Assessing Suicide Risk Among Childbearing Women in the U.S. Before and After Giving Birth
Suicide is the second leading cause of death among women aged 25 to 34, and the proportion of women who die by suicide has steadily increased over the last two decades. A 2017 report highlighting maternal mortality data from 2008 to 2017 collected by nine states showed that suicide accounted for 6.5% of maternal deaths. However, the extent of suicidality—suicidal ideation and/or intentional self-harm—among childbearing women is not well known. Understanding trends in suicide risk in the year before and following childbirth, including which groups of women are at highest risk, could help inform research and suicide prevention interventions.
To characterize trends in suicide risk among childbearing women, an NIMH-supported research team led by Lindsay Admon, M.D., and Kara Zivin, Ph.D., of the University of Michigan, conducted the Maternal Behavioral Health Policy Evaluation study. They analyzed diagnostic codes (referred to in the study as “diagnoses”) from medical claims data for 595,237 commercially insured, childbearing women in the U.S. who presented for care over a 12-year period. The researchers identified suicidality based on suicidal ideation and/or intentional self-harm reported in association with either two outpatient visits or one inpatient hospital stay. The research team also compiled demographic and clinical characteristics for all individuals and identified instances of co-occurring diagnoses of mental health disorders.
The researchers found that from 2006 to 2017, 2,683 childbearing women aged 15 to 44 were identified to be at risk for suicide in the year before or after giving birth. The data showed a three-fold increase in the documented prevalence of suicidality over the study period, increasing from 2 people to 6 people per 1,000. Among these childbearing women with suicidality, nearly 59% (1,592) of the diagnoses occurred in the year after giving birth, while 45% (1,225) happened in the year before giving birth. Suicidality appeared in both time periods for about 4% (103) of individuals in the dataset.
In addition, among the childbearing women with documented suicidality, close to 92% had either co-occurring anxiety or depression diagnoses, and nearly one-third had a comorbid bipolar disorder or psychotic disorder.
Most subgroups showed increases in suicidality over the study period, with sharper increases among younger women, individuals with lower incomes, and non-Hispanic Black women. The researchers noted that these increases should inform intervention efforts.
As the study used diagnostic coding data from a single commercial insurance provider, the researchers pointed out that findings may differ in other populations and settings. In addition, the researchers could not determine whether the increases in suicidality represented the increase in the number of women who were at risk of suicide, improved clinical detection of suicidality, or both. They suggest future research should focus on determining the underlying cause of the increases.
According to the researchers, the findings from this study highlight the need for suicidality screening and appropriate treatment for pregnant and postpartum women. They recommend policymakers, providers, and insurers determine strategies to address this growing public health crisis, especially for high-risk groups.
Admon, L. K., Dalton, V. K., Kolenic, G. E., Ettner, S. L., Tilea, A., Haffajee, R. L., Brownlee, R. M., Zochowski, M. K., Tabb, K. M., Muzik, M., Zivin, K. (2020). Trends in Suicidality 1 Year Before and After Birth Among Commercially Insured Childbearing Individuals in the United States, 2006-2017. JAMA Psychiatry. DOI: 10.1001/jamapsychiatry.2020.3550