Study: New research examines suicide in new and expectant mothers

A new King’s College London study examines suicide deaths within and outside the period surrounding childbirth, specifically in women who had been in recent contact with mental health services. 

Suicide in pregnant and postnatal women is an important cause of maternal death, yet evidence to guide suicide prevention in this group is scarce. The researchers hope these findings, published in The Lancet Psychiatry, will inform suicide prevention strategies for those who suffer from serious mental health problems during or after pregnancy.

The study used UK national data on suicides by people with past-year contact with psychiatric services in the period 1997-2012. Over that period nearly 5,000 women in recent contact with psychiatric services died by suicide, and the team at King’s found that roughly one in 50 of these women were new or expectant mothers. The researchers compared women who died by suicide in pregnancy or the first postnatal year (perinatal suicides) with those who died by suicide outside of this period (non-perinatal suicide).

Suicide in the perinatal group was more often violent (most commonly by hanging or jumping). However, once clinical characteristics such as diagnosis and illness duration were taken into account, there was less of a difference in the nature of the methods used by perinatal and non-perinatal women.

The higher frequency of violent suicides among perinatal women might reflect greater illness severity or higher suicidal intent in this group, according to the study authors. 

The researchers also found that women who died by suicide in the perinatal period were more likely to have a diagnosis of depression and less likely to be receiving active psychiatric treatment, including medication. 

Dr Hind Khalifeh from the Health Service and Population Research Department at King’s College London said: ‘This finding is particularly concerning as it suggests that women with serious mental illness may not be getting the treatment they need.

‘The decision not to take antidepressant medication in the perinatal period might be due to fears of potential harm to the unborn baby or breastfeeding infant.

‘Reports often focus on the possible risks of using antidepressants during pregnancy but our research has highlighted the potential serious risks of untreated severe depression in the perinatal period.’

According to the study authors, clinicians need to closely monitor perinatal suicide risk not only in women with psychotic illnesses, but also in those with depression.

Dr Khalifeh added: ‘Depression is arguably under-recognised as a leading cause of perinatal suicide, with much public and clinical attention focused on the scarce, but very high-risk presentation of postnatal psychosis.

‘Clinicians should be aware that women with severe perinatal depression in particular are a group at risk of suicide who need careful monitoring and treatment. Therefore decisions about use of medication need to be made after carefully weighing up the potential risks and benefits for both mother and baby. Clinicians should ensure that women who choose not to take medication are offered adequate and timely alternative treatments and appropriate follow-up.’

Professor Louise Howard*, also from King’s College London, said: ‘Although the number of pregnancy-related deaths has been steadily falling, the frequency of indirect deaths linked to mental health is a major cause for concern. 

‘Fortunately women who are new or expectant mothers rarely die by suicide. However, when it does occur it is obviously a deeply tragic event. We welcome David Cameron’s promise this week of more services to address mental health problems in pregnant and postnatal women.’

*Professor Howard is National Clinical Advisor for the NICE National Collaborating Centre for Mental Health (NCCMH), who have been commissioned by NHS England to advise on the perinatal mental health service standards programme.

‘Suicide in perinatal and non-perinatal women in contact with psychiatric services: 15 year findings from a UK national inquiry’ is available here: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2816%2900003-1/abstract