Suicide in perinatal and non-perinatal women in contact with psychiatric services: 15 year fi ndings from a UK national inquiry (original) (raw)
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Suicide during Perinatal Period: epidemiology, Risk Factors, and Clinical Correlates
Perinatal period may pose a great challenge for the clinical management and treatment of psychiatric disorders in women. In fact, several mental illnesses can arise during pregnancy and/or following childbirth. Suicide has been considered a relatively rare event during the perinatal period. However, in some mental disorders (i.e., postpartum depression, bipolar disorder, postpartum psychosis, etc.) have been reported a higher risk of suicidal ideation, suicide attempt, or suicide. Therefore, a complete screening of mothers' mental health should also take into account thoughts of suicide and thoughts about harming infants as well. Clinicians should carefully monitor and early identify related clinical manifestations, potential risk factors, and alarm symptoms related to suicide. The present paper aims at providing a focused review about epidemiological data, risk factors, and an overview about the main clinical correlates associated with the suicidal behavior during the pregnancy and postpartum period. Practical recommendations have been provided as well.
The impact of reclassifying suicides in pregnancy and postnatal period on Maternal Mortality Ratios
BJOG : an international journal of obstetrics and gynaecology, 2018
Poor maternal mental health is an important contributor to maternal mortality, which remains a global health priority as expressed in the sustainable development goals. Although underreported and neglected, psychiatric disorders in pregnant women or following childbirth have been shown to increase the risk of death from obstetric and medical conditions in pregnancy and puerperium as well as suicide up to one year postpartum (1,2). Therefore, increased attention to maternal mental health is needed. Many maternal suicides are preventable. This article is protected by copyright. All rights reserved.
Suicides and Suicidal Ideation During the Perinatal Period: Clinical and Demographic Data
International journal of innovative research in medical science, 2022
Suicide is the second-leading cause of death for women in the postpartum period. Psychiatric disorders are common in pregnancy, affecting 15-29% of pregnant women, whereas clinical depression affects 10%-15% of them. Women during pregnancy and the postpartum period are particularly vulnerable to suicidal ideation. The prevalence of suicidal ideation ranges from 5% to 14% worldwide, while the rate of suicide during pregnancy and the postpartum period lies between two to three per 100,000 for countries like the UK and the USA. The main risk factor for suicidal ideation in the perinatal period is depression. Other mental illnesses, like schizophrenia, anxiety, bipolar and adjustment disorder, consist of risk factors too. Some of the high-risk social characteristics for suicide thoughts are younger age, unpartnered status and well-being with their marriage, high parity, non-Caucasian race, no health insurance, poor social support, unplanned pregnancy, low-income origin country, unemployment, low educational level and smoking. Obstetrics complications like severe vaginal laceration, low weight infants and admission in the neonatal intensive care unit, perinatal fetal mortality and prior abortions consist of risk factors. Physical, psychological or sexual intimate partner violence, sexual trauma and history of physical or sexual abuse in the army, physical or sexual abuse during childhood, all contribute to suicidal thought. Knowledge of the psychiatric history from the time of enrolment in maternity units, better identification of mental health problems via psychometric screening tools, as well as the use of proper referral and medication, should be the routine in health care services.
Suicide during pregnancy and its neglect as a component of maternal mortality
International Journal of Gynecology & Obstetrics, 1994
To raise awareness about the socio-cultural factors which may lead pregnant women to commit suicide. Metho& 'Ibis paper reviews and compiles current international literature on this topic, and suggests comparison with evidence from the past. Results: Suicide during pregnancy is often due to the limited choices women face when confronted with an unwanted pregnancy. Neglect of this subject is due in part to the exclusion of suicide from classification as 'maternal death,' and other diffkulties in collecting reliable data. Conclusions: The problem of suicide during pregnancy underscores the need for sex education at an early age, access to family planning, and access to safe abortion services.
Prevalence of suicide risk and its associated factors in patients presenting in antenatal clinic
Journal of Patan Academy of Health Sciences
Introduction: Suicide during the antenatal period is one of the major indirect causes of maternal death. This study aims to determine the prevalence of suicidal risk and its related factors among the patients attending the antenatal clinic of a tertiary care center. Method: This is a cross-sectional study conducted in the antenatal clinic Patan Hospital, Lalitpur, Nepal among 124 pregnant patients using purposive sampling and face-to-face interviews applying a semi-structured proforma and P4 suicide screener. Ethical approval was obtained. The percentage of patients with suicide risk was calculated and stratified into minimal, lower, and higher risk of suicide. The association between suicide risk and different sociodemographic and clinical variables was done using the Chi-square test. A p-values ≤0.05 was considered statistically significant. Result: The prevalence of suicide risk was 32 out of 124 patients (25.8%). When risk stratification was done a maximum of 22(17.7%) had a hig...
PLOS ONE, 2022
Objectives This review aims to map the existing evidence on perinatal suicidal ideation, identify biopsychosocial risk factors associated with suicidal ideation and make recommendations for service provision and future research. Methods Scoping review guided by Arskey's and O'Malley's (2005) framework. Five academic databases (PsycINFO, MEDLINE, CINAHL, ASSIA and Academic Search Complete) were searched from 1 st January 2009 to 1 st April 2022. Studies were screened by title, abstract and full text against inclusion and exclusion criteria. Primary qualitative, quantitative and mixed-methods studies, written in English pertaining to perinatal suicidal ideation were included. Forty-one studies met the eligibility criteria, data were extracted and narratively synthesised. Findings are reported in accordance with the PRISMA-SR extension. Key conclusions Findings were mapped onto the biopsychosocial framework and include sleep deprivation, maternal age, pregnancy complications, mood disorders, intimate partner violence, childhood maltreatment/abuse, low socioeconomic status, alcohol and tobacco misuse, miscarriage/perinatal loss, birth trauma and sleep deprivation. The findings demonstrate that the biopsychosocial risk factors for perinatal suicidal ideation are varied and complex.
Perinatal suicidal ideation and behaviour: psychiatry and adversity
Pregnant women are at increased risk for suicidal ideation and behaviours (SIB) compared to the general population. To date, studies have focused on the psychiatric correlates of SIB with lesser attention given to the associated con-textual risk factors, particularly in low-and middle-income countries. We investigated the prevalence and associated psychiatric and socioeconomic contextual factors for SIB among pregnant women living in low resource communities in South Africa. Three hundred seventy-six pregnant women were evaluated using a range of tools to collect data on socioeconomic and demographic factors, social support, life events, interpersonal violence and mental health diagnoses. We examined the significant risk factors for SIB using univariate, bi-variate and logistic regression analyses (p ≤ 0.05). The 1-month prevalence of SIB was 18%. SIB was associated with psychiatric illness, notably major depressive episode (MDE) and any anxiety disorder. However, 67% of pregnant women with SIB had no MDE diagnosis, and 65% had no anxiety disorder, while 54% had neither MDE nor anxiety disorder diagnoses. Factors associated with SIB included lower socioeconomic status, food insecurity, interpersonal violence, multiparousity, and lifetime suicide attempt. These findings focus attention on the importance of socioeconomic and con-textual factors in the aetiology of SIB and lend support to the idea that suicide risk should be assessed independently of depression and anxiety among pregnant women.
Risk of suicide in high-risk pregnancy: an exploratory study
Objective: To identify the risk of suicidal behavior in high-risk pregnant women at a public hospital in São Paulo. Methods: We conducted a semi-structured interview with each of the participants (n = 268) through a previously prepared questionnaire. Risk of suicidal behavior was assessed by the Portuguese version of PRIME-MD. Results: The mean age of patients was 29 years (SD = 0.507) and gestation period was 30 weeks (SD = 0.556). Of the total sample, specific risk of suicide was found in 5% (n = 14). Of these, 85% have a stable relationship (married or cohabitating), the pregnancy was planned in 50% of cases, and 71% have no religion or professional activities. The correlation of risk of suicide with data from marital status, planned birth, age, education, professional practice, risk of prematurity, and religion showed that having a religion is statistically significant (p = 0.012). There were no positive associations for any of the other selected variables when compared with the risk of suicide. By correlating the risk of suicide with other characteristic symptoms of major depression, there was statistical significance in the sample with regard to insomnia or hypersomnia (p = 0.003), fatigue or loss of energy (p = 0.001), decreased or increased appetite (p = 0.005), less interest in daily activities (p = 0.000), depressed mood (p = 0.000), feelings of worthlessness or guilt (p = 0.000), decreased concentration (p = 0.002), and agitation or psychomotor retardation (p = 0.002). Conclusion: We found that religion can be a protective factor against suicidal behavior. Besides providing a social support network needed by women during pregnancy, religion supports belief in life after death and in a loving God, giving purpose to life and self-esteem and providing models for coping with crises. The results show the importance of prevention and early diagnosis of suicidal behavior, since suicide is an attempt to move from one sphere to another by force, seeking to solve what seems impossible.