Postpartum women at greater risk for fatal suicide attempt than pregnant women

Postpartum women were more likely to use fatal suicide attempt methods and have more distinct and serious psychopathology than pregnant women, according to results of a study conducted in Japan and published in Journal of Clinical Psychiatry.

“Screening positive for depression or anxiety has been reported to be related to later suicidal ideation among postpartum women,” Daisuke Shigemi, MD, of the department of clinical epidemiology and health economics at The University of Tokyo, and colleagues wrote. “Postpartum depression is a common emotional problem, affecting approximately 10% to 15% (with a reported range of 0% to 60%) of women who have delivered, according to a recent worldwide meta-analysis. A Japanese multicenter study reported that 12.1% of pregnant women and 11.7% of postpartum women experienced the onset of some type of mental disorder, such as a major depressive episode, depressive disorder not otherwise specified, a manic episode, generalized anxiety disorder, panic disorder, social/specific phobia or obsessive-compulsive disorder.”

According to the investigators, suicide attempts are a significant predictor of subsequent completed suicide. Thus, epidemiologic analysis of suicide attempts and mental disorders among postpartum and pregnant women may bolster suicide countermeasures among these patient populations. Although a prior U.S. study reported a cumulative incidence of suicide attempts during pregnancy of four per 100,000 pregnancies, overall data are sparse regarding the epidemiology and prevalence of perinatal suicidal behavior.

To address this research gap, Shigemi and colleagues sought to describe the clinical and demographic characteristics of pregnant and postpartum women in Japan with psychoneurological disorders who attempted suicide. They conducted a nationwide retrospective cohort study using the Diagnosis Procedure Combination database — a national database on acute-care inpatients in Japan. The investigators identified all postpartum and pregnant women with psychoneurological disorders according to ICD-10 codes who were admitted to participating hospitals between January 2016 and March 2018. They investigated the prevalence of suicide attempts, risk factors for suicidal behaviors, maternal outcomes and other patient characteristics.

Results showed that among 3,286 eligible patients, of whom 3,026 were pregnant and 260 were postpartum, 22 pregnant women and 16 postpartum women had attempted suicide. The investigators noted that suicide attempt prevalence was significantly higher among postpartum women (6.2%) than pregnant women (0.7%; P < .001). Postpartum women had higher rates of depression and were more likely to be aged 30 years or older. Among pregnant women, wrist cutting was the main method of suicide attempt, whereas hanging was the main method among postpartum women. The researchers noted that three postpartum women died during hospitalization.

“Because the current study investigated only specific patients who had psychoneurological disorders and because the study period was limited, further clinical studies are needed to determine the incidence of and risk factors for suicidal behaviors among all perinatal women in Japan,” the researchers wrote. – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.