New study examines pregnancy, suicidality
Suicide is a leading cause of pregnancy-related deaths in the United States, and new research showed that the number of people having suicidal thoughts after giving birth increased from 2006 to 2017, the largest spikes among women who are Black, lower income or younger.
The study, published Nov. 18 in JAMA Psychiatry, looked at almost 600,000 privately insured people. Researchers analyzed the data to track cases of suicidality — suicidal ideation and deliberate self-harm — within a year either before or after giving birth.
From 2006 to 2017, suicidality diagnoses increased from 0.2% per 100 people to 0.6% per 100. In the same period, cases of self-harm went up from 0.1% per 100 in 2006 to 0.2% per 100 in 2017. When applied to the approximately 4 million births each year, that means an increase in tens of thousands of suicidal cases and self-harm.
“Suicidality is something we don’t think about or talk about as much, and it’s a lot more common than I had realized,” said Kara Zivin, a professor at the University of Michigan and the paper’s senior author.
Zivin pursued the research based on her experience — 10 years ago, after giving birth to her son, her postpartum depression made her suicidal.
The U.S. rate of pregnancy-related deaths is higher than any other wealthy nation. According to a report by the federal Centers for Disease Control and Prevention in 2017, suicide accounted for about 6.5% of all pregnancy-related deaths.
It’s not known what is behind the trend, though the researchers said it’s probably a combination of doctors more often catching cases of suicidality — which is typically underdiagnosed — and the problem growing more common.
Zivin said the study makes a strong case for policy interventions that ensure people can access mental health care during and after pregnancy. People who have Medicaid as their insurance when pregnant will lose that eligibility after 60 days post-birth in most states — even though suicide a year after giving birth is still considered pregnancy-related. Zivin suggested states or the fed
eral government could extend Medicaid to guarantee insurance for a year postpartum, making sure people can see mental health specialists.
The study found that Black women experienced the largest increase in perinatal suicidality of any racial group — increasing from 0.2% per 100 in 2006 to 0.9% in 2017. The nation’s pregnancyrelated death rate is far higher for Black women than for white women.
That’s probably an undercount of the gap, said Katy Kozhimannil, an associate professor at the University of Minnesota and director of its rural health research center. Black women are disproportionately covered through Medicaid, not private insurance. (Kozhimannil was not involved in the study.)
The authors said it’s not known why Black women experienced such a dramatic increase in diagnoses. Experiences of racism have been linked to physical stress and mental illness symptoms, Kozhimannil noted.
This story was published in partnership with The 19th, a nonprofit, nonpartisan newsroom reporting on gender, politics and policy.
If you or a loved one are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 74174.