Understanding Suicide in Pregnant and Postpartum Women, Using the National Violent Death Reporting System Data: Are There Differences in Rural and Urban Status?

Abstract

Background: Suicide rates in the United States have increased by 30% since 1999 and suicide is currently the 10 th leading cause of death. Suicide has also become one of the leading causes of death in pregnant and postpartum women. The aim of this study is to examine whether rurality affects the risk of suicide in pregnant and postpartum women. Methods: This study used data from the National Violent Death Reporting System, Restricted Access Dataset (2003-2012). Bivariate and multivariate analyses were used to first describe the pregnant and postpartum population versus non-pregnant females (ages 15-54), who all died by suicide, and then to examine urban-rural differences. Results: Rural suicide decedents were much older, married, less likely to have had a mental health diagnosis, and more likely to use a firearm. Recent intimate partner crisis and intimate partner problems were both associated with increased odds that the suicide decedent was pregnant or postpartum in both urban and rural counties, whereas presence of job problems and report of history of suicide attempt decreased the odds that the suicide decedent was pregnant or postpartum in both urban and rural counties. Multivariable polytomous logistic regression analyses revealed differences in suicide risk factors among pregnant, postpartum and non-pregnant decedents when stratified by rural and urban status. Conclusion: Our findings suggest that pregnant and postpartum women should be screened for risk of suicide, in the clinical setting, especially if there are intimate partner problems or a crisis. With proper identification and response, suicide in pregnant and postpartum women might be decreased.

Maternal Suicide Ideation and Behaviour During Pregnancy and the First Postpartum Year: A Systematic Review of Psychological and Psychosocial Risk Factors

“…This observation supports Gold’s ( 58 ) findings and demonstrates that intimate partner problems as a key correlate for suicide during the perinatal period from 2007 to 2012. Two issues should be highlighted: a large proportion of Adu et al’s ( 57 ) data were likely to have been the same data used in Gold et al’s ( 58 ) study and neither study clarified what constituted an “intimate partner problem” or “conflict” and when and how frequently the “conflict” occurred.…”

“…Two studies examined IPV and suicide deaths ( 57 , 58 ). Both were case-control studies and used data extracted from the United States National Violent Death Reporting System whereby death by suicide was defined as a record of “death resulting from the intentional use of force against oneself.” Gold et al ( 58 ) compared pregnant and postpartum women with women of reproductive age who were not pregnant or postpartum at the time of death.…”

“…Pregnant women who died by suicide were three times more likely to have experienced intimate partner conflict and postpartum women were over two times more likely to have experienced intimate partner conflict. Similarly, Adu et al ( 57 ) used data gathered from 18 US states from 2003 to 2012 to compare suicides of pregnant and postpartum women with non-pregnant females (15–54 years) and then compared urban and rural differences. The authors identified a total of 4,306 female suicide victims and found recent intimate partner problems were associated with increased odds of the victim being pregnant or postpartum compared to non-perinatal.…”

“…Although it is important that suicidal ideation and behaviours are investigated in all groups of women, this may have resulted in the inclusion of some risk factors that will not apply to all women, such as military sexual trauma. Finally, only two papers investigated suicide deaths ( 57 , 58 ) and these two studies only investigated IPV. It is therefore difficult to draw conclusion about the impact of different risk factors on this most severe suicide outcome.…”

Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence

“…Another study by Adu et al used 2003Adu et al used -2012 NVDRS data from 18 states to assess suicide among pregnant and postpartum women. 38 Recent altercations with intimate partners and a history of IPV were significant factors that increased the odds of suicide for rural-and urban-dwelling women who were pregnant or postpartum. Austin et al linked North Carolina's 2005-2011 Violent Death Reporting System data to CDCs NVDRS and identified 29 suicide cases among pregnant and postpartum women, or 2.3 deaths per 100,000 live births.…”