Abstract
To characterise the demographic and clinical characteristics of women who died by suicide in the perinatal period to inform and improve suicide prevention strategies. Retrospective analysis of maternal suicides during and within 1 year after the end of pregnancy in Queensland between January 2004 and December 2017. Outcomes measured included timing of death in relation to pregnancy, sociodemographic and clinical characteristics and health service use prior to death. There were 65 deaths by suicide in the study period; six occurred during pregnancy, 30 occurred after a live birth, 22 occurred after a termination of pregnancy and seven followed a miscarriage or stillbirth. Most suicides were late maternal deaths. Women were younger, and more likely to identify as Aboriginal or Torres Strait Islander, when compared to all women giving birth for the same time period. Most women had a prior mental health diagnosis, most commonly depression. Over half of women had recent relationship separation or conflict prior to death. Perinatal women had higher rates of death by violent means than all women in Queensland who died by suicide during the same time period. The demographic, psychosocial and clinical characteristics of a group of women who died by suicide have been described, and this shows a high proportion of women with a prior mental health diagnosis. To reduce maternal mortality, psychosocial screening must be implemented broadly and continued until the end of the first year postpartum. Similar screening attention is needed for women who had a termination of pregnancy, miscarriage or stillbirth.
Highlights
Improvements in maternal healthcare over recent decades have been vast, making Australia one of the safest countries in the world to give birth
We identified 65 maternal deaths by suicide
About half of the 61 cases reported to the Queensland Maternal and Perinatal Quality Council (QMPQC) were not identified as pregnancy-related deaths in the Queensland Suicide Register (QSR)
Summary
Improvements in maternal healthcare over recent decades have been vast, making Australia one of the safest countries in the world to give birth. As deaths due to obstetric complications decrease, a trend towards increasing psychosocial causes of maternal mortality is emerging. This trend is reflected nationally, with suicide being the second-leading cause of maternal death in Australia in 2017 and the third-leading cause of maternal. In the most recent Queensland report, which includes late maternal deaths (those occurring up until 1 year after the end of pregnancy), suicide was the second-highest cause of maternal mortality. For some at-risk women, including those who have had a termination of pregnancy, suicide risks may be elevated early in the period after the pregnancy has ended (Gissler 2005; Khalifeh et al 2016)
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