Prevalence and correlates of suicidal behaviors during pregnancy: evidence from the National Survey on Drug Use and Health

Abstract

Suicidal behaviors during pregnancy are prevalent and have the potential to adversely affect a woman's health and her developing infant. The purpose of this study was to examine prevalence and correlates of suicidal behaviors in a national sample of pregnant women. Using data from the 2009-2018 National Survey on Drug Use and Health, a sample of 7479 pregnant women was analyzed. Multiple logistic regression was used to examine associations between sample characteristics and suicidal behaviors overall and by pregnancy trimester. In this sample, 3.4% of women exhibited suicidal behaviors such as ideation, planning, and attempt. Suicidal behaviors were more prevalent at 4.4% among women in the first trimester compared to the second/third trimesters (2.9%). Of those exhibiting suicidal behavior, 63.0% were ideators, 18.9% planned suicide, and 18.1% attempted suicide. Logistic regression analyses revealed that all racial/ethnic groups of women in the third trimester were less likely to be suicidal relative to black non-Hispanic women. Alcohol abuse (OR 3.70, 95% CI 1.97, 6.81) and major depressive episode (OR 4.91, 95% CI 3.10, 7.84) in the past year significantly increased the odds of suicidality for all pregnant women. Perceived unmet need for treatment increased the likelihood (OR 5.64, 95% CI 3.55, 8.97) of suicidal behavior regardless of trimester. These findings underscore the importance of screening for suicidal behaviors in the first trimester, especially among those with existing mood disorders and substance abuse. Racial/ethnic differences should be considered in targeted interventions for suicide prevention.

Suicide and Maternal Mortality

“…Studies have also suggested that risk may vary by timeline during the perinatal period. An analysis of data from 2009 to 2018 National Survey on Drug Use and Health found that suicidal behavior was more prevalent in the first trimester [ 26 ]. Likewise, another study found that intentional poisoning was more common in the first and second trimester relative to the third trimester [ 65 ].…”

“…This finding was replicated in other studies, in which MDD was found in between 30% [ 77 ] and 50% [ 66 ] pregnant patients who died by suicide. Furthermore, a recent major depressive episode (within the past 12 months) is associated with 4.9 times higher odds of exhibiting suicidal behavior compared to women who did not experience a recent major depressive episode [ 26 ]. Among women with hearing loss, postpartum depression increased the risk of suicidal thoughts as measured by the suicidal ideation attributes scale, but the presence of social support decreased the risk [ 78 ].…”

“…However, racial and ethnic differences in maternal mortality due to suicide can be difficult to evaluate; for example, American Indian/Alaska (AI/AN) maternal mortality data for homicide and suicide often include small samples and may categorize AI/AN maternal deaths in an ‘‘Other’’ race/ethnicity category [ 25 ]. Furthermore, an evaluation of suicidal behaviors (thoughts, plans, and attempts) among 7479 pregnant women using the National Survey on Drug Use and Health found that all racial/ethnic groups of women in the third trimester were less likely to be suicidal relative to black non-Hispanic women [ 26 •].…”

“…Other studies have found higher rates of suicide and suicide attempts in the perinatal period. An analysis of data from 7479 pregnant women in the 2009–2018 National Survey on Drug Use and Health [ 26 •] found the prevalence of suicidal behaviors (including ideation, planning and attempt) to be 3.4%. Prevalence was higher in the first trimester (4.4%) compared to the second/third trimesters (2.9%).…”

“…Women with PPMD had HR of 6.2 for self-harm compared to mothers without mental disorders, but self-harm risk was lower in PPMD women compared to mothers with non-PPMD, and childless women with mental disorders Kambach et al [ 94 ] Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination Cross-sectional 267 pregnant women 267 EPDS SI 10.1% endorsed SI; high rumination and insomnia are associated with suicidal ideation Kimmel [ 116 ] Nocturnal cognitive hyperarousal, perinatal-focused rumination, and insomnia are associated with suicidal ideation in perinatal women with mild to moderate depression Prospective observational study Women from late pregnancy through early postpartum 39 EPDS SI Nocturnal cognitive hyperarousal at baseline and women with prior perinatal loss were at increased risk for new onset SI. SI risk was highest when women reported both insomnia combined with nocturnal cognitive hyperarousal or perinatal-focused rumination Kitsantas et al [ 26 •] Maternal Mental Health Matters Invited commentary N/A N/A N/A Suicide Suicide as reports in the National Violent Death Reporting System between 2003 and 2007 accounted for more death than obstetric complications. Massachusetts Child Psychiatry Access Project for Moms and North Carolina MATTERS program can help expand care for maternal mental health Knasmuller et al [ 12 ] Prevalence and correlates of suicidal behaviors during pregnancy: evidence from the National Survey on Drug Use and Health Cross-sectional Pregnant women in the USA 7479 National survey on drug use and health SI, self-harm, SA Suicidal behavior (including ideation, plans, or attempts) was estimated at 3.4% for the entire sample, with 4.4% among women in the first trimester and 2.9% for women in the second/third trimester.…”