Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Fuhr, Daniela C.; Calvert, Clara; Ronsmans, Carine; Chandra, Prabha S.; Sikander, Siham; Silva, Mary J De; Patel, Vikram

doi:10.1016/s2215-0366(14)70282-2

Cited by 86 publications

(93 citation statements)

References 44 publications

(100 reference statements)

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“…Thirdly, deaths from suicide are usually difficult to ascertain. Misreporting of suicide deaths from families and relatives are also possible, which may result in imprecise estimates of suicide risk in diabetes patients (85). Finally, the outcomes from the subgroup analysis by types of diabetes showed that the risk of suicide associated with diabetes was likely to be more profound in T1DM patients, while there was a possible association between T2DM and increased risk of suicide (RR = 1.65, 95% CI: 0.95-2.85; P = 0.07).…”

Section: Discussionmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis

Wang

Shi

et al. 2017

European Journal of Endocrinology

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Background: Previous studies investigating the risk of suicide in diabetes patients reported controversial findings. We did a systematic review and meta-analysis to comprehensively estimate the risk and incidence rate of suicide in diabetic patients. Methods: PubMed, EMBASE and PsycINFO were searched for eligible studies. Random-effects meta-analysis was used to calculate the relative risk (RR) and the incidence rate of suicide in diabetes patients. We also calculated the proportion of deaths attributable to suicide among diabetes patients. Results: 54 studies were finally included, including 28 studies on the suicide risk associated with diabetes, 47 studies on the incidence rate of suicide and 45 studies on the proportion of deaths attributable to suicide. Meta-analysis showed that diabetes could significantly increase the risk of suicide (RR = 1.56; 95% CI: 1.29-1.89; P < 0.001). Subgroup analysis showed that the RR of suicide associated with type 1 diabetes was 2.25 (95% CI: 1.50-3.38; P < 0.001). The pooled incidence rate of suicide in patients with diabetes was 2.35 per 10 000 person-years (95% CI: 1.51-3.64). The pooled proportions of long-term deaths attributable to suicide in type 1 diabetes patients and type 2 diabetes patients were 7.7% (95% CI: 6.0-9.8) and 1.3% (95% CI: 0.6-2.6), respectively. Conclusion: This meta-analysis suggests that diabetes can significantly increase the risk of suicide. Suicide has an obvious contribution to mortality in diabetic patients, especially among type 1 diabetes patients. Effective strategies to decrease suicide risk and improve mental health outcomes in diabetes patients are needed.

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Section: Discussionmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis

Wang

Shi

et al. 2017

European Journal of Endocrinology

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“…A systematic review of studies in low- and middle-income countries found a pooled prevalence rate between 0.65 and 3.55% for maternal deaths attributed to suicide (Fuhr et al 2014). Risk factors identified included poverty, lack of support, lack of trust in health systems and comorbid mental illnesses.…”

Section: Introductionmentioning

confidence: 99%

Perinatal suicidal ideation and behaviour: psychiatry and adversity

Onah

Field

Bantjes

et al. 2016

Arch Womens Ment Health

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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 contextual risk factors, particularly in low- and middle-income countries. We investigated the prevalence and associated psychiatric and socio-economic 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 socio-economic and demographic factors, social support, life events, interpersonal violence and mental health diagnoses. We examined the significant risk factors for SIB using univariate, bivariate 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 socio-economic status, food insecurity, interpersonal violence, multiparousity, and lifetime suicide attempt. These findings focus attention on the importance of socio-economic and contextual 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.

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“…However, several recent studies have suggested that suicide is one of the leading causes of maternal mortality in countries including Australia, Sri Lanka, India, Bangladesh, and the UK (Agampodi et al 2014; Asad et al 2010; Austin and Kildea 2007; Chang et al 2005; Cockburn and Pawson 2007; Fuhr et al 2014; Gavin et al 2011a; Lindahl et al 2005; Oates 2003; Shadigian and Bauer 2005; Yusuf et al 2007). Little is known about the epidemiology of suicide and suicidal behavior among pregnant women in the US (Gold et al 2012; Lindahl et al 2005).…”

Section: Introductionmentioning

confidence: 99%

Suicidal behavior-related hospitalizations among pregnant women in the USA, 2006–2012

Zhong

Gelaye

Miller

et al. 2015

Arch Womens Ment Health

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Purpose Suicide is one of the leading causes of maternal mortality in many countries, but little is known about the epidemiology of suicide and suicidal behavior among pregnant women in the US. We sought to examine trends and provide nationally representative estimates for suicidal behavior (including suicidal ideation, and suicide and self-inflicted injury) among pregnant women from 2006 to 2012 in the US. Methods Pregnant women aged 12-55 years were identified through pregnancy- and delivery-related hospitalization records from the National (Nationwide) Inpatient Sample. Suicidal behavior was identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Annual, nationwide estimates and trends were determined using discharge and hospital weights. Results The prevalence of suicidal ideation more than doubled from 2006 to 2012 (47.5 to 115.0 per 100,000 pregnancy- and delivery-related hospitalizations), whereas the prevalence of suicide and self-inflicted injury remained stable. Nearly 10% of suicidal behavior occurred in the 12-18-year group, showing the highest prevalence per 100,000 pregnancy- and delivery-related hospitalizations (158.8 in 2006 and 308.7 in 2012) over the study period. For suicidal ideation, blacks had higher prevalence than whites; women in the lowest income quartile had the highest prevalence. Although the prevalence of suicidal behavior was higher among hospitalizations with depression diagnoses, more than 30% of hospitalizations were for suicidal behavior without depression diagnoses. Conclusions Our findings highlight the increasing burden and racial differences in suicidal ideation among US pregnant women. Targeted suicide prevention efforts are needed for high-risk pregnant women including teens, blacks, and low-income women.

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Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Cited by 86 publications

References 44 publications

MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis

MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis

Perinatal suicidal ideation and behaviour: psychiatry and adversity

Suicidal behavior-related hospitalizations among pregnant women in the USA, 2006–2012

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