Racial/Ethnic Disparity in Suicidal Ideation, Suicide Attempt and Non-suicidal Intentional Self-harm Among Pregnant Women in the United States

Salihu, Hamisu M.; Dongarwar, Deepa; Oduguwa, Emmanuella; Atkinson, Jonnae; Harris, Toi Blakley

doi:10.1007/s10903-021-01260-1

Cited by 10 publications

(13 citation statements)

References 23 publications

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“…These findings have implications for morbidity and mortality. Pregnant adolescents ages 15–19 years are three times as likely to experience suicidal ideation, behavior, and/or nonsuicidal self-injury than older pregnant individuals [8 ▪▪ ]. Although additional adolescent-specific research is needed, pregnant adolescents generally experience higher levels of depressive symptoms than nonpregnant peers and pregnant adults.…”

Section: Epidemiologymentioning

confidence: 99%

“…The combined effects of pregnancy during adolescence confer additional risk for depressive symptomatology. Pregnant adolescents experience higher levels of depressive symptoms, relative to nonpregnant peers [7] and pregnant adults [6,8 ▪▪ ,9–11]. Pediatric clinicians are likely the first point of clinical contact for pregnant adolescents [12 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

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Depressive symptomatology in pregnant adolescents: considerations for care

Wittenberg

Fitzgerald

Pluhar

2023

Current Opinion in Pediatrics

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Purpose of review Adolescents who are pregnant experience higher levels of depressive symptoms than nonpregnant peers and pregnant adults. Clinicians caring for youth are often the first point of clinical contact for pregnant adolescents but report low confidence in assessing and treating reproductive health concerns. In the current review, we outline risk factors for depressive symptoms among pregnant adolescents and provide guidance on best practices in assessment and treatment of depressive symptoms in this pediatric sub-population. Recent findings Depressive symptoms are persistent across pregnancy. In adolescents, they are linked to greater risk of suicidal ideation, suicidal behavior, and nonsuicidal self-injury. Risk factors for prenatal depressive symptoms among adolescents include lower levels of income, history of depression, exposure to childhood maltreatment and/or recent abuse, and/or lifetime exposure to racial/ethnic discrimination. These risk factors likely interact with each other. Summary Clinicians should assess carefully for depressive symptoms in all pregnant adolescents using a standardized, validated measure supplemented by thoughtful clinical interviewing. Clinicians can educate adolescents on the distinction between symptoms of pregnancy versus symptoms of depression. We encourage clinicians to increase their comfort in providing psychopharmacological treatment, consulting with colleagues in psychiatry, and referring adolescents for psychopharmacological treatment and therapy as needed.

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Section: Epidemiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Depressive symptomatology in pregnant adolescents: considerations for care

Wittenberg

Fitzgerald

Pluhar

2023

Current Opinion in Pediatrics

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“…Across the perinatal period, minoritized women experience more severe symptoms of depression than their White counterparts 10 . For instance, Black and Hispanic pregnant women express suicidal ideation twice as frequently as White pregnant women 14–17 . During the postpartum, factors associated with suicide attempts include experiencing anti-Black and anti-Indigenous racism and being of lower-income status 18,19 .…”

Section: Racial Differences In the Presentation Of Perinatal Psychiat...mentioning

confidence: 99%

“…10 For instance, Black and Hispanic pregnant women express suicidal ideation twice as frequently as White pregnant women. [14][15][16][17] During the postpartum, factors associated with suicide attempts include experiencing anti-Black and anti-Indigenous racism and being of lower-income status. 18,19 Minoritized women also may present with more somatic constellations of symptoms associated with depression that may be underrecognized.…”

Section: Racial Differences In the Presentation Of Perinatal Psychiat...mentioning

confidence: 99%

“…20,21 American Indian women have the highest self-reported postpartum depression rates and severity of symptoms, and Black women have the highest postpartum prevalence of suicidal ideation, suicide attempts, and self-harm compared to all other racial groups. 17,19 Racial differences are observed in substance use during pregnancy and reproductive-potential years. For example, substance use rates are higher in Indigenous pregnant women than the national average, with smoking rates as high as 75%.…”

Section: Racial Differences In the Presentation Of Perinatal Psychiat...mentioning

confidence: 99%

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Medical Mistrust in Perinatal Mental Health

Conteh

Gagliardi

McGahee

et al. 2022

Harv Rev Psychiatry

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Despite the advancement of telemedicine and recent innovations in treatment, minoritized women continue to bear a disproportionate burden of pregnancy-related psychiatric conditions and complications, which the pandemic has further exacerbated. Research demonstrates that medical mistrust and systemic racism play central roles in the underutilization of services by racially and ethnically diverse women during pregnancy and postpartum. To effectively address these disparities, it is imperative to understand the drivers of medical mistrust in perinatal health care systems. This Perspectives article describes the historical context of medical mistrust in psychiatric and obstetric health systems and offers solutions to mitigate mistrust and the impact of systemic racism on perinatal care.

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Suicide Mortality During the Perinatal Period

Zivin,

Zhong,

Rodríguez-Putnam

et al. 2024

JAMA Netw Open

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ImportanceThe US has the highest maternal mortality rate among developed countries. The Centers for Disease Control and Prevention deems nearly all of these deaths preventable, especially those attributable to mental health conditions. Coordination between US health care and social service systems could help further characterize circumstances and risks associated with perinatal suicide mortality.ObjectiveTo examine contextual and individual precipitating circumstances and risks associated with perinatal suicide.Design, Setting, and ParticipantsThis cross-sectional observational study used a convergent mixed methods design to explore factors contributing to maternal suicides and deaths of undetermined intent (hereinafter, undetermined deaths) identified in National Violent Death Reporting System (NVDRS) data for January 1, 2003, to December 31, 2021. Analyses included decedents who were aged 10 to 50 years and pregnant or post partum at death (collectively, the perinatal group) and demographically matched female decedents who were not pregnant or recently pregnant (nonperinatal group) at death. Analyses were performed between December 2022 and December 2023.ExposuresPregnancy status at death (perinatal or nonperinatal).Main Outcomes and MeasuresThe main outcomes included contributing circumstances associated with suicides and undetermined deaths cited in coroner, medical examiner, or law enforcement case narratives. The study examined quantitative differences between groups using a matched analysis and characterized key themes of salient suicide circumstances using qualitative content analysis.ResultsThis study included 1150 perinatal decedents identified in the NVDRS: 456 (39.6%) were pregnant at death, 203 (17.7%) were pregnant within 42 days of death, and 491 (42.7%) were pregnant within 43 to 365 days before death, yielding 694 postpartum decedents. The nonperinatal comparison group included 17 655 female decedents aged 10 to 50 years. The mean (SD) age was 29.1 (7.4) years for perinatal decedents and 35.8 (10.8) years for nonperinatal decedents. Compared with matched nonperinatal decedents, perinatal decedents had higher odds of the following identified contributing circumstances: intimate partner problems (IPPs) (odds ratio [OR], 1.45 [95% CI, 1.23-1.72]), recent argument (OR, 1.33 [95% CI, 1.09-1.61]), depressed mood (OR, 1.39 [95% CI, 1.19-1.63]), substance abuse or other abuse (OR, 1.21 [95% CI, 1.03-1.42]), physical health problems (OR, 1.37 [95% CI, 1.09-1.72]), and death of a family member or friend (OR, 1.47 [95% CI, 1.06-2.02]). The findings of the qualitative analysis emphasized the importance of mental health and identified 128 decedents (12.4%) with postpartum depression.Conclusions and RelevanceThis study provides insights into complex factors surrounding maternal suicide, and it highlights opportunities for further research to understand long-term consequences of perinatal mental health. These findings also underscore the need for targeted evidence-based interventions and effective policies targeting mental health, substance use, and IPPs to prevent maternal suicide and enhance maternal health outcomes.

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Racial/Ethnic Disparity in Suicidal Ideation, Suicide Attempt and Non-suicidal Intentional Self-harm Among Pregnant Women in the United States

Cited by 10 publications

References 23 publications

Depressive symptomatology in pregnant adolescents: considerations for care

Depressive symptomatology in pregnant adolescents: considerations for care

Medical Mistrust in Perinatal Mental Health

Suicide Mortality During the Perinatal Period

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