Maternal suicide attempts and deaths in the first year after cesarean delivery.

Tianyang Zhang,Henrik Larsson,Olof Stephansson,Anna Sidorchuk,David Mataix-Cols,Zheng Chang,Christian Rück,Ängla Mantel,Bo Runeson,Lorena Fernández De La Cruz

doi:10.1017/s0033291721005109

Abstract

Cesarean delivery (CD) has been associated with postpartum psychiatric disorders, but less is known about the risk of suicidal behaviors. We estimated the incidence and risk of suicide attempts and deaths during the first postpartum year in mothers who delivered via CD v. vaginally. All deliveries in Sweden between 1973 and 2012 were identified. The mothers were followed since delivery for 12 months or until the date of one of the outcomes (i.e. suicide attempt or death by suicide), death by other causes or emigration. Associations were estimated using Cox proportional hazards regression models. Of 4 016 789 identified deliveries, 514 113 (12.8%) were CDs and 3 502 676 (87.2%) were vaginal deliveries. During the 12-month follow-up, 504 (0.098%) suicide attempts were observed in the CD group and 2240 (0.064%) in the vaginal delivery group (risk difference: 0.034%), while 11 (0.0037%) deaths by suicide were registered in the CD group and 109 (0.0029%) in the vaginal delivery group (risk difference: 0.008%). Compared to vaginal delivery, CD was associated with an increased risk of suicide attempts [hazard ratio (HR) 1.46; 95% CI 1.32-1.60], but not of deaths by suicide (HR 1.44; 95% CI 0.88-2.36). Maternal suicidal behaviors during the first postpartum year were uncommon in Sweden. Compared to vaginal delivery, CD was associated with a small increased risk of suicide attempts, but not death by suicide. Improved understanding of the association between CD and maternal suicidal behaviors may promote more appropriate measures to improve maternal mental well-being and further reduce suicidal risks.

Highlights

Postpartum psychiatric disorders are a major public health issue affecting up to one in four women who recently gave birth (Fawcett, Fairbrother, Cox, White, & Fawcett, 2019; Gavin et al, 2005; Shorey et al, 2018)
During the 12-month follow-up after delivery, 504 cases of suicide attempts were observed in the Cesarean delivery (CD) group and 2240
Nineteen deaths by suicide were registered in the CD group and 101 in the vaginal delivery group, totaling a prevalence of 0.003% (Fig. 1b)

Summary

Introduction

Postpartum psychiatric disorders are a major public health issue affecting up to one in four women who recently gave birth (Fawcett, Fairbrother, Cox, White, & Fawcett, 2019; Gavin et al, 2005; Shorey et al, 2018). Another study by Schiff and Grossman (2006) did not find an association between CD and risk of postpartum suicide attempts, but a significant risk was found in the mothers who experienced fetal or infant death. Cesarean delivery (CD) has been associated with postpartum psychiatric disorders, but less is known about the risk of suicidal behaviors. CD was associated with an increased risk of suicide attempts [hazard ratio (HR) 1.46; 95% CI 1.32–1.60], but not of deaths by suicide (HR 1.44; 95% CI 0.88–2.36). CD was associated with a small increased risk of suicide attempts, but not death by suicide. Improved understanding of the association between CD and maternal suicidal behaviors may promote more appropriate measures to improve maternal mental well-being and further reduce suicidal risks

Methods

Results

Discussion

Conclusion