Risk Factors Associated With Peripartum Suicide Attempts in Japan

Abstract

ImportancePeripartum suicide attempt is a major psychiatric complication associated with pregnancy, but the risk factors remain largely uncertain.ObjectiveTo identify the demographic characteristics and predisposing risks for peripartum suicide attempts and postpartum depression.Design, Setting, and ParticipantsThis cohort study used retrospective data on pregnant women who delivered children between April 1, 2016, and March 31, 2021, at 712 hospitals in Japan. The nationwide Diagnosis Procedure Combination database was used.ExposuresPsychiatric and nonpsychiatric medical history, age, alcohol and tobacco use, and obstetric complications and procedures.Main Outcomes and MeasuresData on admissions for prepartum suicide attempt and delivery during the same hospital stay and readmissions for depression or suicide attempt within 1 year post partum were collected. Comparisons of prevalence of each study variable were performed, and multivariable logistic regression analyses were used to determine risk factors.ResultsFrom a total of 39 908 649 hospitalization episodes, 804 617 cumulative pregnant women (median [IQR] age at childbirth, 33 [29-36] years) who delivered at the enrolled hospitals were identified, including 1202 who were admitted for suicide attempt and delivery during the same hospital stay and 111 readmitted for suicide attempt within 1 year post partum. Risk factors associated with prepartum suicide attempts included younger age (adjusted odds ratio [aOR], 0.99; 95% CI, 0.98-1.00) and histories of personality disorder (aOR, 10.81; 95% CI, 5.70-20.49), depression (aOR, 3.97; 95% CI, 2.35-6.70), schizophrenia (aOR, 2.89; 95% CI, 1.52-5.50), and adjustment disorder (aOR, 2.66; 95% CI, 1.07-6.58). Risk factors associated with postpartum suicide attempts included younger age (aOR, 0.96; 95% CI, 0.93-1.00), heavy tobacco use (aOR, 23.09; 95% CI, 5.46-97.62), and histories of alcohol use disorder (aOR, 163.54; 95% CI, 28.30-944.95), personality disorder (aOR, 10.28; 95% CI, 3.29-32.10), anxiety disorders (aOR, 8.13; 95% CI, 2.88-22.98), depression (aOR, 7.27; 95% CI, 2.95-17.91), schizophrenia (aOR, 5.77; 95% CI, 2.17-15.38), bipolar disorder (aOR, 3.98; 95% CI, 1.36-11.67), and insomnia (aOR, 3.17; 95% CI, 1.30-7.78). On sensitivity analysis, risk factors associated with postpartum depression after excluding those with prenatal depression included histories of personality disorder, adjustment disorder, bipolar disorder, insomnia, and anxiety disorders.Conclusions and RelevanceThe findings of this cohort study suggest that histories of smoking and prenatal psychiatric disorders are potential risk factors for peripartum suicide attempts and may require additional treatment and prevention interventions.

Insomnia, poor sleep quality and perinatal suicidal risk: A systematic review and meta‐analysis

“…The risk factors associated with prepartum suicide attempts included a younger history of personality disorder (aOR, 10.81; 95% CI, 5.70–20.49), depression (aOR, 3.97; 95% CI, 2.35–6.70), schizophrenia (aOR, 2.89; 95% CI, 1.52–5.50), and adjustment disorder (aOR, 2.66; 95% CI, 1.07–6.58). The most important risk factors associated with postpartum suicide attempts included heavy tobacco use (aOR, 23.09; 95% CI, 5.46–97.62), histories of alcohol use disorder (aOR, 163.54; 95% CI, 28.30–944.95), personality disorder (aOR, 10.28; 95% CI, 3.29–32.10), anxiety disorders (aOR, 8.13; 95% CI, 2.88–22.98), depression (aOR, 7.27; 95% CI, 2.95–17.91), schizophrenia (aOR, 5.77; 95% CI, 2.17–15.38), bipolar disorder (aOR, 3.98; 95% CI, 1.36–11.67), and insomnia (aOR, 3.17; 95% CI, 1.30–7.78) (Akaishi et al, 2023).…”

“…When including the clinical population, such as pregnant women with perinatal depression or women who attempted suicide the odds ratio for insomnia symptoms was OR = 2.98 (95% CI: 1.95–4.55; p < 0.001). In particular in a study insomnia increased the risk of postpartum suicidal attempts within one year by OR: 3.17 (95% CI, 1.30–7.78) (Akaishi et al, 2023).…”

“…We conducted a meta‐analysis to identify the potential association between disturbed sleep such as insomnia and poor sleep quality and suicidal ideation and behaviours. Since only two papers displayed longitudinal postpartum data (Akaishi et al, 2023; Kalmbach et al, 2021), we elected to include only prepartum data in the model calculations to reduce heterogeneity. Our meta‐analysis model thus refers only to the odds ratio for prenatal suicidal ideation and behaviours.…”

Risk Assessment of Critical Obstetric Bleeding With Low-Molecular-Weight Heparin

“…The observed frequency of obstetrical DIC among the initially recruited 354,299 women with childbirth was 0.9 % (n=3,099); however, this rate could be unreliable as most of the women who delivered without any complications, including DIC, were not included in the DPC database [ 29 ]. Considering that the annual number of childbirths in Japan is approximately 800,000, the total number of childbirths in Japan during the study period would be approximately 3 to 4 million.…”

Improved Activities of Daily Living With Adjunctive Intravenous Steroids in Bacterial Meningitis: A Nationwide, Population-Based Medical Database Study

“…The aforementioned DPC database covers more than 7 million patients treated at DPC-covered hospitals in Japan annually [ 7 , 8 ]. The DPC payment system was initiated by the government in 2003 [ 9 , 10 ].…”