Warning: If you are feeling fragile right now and think a discussion about the loss of new mothers will upset you, you should consider skipping this article.
I heard about pregnancy and suicide for the first time during a short stay in Budapest, Hungary, back in the early 2000’s. At that time, I was researching how certain medications affected babies and pregnancies. My host and colleague, Professor Andrew Czeizel, mentioned to me that he had collected information from about 50 Hungarian women who had attempted suicide during pregnancy and survived. The majority of them overdosed with medications. The scope of his research was to evaluate the potential congenital abnormality effect of ingesting large doses of drugs among pregnant women (read one of Prof. Czeizel’s articles about 1,044 self-poisoned pregnant women here). Although I never met a woman who attempted suicide during pregnancy, neither before nor after that visit in Hungary, the scenario never escaped my mind.
“I’m 27 and 12 weeks away from my due date and I want to kill myself. Not my baby. I will never do anything to harm him. But his father and I are broke and I don’t have anything to offer him.”
I read this statement on a pregnancy social forum not long time ago. Reading it was painful.
“When I give birth I just want to give him to his dad’s family and go somewhere and kill myself. I always tell my boyfriend but he don’t believe me.”
How did her pain become so unbearable? – I wonder.
“I don’t want to die but I have nothing to live for and I don’t want my son to witness his mom depressed and crying every day. I rather disappear.”
What could I do to help?
“My only purpose in life is to birth him. I so sad and when I try to talk to people they make me feel like crap. I hate this feeling.”
What can we do to help?
How frequent is suicide during pregnancy?
Although not widely known, suicide is a leading cause of death among pregnant and postpartum women. In fact, one study published in the journal Obstetrics & Gynecology reports that suicide is the fifth leading cause of death among pregnant women. Depression can lead to suicidal ideation and suicide attempts. Unfortunately, sometimes prenatal depression does not get identified or treated and what began as an idea progresses to an attempt. In some cases, the attempt is fatal.
In a 2011 study of more than 2,000 pregnant women in the United States, Gavin and colleagues found that 2.7% of them reported antenatal suicidal ideation (find the study report here). If these results are applied to the entire population of pregnant women in the United States, about 162,000 women every day think of committing suicide at one point in time during pregnancy. And that staggering number is just in the United States.
Another study by Palladino and colleagues (here) found that the rate of death from suicide among pregnant and new mothers is 2.0 (2 out of every 100,000 births).
A review of 17 studies in high- and low-income countries found the prevalence of suicidal ideation among pregnant and postpartum women ranged from 5% to 18%. Rates were higher among pregnant women living in low-income countries.
What are the most common risk factors for suicidal ideas during pregnancy?
In addition to depression, which is the most common finding among pregnant women with suicidal ideas, a large proportion of women who attempt suicide have serious physical issues, such as hyperemesis gravidarum (a severe form of nausea and vomiting) or cancer, and other mental afflictions, such as schizophrenia, personality disorder, bipolar disorder, or anxiety.
Another risk factor is that many women who have been treated successfully with a medication for their depression, anxiety, or bipolar disorder come off of it when they become pregnant. Either they quit because they believe they must, friends and family insist they quit, or their obstetricians make them quit.
In the study by Palladino and colleagues mentioned above, as many as 16–23% of American women experienced intimate partner violence (IPV) during their pregnancy. IPV is a major risk factor for suicidality and suicides in women.
Socioeconomic adversity, interpersonal violence and lack of social support also produce a profound impact on pregnant women’s wellbeing. Bantjes and colleagues concluded that pregnant women who are the victims of intimate partner violence are twice as likely to engage in suicidal behavior compared to other pregnant women. And those who experience food insecurity – either they go hungry regularly or they have considerable trouble feeding themselves and their families – are almost four times more likely to report suicidal behavior.
How do pregnant women attempt to commit suicide?
The majority of pregnant women who attempt suicide overdose on prescription medications. However, “almost three quarters of women who died by suicide in the perinatal period used a violent method, such as hanging or jumping from a height ― a likely indication of more severe illness and serious suicidal intent,” said Dr Khalifeh, who works at the Section of Women’s Mental Health, Health Service and Population Research Department, in the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, United Kingdom.
How can suicide during pregnancy be prevented?
Screening. A major step for an effective suicide prevention strategy is to identify pregnant women who are depressed or are at risk of being depressed. The American Congress of Obstetricians and Gynecologists recommends that pregnant women should be screened at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. Furthermore, women with current depression or anxiety, a history of perinatal mood disorders, or risk factors for perinatal mood disorders warrant particularly close monitoring, evaluation, and assessment.
Although screening is important for detecting perinatal depression, screening by itself is insufficient to improve clinical outcomes and must be coupled with appropriate follow-up and treatment when indicated; clinical staff in obstetrics and gynecology practices should be prepared to initiate medical therapy, refer patients to appropriate behavioral health resources when indicated, or both.
Support. Women with mental illness in the perinatal period, wherever they live, must have guaranteed access to the specialist services they need.
When should a pregnant woman at risk of suicide seek medical help?
The symptoms of depression vary from person to person. However, following are some common signs. Please, seek medical help immediately if you have any of these signs:
- feelings of sadness, bleakness or hopelessness
- lack of interest or pleasure in doing anything
- trouble getting to sleep, waking up in the night or sleeping too much
- feeling tired or having little energy
- overeating or lack of appetite
- low self-esteem, or feelings of guilt or failure
- difficulty concentrating
- fidgeting a lot, or moving and speaking very slowly
- thoughts of suicide or self-harm
Do you or anybody you know need emergency help now?
Call 911 or 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255).
Línea de Emergencia de Suicidio en Español: 1-800-273-TALK (Presione el número 2).
LGBT Youth Suicide Hotline: 1-866-4-U-TREVOR.
More resources can be found in http://www.suicide.org.