Maternal Suicidal Behavior: Comparisons Between Pregnancy and Postpartum Periods and Nonpregnancy, 2006-2019

The perinatal period is considered protective against suicide among women of reproductive age. However, it is unclear if this applies to nonfatal suicidal behavior. This study compared rates and determinants of suicidal behavior during pregnancy/delivery, postpartum, and nonpregnancy/nonpostpartum.

A repeated cross-sectional study was performed using 2006-2019 Florida hospital discharge records. Trends in hospitalization rates were assessed for suicidal ideation and intentional self-harm by pregnancy period, and adjusted rate ratios (aRRs) were estimated using negative binomial regression models to compare pregnancy/delivery and postpartum to nonpregnancy/nonpostpartum. Determinants were also compared across pregnancy periods.

Hospitalization rates for suicidal ideation in 2018-2019 versus 2006-2007 were 3.5, 5.9, and 5.1 times higher during pregnancy/delivery, postpartum, and nonpregnancy/nonpostpartum, respectively. In contrast, rates for intentional self-harm declined during nonpregnancy/nonpostpartum (RR = 0.85), with no significant change during pregnancy/delivery or postpartum. Compared with nonpregnancy/nonpostpartum, aRRs for suicidal ideation were significantly lower during pregnancy/delivery (aRR = 0.08) and postpartum (aRR = 0.13). Similar findings were observed for intentional self-harm (aRRs = 0.08 and 0.14, respectively). Determinants varied slightly by behavior and period. During pregnancy/delivery and postpartum, younger age, non-Hispanic Black race (pregnancy/delivery only), and Medicaid/Medicare or "Other" payer were positively associated with both behaviors, whereas Hispanic ethnicity and Medicaid/Medicare or "Other" payer were positively associated with both behaviors during nonpregnancy/nonpostpartum.

Suicidal behavior is a significant concern during the reproductive period. Increasing access to mental healthcare and tailoring interventions to high-risk populations are important to reducing hospitalization rates.