While the larger picture of maternal mortality rates in the United States is one that can be traced to many different factors, a new study published in JAMA Psychiatry looks closer at instances of suicidal thoughts and intentional harm in people who are pregnant or recently gave birth and found that there was as significant increase in a 12 year period between January 2006 and December 2017.
According to researchers, “Pregnancy-related suicides occur in 1.6 to 4.5 per 100 000 live births in state samples.” They also note that “suicide near misses, such as suicidal ideation and intentional self-harm” were also on the rise — and note that, troublingly, these instances have been excluded from data looking at maternal deaths.
“Given the severe maternal mortality crisis among racial/ethnic minority individuals, especially Black women, it is imperative to include psychiatric risks in predictive models and practice guidelines,” researchers write. “Similar to our findings, prior studies have found that most pregnancy-associated suicide deaths occur among older and non-Hispanic White women. However, the present study adds evidence of a sharp increase in suicidality among younger and non-Hispanic Black women over a recent 12-year period that should inform intervention efforts.”
As Kara Zivin, one of the researchers behind the study from University of Michigan’s School of Public Health told HuffPost, the reasons for this uptick are complicated and connected to larger systems of inequality — and may also have a lot to do with attitudes around talking about postpartum depression and suicidal ideation improving.
New research finds that between 2006-2017, there were significant increases in suicidal ideation and intentional self-harm among childbearing people during pregnancy and up to one year postpartum, and Black moms were disproportionately impacted. https://t.co/XqKlGyRYqF
— Black Maternal Health Caucus (@BMHCaucus) November 24, 2020
“There are multiple reasons why there may be upticks. One might be greater willingness for women to disclose suicidality as discussions about mental health become more commonplace,” Zivin said, though noted that suicide as a whole remains “stigmatized” and “under-discussed.”
In a personal essay she wrote for Medpagetoday about her own experiences with suicidal thoughts during her pregnancy, Zivin adds “I hope that my work will help other patients and families, including parents. I recognize my many privileges. This disease cuts across race, ethnicity, class, educational attainment and geography. Most women do not receive any treatment. My story illustrates the potential depth and severity of this disease and provides an example of someone who survived and thrived in its aftermath. Decreasing stigma, increasing awareness of the range of experiences of perinatal mental illness, and greater access to care for all delivering women remains essential. As a society, we must address the significant and long-term multi-generational burden of this illness. There is no health without perinatal mental health.”
Researchers did note, however, that “mood disorders represent a key risk factor for suicide” and that their study considered factors contributing to these risks: “Medication discontinuation, lack of ongoing treatment, and intimate partner violence are further risk factors for suicide among those with mood disorders. Further, that nearly one-quarter of those with bipolar disorder and half of those with psychotic disorders experienced suicidality in the year before or following birth is striking. Although differential effects of treatment, or lack thereof, are outside the scope of our analysis, this remains an important direction for future work.”
“Policy makers, health plans, and clinicians should ensure access to universal suicidality screening and appropriate treatment for pregnant and postpartum individuals and seek health system and policy avenues to mitigate this growing public health crisis, particularly for high-risk groups,” researchers write.
Pregnant and on bed rest? Here’s our survival kit for staying comfy and sane: