Homicide and Suicide During the Perinatal Period

Abstract

Objective Homicide and suicide are two important and potentially preventable causes of maternal injury. We analyzed data from the National Violent Death Reporting System to estimate the rates of pregnancy-associated homicide and suicide in a multi-state sample, to compare these rates with other causes of maternal mortality, and to describe victims’ demographic characteristics. Methods We analyzed data from female victims of reproductive age from 2003–2007. We identified pregnancy-associated violent deaths as deaths due to homicide or suicide during pregnancy or within the first year postpartum. We calculated the rates of pregnancy-associated homicide and suicide as the number of deaths per 100,000 live births in the sample population. We used descriptive statistics to report victims’ demographic characteristics and prevalence of intimate partner violence (IPV). Results There were 94 counts of pregnancy-associated suicide and 139 counts of pregnancy-associated homicide, yielding pregnancy-associated suicide and homicide rates of 2.0 and 2.9 deaths/100,000 live births, respectively. Victims of pregnancy-associated suicide were significantly more likely to be older and of Caucasian or American Indian descent as compared to all live births in NVDRS states. Pregnancy-associated homicide victims were significantly more likely to be at the extremes of the age range and African American. 54.3% of pregnancy-associated suicides involved intimate partner conflict that appeared to contribute to the suicide. 45.3% of pregnancy-associated homicides were IPV-associated. Conclusions Our results indicate that pregnancy-associated homicide and suicide are important contributors to maternal mortality and confirm the need to evaluate the relationships between socio demographic disparities and IPV with pregnancy-associated violent death.

Pregnancy-associated homicide and suicide in 37 US states with enhanced pregnancy surveillance

“…31 Where comparisons were available, sparse evidence suggests that pregnant/postpartum women may be at the same or lower risk for suicide compared to non-pregnant/non-postpartum women, consistent with our finding. 30, 32 Given the disproportionate burden of suicide among late postpartum women in particular, there may be important heterogeneity that is masked by calculating pregnancy-associated risk as defined (pregnant and postpartum combined).…”

“…Other studies on pregnancy-associated homicide have reported rates per 100,000 ranging from 8.6 in Tennessee from 1989 to 1991 (postpartum only), 6 9.3 in Maryland 1993–2008, 4 2.9 in North Carolina from 2004–2006, 30 and 2.9 in 17 states participating in the National Violent Death Reporting System (NVDRS) from 2003–2007 (SC, GA, NC, VA, NJ, MD, AK, MA, OR, CO, OK, RI, WI, CA, KT, NM, UT). 31 Although we find similar rates of pregnancy-associated homicide, Samandari et al 30 concluded that the risk of homicide was decreased among pregnant/postpartum women in North Carolina based on a homicide rate of 4.9 per 100,000 in the referent non-pregnant/non-postpartum population. This estimate is notably higher than the national rate among all women reported by the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control from 2005–2010 (2.9 per 100,000), 26 as well as our estimated range of 2.5–2.6 among the 37 states included in this analysis.…”

“…It is impossible to determine if pregnancy-associated violent deaths would not have occurred in the absence of pregnancy; however, the significant role intimate partner violence and conflict plays in many cases of pregnancy-associated homicide and suicide 4,31, 35–39 , suggests that pregnancy may be an additional stressor in already vulnerable circumstances, 39 or that these deaths may be the conclusion of a cycle of physical and sexual abuse that ends during pregnancy. 37 What is clear is that pregnancy may be a potentially important window of opportunity to identify women who are at risk for homicide and suicide, especially those who might not otherwise be in contact with health care and social services.…”

Intimate partner violence and suicidal ideation in pregnant women

“…Suicidality during the perinatal period represents a significant public health issue as it is a leading cause of maternal mortality in the USA (Chang et al 2005; Palladino et al 2011). Suicidal ideation or suicidal thoughts are significant predictors of suicide attempts and completions making suicidal ideation an important issue to address when revealed during pregnancy (Moller, 2003).…”

“…The association between IPV and depression, both during pregnancy and the postpartum period, is well-established (Agrawal et al 2014; Connelly et al 2013; Kiely et al 2013). Importantly, 54.3% of pregnancy-associated suicides involved intimate partner conflict attributable to the suicide (Palladino et al 2011). However, the association between IPV and suicidal ideation during pregnancy is under-researched.…”