Investigators from Japan have identified several factors related to peripartum suicide attempts, including younger age, personality disorders, and alcohol use.

A team, led by Tetsuya Akaiishi, MD, PhD, Department of Education and Support for Regional Medicine, Tohoku University Hospital, identified the demographic characteristics and predisposing risks for peripartum suicide attempts and postpartum depression.

Limited Data

The factors that lead to increased peripartum suicide attempt risks are largely unknown.

However, the maternal death rate by suicide has increased in recent years, currently accounting for 5-20% of maternal mortality in developed countries.

In the study, the investigators used retrospective data on pregnant women who delivered birth between April 1, 2016 and March 31, 2021 at 712 hospitals in Japan from the nationwide Diagnosis Procedure Combination database.

Exposures in the study included psychiatric and nonpsychiatric medical history, age, alcohol and tobacco use, and obstetric complications.

The investigators sought main outcomes of data on admissions for prepartum suicide attempts and delivery during the same hospital stay and readmissions for depression or suicide attempts within 1 year following post-partum.

The team compared the prevalence of each variable and determined risk factors using multivariable logistic regression analyses.

Overall, there were 39.9 million hospitalization episodes, with 804,617 cumulative pregnant women. The mean age at childbirth was 33 years for those that delivered at the enrolled hospitals. This included 1202 individuals who were admitted for suicide attempts and delivery during the same hospital stay and 111 individuals readmitted for suicide attempts within 1 year post-partum.

Risk Factors

The investigators identified several risk factors linked to prepartum suicide attempts including younger age (aOR, 0.99; 95% CI, 0.98-1.00) and histories of personality disorder (aOR, 10.81; 95% CI, 5.70-20.49), depression (aOR, 3.97; 95% CI, 2.35-6.70), schizophrenia (aOR, 2.89; 95% CI, 1.52-5.50), and adjustment disorder (aOR, 2.66; 95% CI, 1.07-6.58).

However, there were some differences in the risk factors for suicide attempts postpartum. This included younger age (aOR, 0.96; 95% CI, 0.93-1.00), heavy tobacco use (aOR, 23.09; 95% CI, 5.46-97.62), and histories of alcohol use disorder (aOR, 163.54; 95% CI, 28.30-944.95), personality disorder (aOR, 10.28; 95% CI, 3.29-32.10), anxiety disorders (aOR, 8.13; 95% CI, 2.88-22.98), depression (aOR, 7.27; 95% CI, 2.95-17.91), schizophrenia (aOR, 5.77; 95% CI, 2.17-15.38), bipolar disorder (aOR, 3.98; 95% CI, 1.36-11.67), and insomnia (aOR, 3.17; 95% CI, 1.30-7.78).

After conducting a sensitivity analysis, the investigators found personality disorders, adjustment disorder, bipolar disorder, insomnia, and anxiety disorders were risk factors associated with postpartum depression after excluding individuals with prenatal depression.

“The findings of this cohort study suggest that histories of smoking and prenatal psychiatric disorders are potential risk factors for peripartum suicide attempts and may require additional treatment and prevention interventions,” the authors wrote.

The study, “Risk Factors Associated With Peripartum Suicide Attempts in Japan,” was published online in JAMA Network Open.