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Providers must be vigilant for postpartum suicide risk

Recent findings highlighted the importance of assessing suicide risk throughout the perinatal period.

“Existing Canadian data suggest that suicide is the fourth leading cause of death in the perinatal period,” Sophie Grigoriadis, MD, PhD, of the University of Toronto, and colleagues wrote. “However, rates may be underestimated, because they typically include only ‘maternal deaths’ in pregnancy or up to 6 weeks (42 days) after the birth, despite the fact that the burden of suicide related to postpartum mental illness is likely to extend beyond 6 weeks postpartum.”

To assess epidemiology and health care use for suicide during pregnancy and the first postpartum year, researchers linked health administrative databases with coroner death records from 1994 to 2008 for Ontario, Canada.

Overall, the perinatal suicide rate was 2.85 per 100,000 live births, with 51 out of 966 perinatal deaths by suicide.

Suicides occurred most often during the final quarter of the first postpartum year.

Highest rates of perinatal suicide occurred in rural and remote regions.

Perinatal suicides were more often by hanging (33.3%) or jumping or falling (19.6%), compared with women who died by suicide nonperinatally (P = .04).

Within 30 days before death, 39.2% of women had mental health contact, which was comparable to the rate among women who died by suicide nonperinatally (47.7%; OR = 0.71; 95% CI, 0.4-1.25).

Nonmental health primary care and obstetric care before index date was comparable among perinatal women who died by suicide and living perinatal women. However, perinatal women who died by suicide were less likely to have pediatric contact within 30 days before death (64.5% v. 88.4%; OR = 0.24; 95% CI, 0.1-0.58).

“With one in 19 maternal deaths attributable to suicide in Ontario, the findings of our study suggest that there is room to improve engagement of pregnant and postpartum women in perinatal mental health services,” the researchers wrote. “Moreover, our suicide surveillance and mental health intervention efforts must focus on pregnancy and must continue well into the first postpartum year.” – by Amanda Oldt

Disclosures: Grigoriadis reports receiving personal fees from Sage, Eli Lilly Canada, Allergan/Actavis, Pfizer and Bristol Myers Squibb for activities unrelated to the current manuscript. The other researchers report no relevant financial disclosures.