Sociodemographic factors linked to pregnancy-associated suicide, homicide
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Pregnancy-associated suicide was linked to mental health issues and substance use, and pregnancy-associated homicide was linked to intimate partner violence, according to a retrospective cohort study published in Obstetrics & Gynecology.
Other factors linked to pregnancy-associated suicide and homicide were race and ethnicity, age, marital status and education level.
"We were interested in pursuing this study question as a way to contribute to the conversation regarding maternal mortality in the United States,” Anna M. Modest, PhD, MPH, an assistant professor of obstetrics, gynecology and reproductive biology at Beth Israel Deaconess Medical Center in Boston, told Healio. “There has been a lot of necessary attention paid to obstetric causes of maternal mortality. However, there are other causes of death among pregnant and recently pregnant people.”
Modest and colleagues used the CDC’s National Violent Death Reporting System to identify 38,417 people of child-bearing age — defined by the CDC as age 15 to 44 years — who died by suicide or homicide. Those that occurred during pregnancy or within 1 year of delivery were categorized as pregnancy-associated deaths.
In the full cohort, a greater proportion of people who died by homicide vs. suicide were younger (29.4 ± 8.2 years vs. 31.5 ± 8.6 years) and single or never married (61% vs. 50%), whereas a lower proportion received at least some college education (28.1% vs. 43.9%).
Overall, 1,300 deaths in the cohort were associated with pregnancy. Of those, 660 were homicide deaths, accounting for 20.6% of all homicide deaths in the cohort. The remaining 640 were suicide deaths, accounting for 8.8% of all suicide deaths in the cohort.
Among people who had a pregnancy-associated death, a greater proportion of those who died by homicide were Black or African American (48.8% vs. 12.3%) single or never married (72.3% vs. 50.5%) and have less than a high school diploma (61.7% vs. 46.8%) compared with those who died by suicide.
Of note, firearms were involved in 68.3% and 35.3% of pregnancy-associated homicide and suicide deaths, respectively.
Additionally, a greater proportion of people who died by pregnancy-associated suicide vs. pregnancy-associated homicide had a mental health problem (77.4% vs. 7.2%) or any substance use (33.3% vs. 12.8%; both, P < .001). On the other hand, a greater proportion of those who died by pregnancy-associated homicide were victims of intimate partner violence (IPV) compared with those who died by pregnancy-associated suicide (57.3% vs. 37.1%; P < .001).
“There is a need for improved screening and intervention to prevent pregnancy-associated homicide and suicide,” Modest said. “Our society also needs a better way to track these deaths in order to better understand the impacts.”
However, Modest noted that there are no interventions proven to reduce pregnancy-associated homicide and suicide. “Without interventions, even improved screening will not reduce these deaths,” she said.