Mental, physical health, domestic violence, substance use tied to maternal suicide rate

Key takeaways:

• Depression, substance or other abuse, and physical health impairments were more likely for perinatal vs. non-perinatal suicides.
• Perinatal vs. non-perinatal suicides had a higher likelihood of recent loss.

Perinatal vs. non-perinatal suicide was more likely to be associated with depression, substance use, physical health issues and recent bereavement, highlighting the need for targeted interventions and policies, researchers reported.

“Previous studies that have examined quantitative factors associated with pregnancy-related deaths have reported that mental health problems, substance use disorders and intimate partner problems preceded suicide and homicide in pregnancy,” Kara Zivin, PhD, MS, MA, MFA, health services and policy researcher in the department of psychiatry and the department of obstetrics and gynecology at Michigan Medicine and the Center for Clinical Management Research in the Veterans Affairs Ann Arbor Healthcare System, and colleagues wrote. “Limitations of the aforementioned studies include sole use of older quantitative data sources, which typically reflect a limited number of states, smaller sample sizes or both.”

Zivin and colleagues conducted a cross-sectional observational study and qualitative analysis, published in JAMA Network Open, using data from 1,150 perinatal deaths (mean age, 29.1 years) from the National Violent Death Reporting System from 2003 to 2021 to evaluate factors contributing to maternal suicide and death of undetermined intent. All women were aged 10 to 50 years and were pregnant or postpartum at the time of death. Researchers compared these deaths to 17,655 matched deaths of nonpregnant or recently pregnant women (mean age, 35.8 years).

Primary outcomes were contributing factors associated with suicides and undetermined deaths cited in coroner, medical examiner or law enforcement case narratives.

Overall, 39.6% of women were pregnant, 17.7% were 1 to 42 days postpartum and 42.7% were 43 to 365 days postpartum at time of death.

Researchers observed higher odds of the following contributing factors for perinatal vs. matched non-perinatal deaths:

• intimate partner problems (OR = 1.45; 95% CI, 1.23-1.72);
• recent argument (OR = 1.33; 95% CI, 1.09-1.61);
• depressed mood (OR = 1.39; 95% CI, 1.19-1.63);
• substance or other abuse (OR = 1.21; 95% CI, 1.03-1.42);
• physical health problems (OR = 1.37; 95% CI, 1.09-1.72); and
• death of a family member or friend (OR = 1.47; 95% CI, 1.06-2.02).

“Suicide death remains the leading cause of maternal mortality, and preventing maternal suicides represents an unmet public health need,” the researchers wrote. “Clinicians and policymakers should target these vulnerable populations by implementing existing evidence-based interventions and reducing stigma around reporting mental health conditions, substance use conditions and intimate partner problems in efforts to reduce maternal mortality by suicide.”