Suicide and other causes of morality after post-partum psychiatric admission

Department of Psychiatry, Aarhus University, Aarhus, Central Jutland, Denmark
The British Journal of Psychiatry (Impact Factor: 7.99). 10/1998; 173(3):209-11. DOI: 10.1192/bjp.173.3.209
Source: PubMed


The risk of suicide in postnatal women is low and those suicides that occur appear to be associated with severe psychiatric illness. No previous study has specifically studied the risk of suicide following post-partum psychiatric disorder.
We calculated standardised mortality ratios (SMRs) for suicide, unnatural deaths and deaths from natural causes for women admitted to psychiatric hospital in the first year after childbirth, using computerised cross-linkages between the Danish Psychiatric Case Register and the Danish registers of birth and causes of death for 1973-1993.
During the study period 1567 women were admitted to psychiatric hospital of whom 107 (6.8%) died. The SMRs (compared with 100) were 1719 (95% CI1284-2254) for suicide, 1329 (95% CI1038-1676) for all unnatural causes and 238 (95% CI167-329) for natural causes. Suicides and deaths from all unnatural causes were most likely to occur in the first year after childbirth, the SMR for suicide within one year being 7216 (95% CI 3945-12 108).
Although postnatal women as a whole appear to have a low rate of suicide, severe post-partum psychiatric disorder is associated with a high rate of deaths from natural and unnatural causes, particularly suicide. The risk is especially high in the first postnatal year, when the suicide risk is increased 70-fold. Close clinical supervision at this time is indicated.

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    • "Suicide is the fourth cause of maternal deaths in the world [75] and the leading cause of death in first-year postpartum women in the United Kingdom [76, 77]. The risk of suicide was calculated to be 70 times higher in women with psychiatric disorders during the first year after childbirth compared to the general female population [78]. In the same vein, Gissler et al. [68] reported a suicide rate of 11 per 100.000 in a large sample of Finnish postpartum women. "
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    ABSTRACT: It is nowadays accepted that, independently of methodological issues, women commit fewer suicides than men but make more frequent attempts. Yet, female suicidal risk varies greatly along the lifetime and is linked to the most significant moments in it. A wide analysis of the existing literature was performed to provide a narrative description on the evolution of female suicidal rates from childhood to old age, considering the milestones in their life history. A detailed analysis of gender differences in suicidal behavior is key to establish preventive measures and priorities. More specific studies are needed to adapt future interventions on female suicide.
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    • "History of major depressive disorder has consistently been identified as a strong risk factor for PPD (Bloch et al., 2005; Stowe & Nemeroff, 1995). In fact, a past episode of depression is commonly one of the strongest predictors of PPD as women with a history of an affective disorder have a 1:3 chance of developing PPD (Appleby et al., 1998). Similarly, a previous episode of PPD has been found to put women at considerable risk for recurrent episodes following subsequent pregnancies (O'Hara, 1991). "
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    ABSTRACT: Major depression during pregnancy is a risk factor for postpartum depression (PPD). Medically acceptable treatments for depression during pregnancy and postpartum are limited and many women are turning to complementary and alternative treatments. The current project examined whether treatment of major depression during pregnancy reduced the risk for PPD and explored predictors of PPD in this high-risk sample. One hundred twenty women were clinically assessed using the Hamilton Rating Scale for Depression (HRSD17), the Beck Depression Inventory (BDI-II), and the Structured Clinical Interview for DSM-IV (SCID) at ten weeks, six months, and nine months postpartum following random assignment to one of three treatments delivered over eight weeks during pregnancy: active acupuncture, control acupuncture, and control prenatal massage. Mixed effects analyses revealed that responders to the acute phase of treatment during pregnancy had significantly lower postpartum BDI-II scores compared to non-responders. Results also revealed a significant treatment assignment by time interaction on postpartum HRSD17 scores such that the active acupuncture group maintained improvement while the control groups worsened postpartum. Exploratory ROC analyses revealed the following predictors of PPD: discontinuing antidepressant medication, high intake HRSD17 scores, high late pregnancy HRSD17 scores, low expectations of treatment, and a history of childhood emotional abuse. Results suggest that successful treatment of depression during pregnancy may lower the risk of developing PPD.
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    • "In terms of maternal outcomes, we see both greater morbidity and mortality when it comes to severe mental health disorders especially postpartum. Oates (2003) has identified psychiatric morbidity as the leading cause of maternal death in the perinatal period while Appleby et al. (1998) reported an 80 fold increase in suicide in the first year postpartum in women with severe mental health conditions. Recent studies in women with significant preexisting mood disorders suggest that this group is as much, if not more, at risk of relapse perinatally, especially when unmedicated. "

    Preview · Article · Feb 2010 · Archives of Women s Mental Health
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