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Suicides during pregnancy and one year postpartum in Sweden, 1980–2007
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Obstetrisk forskning/Högberg)ORCID iD: 0000-0001-5545-1413
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- och mödrahälsovård och migration)
Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
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2016 (English)In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 208, no 5, 462-469 p.Article in journal (Refereed) Published
Abstract [en]

Background

Although the incidence of suicide among women who havegiven birth during the past 12 months is lower than that ofwomen who have not given birth, suicide remains one of themost common causes of death during the year followingdelivery in high-income countries, such as Sweden.

Aims

To characterise women who died by suicide duringpregnancy and postpartum from a maternal careperspective.

Method

We traced deaths (n = 103) through linkage of the SwedishCause of Death Register with the Medical Birth and NationalPatient Registers. We analysed register data and obstetricmedical records.

Results

The maternal suicide ratio was 3.7 per 100 000 live births forthe period 1980–2007, with small magnitude variation overtime. The suicide ratio was higher in women born inlow-income countries (odds ratio 3.1 (95% CI 1.3–7.7)).Violent suicide methods were common, especially during thefirst 6 months postpartum. In all, 77 women had receivedpsychiatric care at some point, but 26 women had nodocumented psychiatric care. Antenatal documentationof psychiatric history was inconsistent. At postpartumdischarge, only 20 women had a plan for psychiatricfollow-up.

Conclusions

Suicide prevention calls for increased clinical awareness andcross-disciplinary maternal care approaches to identify and support women at risk.

Place, publisher, year, edition, pages
2016. Vol. 208, no 5, 462-469 p.
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-216779DOI: 10.1192/bjp.bp.114.161711ISI: 000375515700013PubMedID: 26494874OAI: oai:DiVA.org:uu-216779DiVA: diva2:690747
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, FAS 2007-2026
Available from: 2014-01-24 Created: 2014-01-24 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Maternal Mortality in Sweden: Classification, Country of Birth, and Quality of Care
Open this publication in new window or tab >>Maternal Mortality in Sweden: Classification, Country of Birth, and Quality of Care
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

After decades of decrease, maternal mortality rates have shown a slight increase in Europe. Immigrants, especially Africans, have shown to be at higher risk than native women. This could not be explained solely by well-known obstetric and socio-economic risk factors. The aim of this thesis was to study incidence, classification and quality of care of maternal deaths in Sweden, with focus on the foreign-born population. The study population was identified through linkage of the Cause of Death Register, Medical Birth Register, and National Patient Register, and medical records obtained from hospitals. Data from registers, death certificates, and medical records were reviewed. Suboptimal care was studied by structured implicit review of medical records. Differences between foreign- and Swedish-born women were analysed by relative risks, Chi2- and Fisher’s exact test.

Underreporting of maternal mortality was shown to be substantial: as compared to the official statistics, 64% more maternal deaths were identified. Women born in low-income countries were identified as being at highest risk of dying during reproductive age in Sweden. The relative risk of dying from diseases related to pregnancy was 6.6 (95% confidence interval 2.6–16.5) for women born in low-income countries, as compared to Swedish-born women. Major and minor suboptimal factors related to care-seeking, accessibility, and quality of care were found to be associated with a majority of maternal deaths and significantly more often to foreign-born women. Suboptimal factors identified included non-compliance, communication barriers, and inadequate care. The rate of suicides during pregnancy or within one year after delivery did not change during the last three decades, and was higher for foreign-born women. A majority of women who committed suicide had been under psychiatric care, but such documentation at antenatal care was inconsistent, and planning for follow-up postpartum was generally lacking.

The conclusion of this thesis is that foreign-born women are a high-risk group for maternal death and morbidity that calls for clinical awareness with respect to their somatic and psychiatric history, care-seeking behaviour, and communication barriers. Cross-disciplinary care is necessary, both in obstetric emergencies and in cases of maternal psychiatric illness, to avert maternal death and suicide.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 69 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 970
Keyword
underreporting, foreign-born, immigrants, low-income countries, suboptimal care, audit, suicide, reproductive age, maternal death, maternal care
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-216781 (URN)978-91-554-8863-5 (ISBN)
Public defence
2014-03-13, Rosénsalen, Akademiska sjukhuset ingång 95/96, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2014-02-19 Created: 2014-01-24 Last updated: 2014-04-29

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Esscher, AnnikaEssén, BirgittaPapadopoulos, FotiosSkalkidou, AlkistisSundström-Poromaa, IngerHögberg, Ulf

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Esscher, AnnikaEssén, BirgittaPapadopoulos, FotiosSkalkidou, AlkistisSundström-Poromaa, IngerHögberg, Ulf
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International Maternal and Child Health (IMCH)Department of Women's and Children's HealthPsychiatry, University Hospital
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British Journal of Psychiatry
Obstetrics, Gynecology and Reproductive MedicinePsychiatry

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