Understanding Suicide in Pregnant and Postpartum Women, Using the National Violent Death Reporting System Data: Are There Differences in Rural and Urban Status?

Akosua Adu,Ibitola Asaolu,Wayne Sanderson,Sabrina V Brown

doi:10.4236/ojog.2019.95054

Abstract

Background: Suicide rates in the United States have increased by 30% since 1999 and suicide is currently the 10th leading cause of death. Suicide has also become one of the leading causes of death in pregnant and postpartum women. The aim of this study is to examine whether rurality affects the risk of suicide in pregnant and postpartum women. Methods: This study used data from the National Violent Death Reporting System, Restricted Access Dataset (2003-2012). Bivariate and multivariate analyses were used to first describe the pregnant and postpartum population versus non-pregnant females (ages 15 - 54), who all died by suicide, and then to examine urban-rural differences. Results: Rural suicide decedents were much older, married, less likely to have had a mental health diagnosis, and more likely to use a firearm. Recent intimate partner crisis and intimate partner problems were both associated with increased odds that the suicide decedent was pregnant or postpartum in both urban and rural counties, whereas presence of job problems and report of history of suicide attempt decreased the odds that the suicide decedent was pregnant or postpartum in both urban and rural counties. Multivariable polytomous logistic regression analyses revealed differences in suicide risk factors among pregnant, postpartum and non-pregnant decedents when stratified by rural and urban status. Conclusion: Our findings suggest that pregnant and postpartum women should be screened for risk of suicide, in the clinical setting, especially if there are intimate partner problems or a crisis. With proper identification and response, suicide in pregnant and postpartum women might be decreased.

Highlights

Suicide during pregnancy and the postpartum period is the major public health problem worldwide and in the United States (U.S.) [1]
Recent intimate partner crisis and intimate partner problems were both associated with increased odds that the suicide decedent was pregnant or postpartum in both urban and rural counties, whereas presence of job problems and report of history of suicide attempt decreased the odds that the suicide decedent was pregnant or postpartum in both urban and rural counties
We examined whether rural-urban county status modifies measures of association between suicide risk factors and pregnancy status among pregnant, postpartum and non-pregnant female suicide decedents aged 15 - 54 years for the years 2003 to 2012

Summary

Introduction

Suicide during pregnancy and the postpartum period is the major public health problem worldwide and in the United States (U.S.) [1]. Such fatal events are tragic to the victim, and profoundly impact the baby, family and community [1]. In the U.S, suicides were the fourth leading cause of death among women between the ages of 15 - 54 years in 2012 [2]. Bivariate and multivariate analyses were used to first describe the pregnant and postpartum population versus non-pregnant females (ages 15 - 54), who all died by suicide, and to examine urban-rural differences. Multivariable polytomous logistic regression analyses revealed differences in suicide risk factors among pregnant, postpartum and non-pregnant decedents when stratified by rural and urban status. With proper identification and response, suicide in pregnant and postpartum women might be decreased

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