The tip of the iceberg: postpartum suicidality in Israel

Abstract

BackgroundPostpartum suicidality, a result of extreme distress or depression, is a tragedy for the woman, infant, and family. Screening for postpartum depression (PPD) is mandatory in Israel, including a question on suicidal ideation. This study presents and analyzes data regarding rates, trends and characteristics of postpartum women who considered, attempted, or completed suicide, to help direct services aimed at preventing these occurrences.MethodsSuicidal ideation data based on PPD screening was drawn from various publications and databases. Suicide attempt data was obtained from the Emergency Department database for 2006–2015 and matched with the National Birth Registry. Cause of death from the national database for those years were similarly linked to births to identify postpartum suicides and deaths. Postpartum and non-postpartum suicide attempt rates were computed by year, and by age and ethnic/immigrant group. A multivariate logistic model was used to estimate relative risk for postpartum attempts, controlling for age and ethnic group.ResultsSuicidal ideation in recent years has been reported as 1% or less, with higher rates found in studies of Arab women. Suicide attempt rates for non-postpartum women were 3–5 times that of postpartum women, rising over the years, while remaining relatively stable for postpartum women. Adjusted risk of suicide attempt for non-postpartum women was significantly higher; adjusted odds ratio was 4.08 (95% CI 3.75–4.44). It was also significantly higher for Arabs and immigrants from the Former Soviet Union, compared to Israeli-born Jews/veteran immigrants, and for younger women compared to those aged 35–44. Seven postpartum suicides were recorded during 2006–2015, a rate of 0.43 per 100,000 births.ConclusionPostpartum suicidality in Israel is low relative to other countries. Although relatively rare and lower than among non-postpartum women, health professionals should be attentive to risk factors, such as past psychiatric disorders, suicide attempts and current emotional distress, particularly among higher-risk populations. The universal screening program for PPD is a valuable opportunity for this, but increased resources should be allotted to implement and utilize it optimally. Prenatal screening should be added as an Israeli Quality Indicator, and postpartum completed suicides should be thoroughly investigated to guide prevention efforts.

Early detection of mental illness for women suffering high-risk pregnancies: an explorative study on self-perceived burden during pregnancy and early postpartum depressive symptoms among Chinese women hospitalized with threatened preterm labour

“…There is a global consensus that postpartum depressive disorders exert negative short-and long-term effects on the establishment of motherhood, child development, and family wellbeing [30][31][32][33] and may lead to tragic consequences. For instance, PPD has been found to be a putative cause of disastrous behavioural tendencies, such as suicidal intent [34]. A substantial body of research has reported possible risk factors, e.g., socio-demographic factors, obstetric factors, the course of pregnancy and social support, for the development of postpartum depressive disorders [35][36][37][38][39].…”

Suicide and Maternal Mortality

“…Global perinatal suicide rates range between 1.27 and 3.7 per 100,000 live births [ 22 ]. Israel reports a lower rate of 0.43 per 100,000 live births, or 3.6% of postpartum mortality [ 24 ], reasons for this being religion as a protective factor, or under-reporting of suicide due to mental health stigma. Trost et al [ 4 •] in reviewing pregnancy-related mental health deaths (including suicides and accidental overdoses) in 14 states, found that, 11% of pregnancy-related deaths were due to mental health conditions, and 63% of pregnancy-related mental health deaths were by suicide.…”

“…Average infant birthweight was 96.5 g lower for participants with SI compared to those without, and 94.2 g lower after adjusting for confounders. After adjusting for confounders, women with SI had 3.73 × increased odds of small for gestational age infants Glasser et al [ 24 ] The tip of the iceberg: postpartum suicidality in Israel Review/meta-analysis Published and unpublished literature on SI in Israel, and analysis of data on death within a year of childbirth N/A EPDS for SI, Analysis of 193 deaths within a year of childbirth for SA SI and SA Of the 20,259 suicide attempts recorded in EDs of general hospitals in Israel, 565 (2.8%) were by women in the postpartum period. The suicide attempt rate for non-postpartum women was 3 - 5 × that of postpartum women.…”

Non-pharmacological interventions for postpartum depression

“…Postpartum depression(PPD) is the most common mental disorder for women following childbirth, which can deleteriously affect maternal behaviors and impair the cognitive, behavioral, emotional development of children. [ 1 ] Epidemiological studies have found that women with PPD were at high risk for suicidality, [ 2 ] and almost 1/3 women still reported depressive symptoms even 4 years after childbirth. [ 3 ] Besides, the global pooled incidence of PPD is estimated to be 17.7%, which is up to 38% in Chile.…”