SEATTLE -- The risk of a maternal postpartum suicide attempt increases more than threefold after a fetal or infant death, findings of a large case-control study show.
An analysis that linked Washington state hospital records to detailed state-mandated fetal birth and death data for the period from 1987 to 2001 found that fetal or infant death was associated with a 3.1-fold increased risk of hospitalization for a postpartum suicide attempt, Dr. Melissa A. Schiff said at the annual meeting of the American Association of Suicidology.
For all women who gave birth, Dr. Schiff found that a history of a prior psychiatric and/or substance abuse diagnosis was even more potent as a risk factor for maternal suicidal behavior.
Women with a history of psychiatric hospitalization had a 19.6-fold greater risk of a postpartum suicide attempt than those with no psychiatric diagnosis. Those with a history of a substance use disorder had a 6.9-fold increased risk. Dual diagnosis patients with psychiatric and substance abuse diagnoses were at 11.4-fold elevated risk.
Women who smoked prenatally were at 2.7-fold increased risk compared with nonsmokers.
One possible explanation, Dr. Schiff said, is that smoking in pregnancy may in some cases represent a form of self-medication aimed at relieving psychological stress.
In the area of live births, the analysis found that 1 in 2,276 in the state during that time period was followed within the next year by a maternal suicide attempt resulting in hospitalization.
This trend translated into an overall postpartum suicide attempt rate in Washington state of 43.9 cases per 100,000 live births, said Dr. Schiff of the department of epidemiology at the University of Washington, Seattle.
The rate varied inversely with maternal age. Mothers aged 15-19 years had the highest rate, at 85.1 cases per 100,000; those aged 40-49 had a rate of 13.0 cases per 100,000, said Dr. Schiff, who trained as an obstetrician gynecologist.
She was quick to add, however, that those figures are underestimates because they include only attempts deemed serious enough to warrant hospitalization.
Other investigators have variously estimated that 2.7%-15% of all maternal deaths in the postpartum year are attributable to suicide, she noted.
In contrast, among the many factors that upon close examination had no bearing on the risk of postpartum suicide attempts were labor and delivery complications, congenital malformations, Cesarean section, low birth weight, and prior spontaneous or therapeutic abortion, Dr. …