Friday, November 20, 2020

Suicidality Among Childbearing Women Found to Increase Over 12-Year Period

From 2006 to 2017, the prevalence of suicidal ideation and intentional self-harm among women in the year before or after birth increased substantially, according to a study published this week in JAMA Psychiatry.

“Maternal health experts note that the lack of consistent, inclusive data on suicidality before and after birth is alarming,” wrote Lindsay Admon, M.D., M.Sc., of the University of Michigan and colleagues. “Further, … suicidal ideation and intentional self-harm remain excluded from standard measures of severe maternal morbidity.”

Admon and colleagues conducted the Maternal Behavioral Health Policy Evaluation study to evaluate suicidality trends from 2006 to 2017 among women aged 15 to 44. They used Optum Clinformatics Data Mart, which included medical claims data from a national, commercially insured population from all 50 states. The researchers compared women with or without a suicidality diagnosis (defined as a diagnosis of suicidal ideation and/or intentional self-harm in inpatient or outpatient settings) in the year before and after giving birth. The authors also identified whether the patients had clinical comorbidities, including depression, anxiety, bipolar disorder, psychosis, and substance use disorders.

The authors identified 698,239 deliveries among 595,237 commercially insured women during the study period. Of these women, 2,683 individuals were diagnosed with suicidal ideation or intentional self-harm one year before or after giving birth. Other findings, as described by the authors, include the following:

  • Suicidality increased from 0.2% per 100 individuals in 2006 to 0.6% per 100 individuals in 2017.
  • Suicidal ideation increased from 0.1% per 100 individuals in 2006 to 0.5% per 100 individuals in 2017.
  • Intentional self-harm increased from 0.1% per 100 individuals in 2006 to 0.2% per 100 individuals in 2017.
  • Suicidality with comorbid depression or anxiety increased from 1.2% per 100 individuals in 2006 to 2.6% per 100 individuals in 2017.
  • Suicidality with comorbid psychotic disorders increased from 7.1% per 100 individuals in 2006 to 47.6% per 100 individuals in 2017.

The authors noted that Black women, those with lower incomes, and younger women experienced the larger increases in suicidality. “Given the severe maternal mortality crisis among racial/ethnic minority individuals, especially Black women, it is imperative to include psychiatric risks in predictive models and practice guidelines,” they wrote.

“[P]olicymakers, health plans, and clinicians should ensure access to universal suicidality screening and appropriate treatment for pregnant and postpartum individuals and seek health system and policy avenues to mitigate this public health crisis, particularly for high-risk groups,” they concluded.

For related information, see the Psychiatric News article “Drugs, Suicide Among Leading Causes of Postpartum Death in California.”

(Image: iStock\fotostorm)

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