sections, folic acid](https://tech.icrewplay.com/wp-content/uploads/2023/11/gravidanzaecovid_thumb_720_480.jpg)
“Our study highlights the need for policies and practices targeting mental health, substance use and partner issues as part of a strategic approach to reduce maternal suicide risk.”
Zivin co-authored the study with Briana Mezuk, professor of epidemiology and director of the Center for Social Epidemiology and Population Health at the UM School of Public Health. Together, they are the principal investigators of the Aging, Transitions over the Lifespan, and Suicide Study, which explores how major life events, including pregnancy, impact suicide risk.
“This work suggests that pregnancy is a transitional period in people’s lives in which pre-existing factors contributing to suicide risk may combine in various ways, in addition to the social, psychological and biological risk factors that are part of the perinatal period itself ,” Mezuk said.
Co-authors of the study with Zivin and Mezuk include: Chuwen Zhong, Alejandro Rodríguez-Putnam, Emma Spring, Qingyi Cai, Alyson Miller, Lily Johns, Viktoryia Kalesnikava, and Anna Courant.
Women’s experiences of maternal suicide attempts
Researchers at King’s College London conducted in-depth interviews with women who attempted suicide during pregnancy or shortly after giving birth. They found three key themes in the women’s experiences that could help identify and support those at risk of maternal suicide.
Suicide is a leading cause of maternal death during pregnancy and the year after birth (the perinatal period). This study was the first of its kind to focus on suicide attempts during this period, and nearly half of the participants attempted suicide during pregnancy.
During interviews, women spoke about myriad factors that influenced their mental health during the perinatal period. One participant, Lauren, discussed her experience with domestic abuse, saying, “It was actually a punishment that I dared to get pregnant even though she knew I wasn’t using any contraception or anything.”
Another, Marie, spoke of her fear after experiencing postpartum psychosis with her first child: “I remember going to the 12-week scan with [la seconda gravidanza] and that I made the image and thought shit, it’s really real now and it could all happen again.”
![Prenatal genetic test, folic acid](https://tech.icrewplay.com/wp-content/uploads/2023/11/dieta-gravidanza_thumb_720_480.jpg)
From examining all the interviews, the researchers identified three key themes that contributed to the maternal suicide attempt:
- Trauma and Adversity: Captures the traumatic events and life adversities that participants began their pregnancy journey with
“I think there was something about the anxiety of having to do it all again, because I think I suffered antenatal depression with my first child, which went undetected, and then sky-high postnatal anxiety, which went undetected, and I was told it was normal.”—Sam.
- Disillusionment with motherhood: brings together a series of subthemes that highlight various challenges related to pregnancy, childbirth and motherhood resulting in declines in women’s mental health
“They always say that during pregnancy you should be glowing, that everything is wonderful and that you have these wonderful hormones, but I was lying on the sofa, hot and sweaty, and I was thinking: when will this baby be born, when will he be born?”—Simone.
- Entrapment and despair: present a number of factors that lead to a significant deterioration in women’s mental health, characterized by feelings of failure, hopelessness and loss of control.
“I don’t know how to explain it. I felt like all the things I had to do were like water in my hands. I could see it. I could feel it. I could hold it. But it was coming to my fingers and I couldn’t do anything about it.”—Liv.
“We are incredibly grateful to the women who shared their experiences as part of this research study. We hope that the findings highlighted will lead to greater awareness and support during the perinatal period and help prevent future maternal suicides,” said Dr. Dr Abigail Easter, lecturer in perinatal mental health at King’s College London and lead researcher on the study.
Although maternal suicide is a relatively rare event with a prevalence of 3.84 per 100,000 live births in the UK, the impact on the mother, children, family and wider society is profound and long-lasting. Qualitative research on perinatal suicide attempts is critical to understanding the experiences and circumstances surrounding these events, but has until now been largely unexplored.
The research, published in BMC Psychiatry, aimed to explore the experiences of women and mothers who have had a maternal suicide attempt and to understand the context and factors that contribute to it.
![Prenatal genetic testing](https://tech.icrewplay.com/wp-content/uploads/2023/11/gravidanza-mamma-750x422_center_center.jpg)
The researchers recruited 11 women and birth attendants in the UK who said they had attempted suicide. The interviews were conducted virtually, recorded and transcribed.
“As a midwife, I witnessed how hopeless some women felt during pregnancy or after giving birth. With this study, we wanted to give women a voice to help us understand how to improve their care.
“We hope that the findings of our study can provide strategies and recommendations to help identify women at risk of maternal suicide and ultimately improve the care and support that women and families receive,” said Kaat De Backer , Research Associate, King’s College London. and lead author.
The research team worked closely with a group of women with lived experience of perinatal mental health difficulties, key stakeholders and voluntary sector partners, to shape the design and delivery of the research.
This unique research demonstrates how important it is for healthcare professionals to talk about mental health with new and expectant mothers.
“Every contact is an opportunity for sensitive investigation and to create positive change by ensuring compassionate and potentially life-saving support is provided to those who need it.
“The clear recommendations from ASPEN and MBRRACE and the welcome inclusion of pregnant women and new mothers in the recent national strategy for suicide prevention offer an opportunity for collective action and targeted interventions, which we hope will save women’s lives,” said Karen Middleton, campaigns and policy manager at the Maternal Mental Health Alliance.
Mothers diagnosed with perinatal depression have a three times higher risk of suicidal behavior
Maternal suicide is a public health concern and the second most common cause of death during the postnatal period. New research from the Institute of Environmental Medicine (IMM) published in JAMA Network Open shows that mothers with clinically diagnosed perinatal depression were three times more likely to engage in suicidal behavior than mothers without perinatal depression.
Of maternal deaths, 13%–36% are attributable to suicide, and the consequences are devastating for the newborn and the family. Maternal suicide is linked to a complex interaction of risk factors, including history of psychiatric disorders, socioeconomic disparities, and inadequate access to health services. It is critically important to identify high-risk populations to prevent maternal suicide and attempted suicide.
![Prenatal genetic test, phthalates, pregnancy education, maternal acid, nausea, morning sickness, sepsis, folic acid, maternal, cortisol](https://tech.icrewplay.com/wp-content/uploads/2023/11/bugie-donne-in-gravidanza-1024x468.jpg)
“Our findings suggest that women with clinically diagnosed PND are at increased risk for suicidal behavior, particularly within 1 year of PND but throughout the 18 years of follow-up. This highlights the urgent need for careful clinical monitoring and timely intervention for this vulnerable population to prevent such devastating outcomes, regardless of pre-pregnancy history of psychiatric disorders,” says Hang Yu, PhD student.
In this nationwide, population-matched cohort study with a maximum follow-up of 18 years, 86,551 women with PND from 2001 to 2017 and 865,510 unaffected women were individually matched for age and calendar year at delivery. Sibling comparison was employed to account for familial confounding.
The researchers found that women with a clinical diagnosis of PND had an elevated risk of suicidal behavior compared to women from the same population or their full sisters without PND. Attenuated but still substantially elevated risks were observed compared to full sisters without PND who shared partial genetic and familial environmental factors with affected women.
Importantly, this excess risk was evident among women regardless of their history of psychiatric disorders, suggesting that PND is associated with an additional risk of suicidal behavior beyond that associated with psychiatric disorders occurring before the perinatal period. Furthermore, the increases in risk were particularly high immediately after PND diagnosis and, despite rapidly declining over time, persisted throughout the 18-year follow-up.
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