Suicide Risk During Pregnancy, After Childbirth on the Rise

Study finds prevalence of suicidal thoughts and self-harm among childbearing women nearly tripled over a decade, with an estimated 24,000 individuals at potential suicide risk.

2:05 PM

Author | Beata Mostafavi

young mother holding head with child in background
Getty Images

Pregnancy and the period after delivering a baby can be one of the riskiest times for depressive symptoms, with suicide among the leading causes of death among new moms.

And now a new study suggests that suicide "near misses" during pregnancy and after childbirth are increasing.

The prevalence of suicidal thoughts and self-harm in the year before and after giving birth nearly tripled among childbearing people between 2006 and 2017, according to the findings in JAMA Psychiatry.

The greatest increases were seen among Black, low-income, and younger individuals, along with people with comorbid anxiety and depression or serious mental illness.

"Suicide deaths are a leading cause of maternal mortality in the U.S. It's a public health crisis that has silently grown worse," says lead author Lindsay Admon, M.D., M.Sc., an obstetrician-gynecologist at Michigan Medicine Von Voigtlander Women's Hospital and researcher with the University of Michigan Institute for Healthcare Policy and Innovation.

MORE FROM THE LAB: Subscribe to our weekly newsletter

Researchers evaluated data from the Maternal Behavioral Health Policy Evaluation (MAPLE) study to evaluate suicidality trends among individuals aged 15-44 in the year before and following birth.

Of 595,237 commercially insured childbearing individuals across the U.S., 2,683 had either suicidal ideation or had tried to harm themselves.

Maternal suicidality overall increased from 0.2 to 0.6% among people giving birth. That could translate to nearly 24,000 individuals among the estimated 4 million who give birth a year.

But these are likely underestimates, Admon says, since research suggests that depressive problems may be even higher among those who are on Medicaid – a population not included in the study.

Researchers identified concerning disparities too.

Particularly notable increases in suicidality were identified among those who were non-Hispanic Black, in younger age categories and with the lowest household incomes. For instance, suicidality increased from affecting 0.2 to 0.9% of the non-Hispanic Black population over the study period, affecting 1% of the population by 2017.

Suicidality also increased from impacting 1.6 to 9.5% of those aged 15-18 over the study period, affecting 10% of the population by 2017.  

The absolute greatest risks for suicidality appeared among those with serious mental health diagnoses and substance abuse disorders.

Identifying maternal suicidality

Suicide is the second leading cause of death among women 25-34 years of age and has steadily increased in prevalence since 2001. However, mental health is not captured in data used to study maternal morbidity and mortality, which has increased in the U.S.

Researchers and national committees have examined "near misses" to understand how to prevent maternal death. But psychiatric near misses, such as suicidal ideation or intentional self-harm, remain excluded from standard severe maternal morbidity measures.

"Suicide in the perinatal period represents an important but understudied health outcome," says senior author Kara Zivin, Ph.D., professor of psychiatry and obstetrics and gynecology at the University of Michigan and who has publicly shared her personal struggles with suicidality during her pregnancy a decade ago.

Suicide deaths are a leading cause of maternal mortality in the U.S. It's a public health crisis that has silently grown worse.
Lindsay Admon, M.D., M.Sc.

Numbers can be hard to pinpoint, she notes. Maternal mortality statistics reported by the Centers for Disease Control and Prevention excludes suicide deaths, deeming them "incidental or accidental" rather than pregnancy-related.

But a report using data from 14 maternal mortality review committees documented suicide as comprising 8.8% of maternal deaths from 2008-2017.

The new research follows another recent U-M-led study finding that over the past decade (2006-2019), the prevalence of both perinatal mood and anxiety disorders and serious mental illness among delivering women increased substantially across the United States.

Women with these conditions experienced a higher incidence of severe maternal morbidity and mortality, and increased hospital transfers and lengths of stay.

"The increases and disparities in suicidality over time, and the likelihood that suicidality is both under detected and under treated remains concerning," says Zivin, also senior author on the previous study.

"This research indicates we have more policy and clinical work to do to support struggling women and their families."

Like Podcasts? Add the Michigan Medicine News Break on iTunes or anywhere you listen to podcasts.

Pregnancy is an especially unique time when women are in more frequent contact with health providers, authors note, potentially increasing opportunities to identify depressive symptoms during pregnancy and postpartum.

"We need to improve screening for mental health wellness during and after pregnancy," Admon says. "We know that untreated mental health conditions put both moms and their children at higher risk for adverse health outcomes, including preterm birth and maternal suicide."

Policymakers, health plans and clinicians should ensure access to universal suicidality screening and appropriate treatment for pregnant and postpartum individuals, particularly for high-risk groups, she says. Clinical and policy interventions should also be tailored to meet the specific needs of individuals.

"We need to seek health system and policy avenues to better identify suicidal symptoms in childbearing women, "Admon says. "It's critical that we intervene as early as possible and provide necessary therapies to reduce the risk of the most tragic outcome."

Paper Cited: "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


More Articles About: Rounds Womens Health Gynecology Health Care Delivery, Policy and Economics Health Care Quality Von Voigtlander Women's Hospital childbirth Depression Mental Health Assessment Adult Psychiatric Treatment Postpartum Depression Pregnancy Caesarean Section Hospitals & Centers
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories
Health Lab
Fitness instructor, backpacker returns to active lifestyle after years of pain from endometriosis
Woman seeks answers for painful periods, leading to the discovery of endometriosis, large ovarian cysts, organ inflammation and appendix cancer
computer
Health Lab
Same patient. Different visit. Different race and ethnicity?
Data on the race and ethnicity of patients underpins efforts to reduce health care disparities, but a study shows inconsistent recording in emergency departments
Blurred image of health care professionals in blue scrubs pushing a gurney down a hallway
Health Lab
Primary care scarcity linked to more surgical emergencies, problems
Patients living in areas with the worst shortages of primary care providers are more likely to have emergency surgery, surgical complications and hospital readmissions.
Mom at table with baby, working on calculator with stressed out first expression
Health Lab
Medicaid eligibility during pandemic led to increased postpartum coverage, study suggests
Medicaid eligibility during pandemic led to increased postpartum coverage, study suggests
Person's hand holding an aspirin tablet with a glass of water nearby
Health Lab
An aspirin a day? Some older adults who take it may be following outdated advice
Many people aged 50 to 80 who said they take aspirin multiple times a week may not need to do so and could be causing health risks, according to National Poll on Healthy Aging.
Illustration of girl with blue water line, depicting a figure drowning, as girl contemplates pill in hand
Health Lab
Antidepressant dispensing to adolescents and young adults surges during pandemic
Rate of antidepressant dispensing to young people rose faster after March 2020, especially among females