We all have heard about the risks of childbirth, especially in developing countries. We know about
bleeding, infections, high blood pressure during pregnancy, and birth complications. But it might surprise you that
suicide is a
leading cause of maternal mortality in developed nations.
Perinatal suicidality, which includes completed suicides, suicide attempts, suicidal ideation, and thoughts of self-harm, is considered one of the leading causes of maternal mortality in the first 12 months postpartum (Orsolini et al, 2016).
While suicide deaths and attempts are lower during pregnancy and the postpartum than in the general population of women, suicides account for up to 20% of postpartum deaths and is significantly greater for women in the perinatal period who are experiencing depression (Lindahl et al, 2005).
Self-harm ideation is more common than attempts or deaths, with thoughts of self-harm during pregnancy and the postpartum period ranging from 5 to 14% (Lindahl et al, 2005).
Suicide vs. Suicidal Ideation: Defining Terms
An important term to understand is "suicidal ideation." The National Institute of Mental Health (NIMH) Developing Centers for Intervention and Prevention of Suicide defines suicidal ideation as: the wish to die, thoughts of killing oneself, and the intent to kill oneself.
Suicidal ideation can be passive or active. Thoughts of killing oneself are thoughts, beliefs, images, voices, or other cognitions about intentionally ending one
's own life (suicide); ideation may also include the intent to act on such thoughts.
Suicidal ideation or thoughts are important to pay attention to because they have been found to be associated with suicide attempts and completions. Additionally, a person who is feeling this way is suffering greatly, and deserves to get relief and help.
Another important concept related to perinatal suicide is self-harm. The World Health Organiz
ation defines self-harm as "an act with non-fatal outcome, in which an individual deliberately initiates a non-habitual behavior that, without intervention from others, will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognized therapeutic dosage, and which is aimed at realizing changes which the subject desired via the actual or expected physical consequences." Simply put, self-harm means hurting yourself on purpose. Common methods include cutting yourself with a knife, razor or other sharp object, burning, pulling out hair, or picking at wounds to prevent healing. Extreme injuries can result in broken bones.
Following an act of self-harm, the rate of suicide increases between 50 and 100 times the rate of suicide in the general population. Women who self-harm have an increased risk of suicide, which is increased with the presence of depression during pregnancy and in the postpartum period. Self-harm during pregnancy is estimated to be about half the rate for non-pregnant women (Healey et al, 2013).
Warning Signs for Suicide
According to the Mayo Clinic, warning signs for suicide include:
- Talking about suicide, including making such statements as "I'm going to kill myself," "I wish I were dead," or "I wish I hadn't been born."
- Getting the means to commit suicide, such as getting a gun or stockpiling pills
- Withdrawing from social contact and wanting to be left alone
- Having mood swings, such as being emotionally high one day and deeply discouraged the next
- Being preoccupied with death, dying, or violence
- Feeling trapped or hopeless about a situation
- Increased use of alcohol or drugs
- Changing normal routine, including eating or sleeping patterns
- Doing risky or self-destructive things, such as using drugs or driving recklessly
- Giving away belongings or getting affairs in order
- Saying goodbye to people as if they won't be seen again
- Developing personality changes, such as becoming very outgoing after being shy
The AFSP (American Foundation for Suicide Prevention) says that the signs that most directly warn of suicide are:
- Threatening to hurt or kill oneself
- Looking for ways to kill oneself
- Talking or writing about suicide
- Plans or preparations for a potentially serious attempt
Risk Factors for Suicide
- A current or prior diagnosis of Major Depressive Disorder or other affective disorder
- Previous suicidal ideation and/or suicidal behavior
- Family history of suicide
- Intimate partner violence including emotional abuse, physical abuse, and/or sexual violence
- Younger maternal age
- Unplanned pregnancy
- Unpartnered relationship status
- Prior abortion
- Severe vaginal laceration
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