The contribution of suicide to maternal mortality: A nationwide population-based cohort study

Kinke M Lommerse; Saskia Mérelle; Anna L Rietveld; Guus Berkelmans; Thomas van den Akker; Netherlands Audit Committee Maternal Mortality and Morbidity

doi:10.1111/1471-0528.17784

The contribution of suicide to maternal mortality: A nationwide population-based cohort study

BJOG. 2024 Feb 12. doi: 10.1111/1471-0528.17784. Online ahead of print.

Authors

Kinke M Lommerse^{1

2}, Saskia Mérelle², Anna L Rietveld^{3

4}, Guus Berkelmans², Thomas van den Akker^{5

6}; Netherlands Audit Committee Maternal Mortality and Morbidity

Collaborators

Netherlands Audit Committee Maternal Mortality and Morbidity:
Kitty Bloemenkamp, Joost Zwart, Ingrid Beenakkers, Babette Braams-Lisman, Jérôme Cornette, Athanasios Kallianidis, Simone Kuppens, Marjolein Lansbergen-Mensink, Timme Schaap, Jelle Stekelenburg

Affiliations

¹ Department of Psychiatry, Haaglanden Medisch Centrum, The Hague, The Netherlands.
² Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands.
³ Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
⁴ Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
⁵ Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
⁶ Athena Institute, VU University, Amsterdam, The Netherlands.

PMID: 38344899
DOI: 10.1111/1471-0528.17784

Abstract

Objective: To identify the incidence and characteristics of maternal suicide.

Design: Nationwide population-based cohort study.

Setting: The Netherlands, 2006-2020.

Population: Women who died during pregnancy or within 1 year postpartum, and a reference population of women aged 25-45 years.

Methods: The Cause of Death Register and Medical Birth Register were linked to identify women who died within 1 year postpartum. Data were combined with deaths reported to the Audit Committee for Maternal Mortality and Morbidity (ACMMM), which performs confidential enquiries. Maternal suicides were compared with a previous period (1996-2005). Risk factors were obtained by combining vital statistics databases.

Main outcome measures: Comparison of incidence and proportion of maternal suicides among all maternal deaths over time, sociodemographic and patient-related risk factors and underreporting of postpartum suicides.

Results: The maternal suicide rate remained stable with 68 deaths: 2.6 per 100 000 live births in 2006-2020 versus 2.5 per 100 000 in 1996-2005. The proportion of suicides among all maternal deaths increased from 18% to 28%. Most suicides occurred throughout the first year postpartum (64/68); 34 (53%) of the women who died by suicide postpartum were primiparous. Compared with mid-level, low educational level was a risk factor (odds ratio 4.2, 95% confidence interval 2.3-7.9). Of 20 women reported to the ACMMM, 11 (55%) had a psychiatric history and 13 (65%) were in psychiatric treatment at the time of death. Underreporting to ACMMM was 78%.

Conclusions: Although the overall maternal mortality ratio declined, maternal suicides did not and are now the leading cause of maternal mortality if late deaths up to 1 year postpartum are included. Data collection and analysis of suicides must improve.

Keywords: maternal mortality; pregnancy-related mortality; suicide; underreporting.