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Bete T, Ali T, Misgana T, Negash A, Abraham T, Teshome D, Sirtsu A, Nigussie K, Amano A. Suicidal ideation and associated factors among pregnant women attending antenatal care at public hospitals of Harari regional state, eastern Ethiopia: A cross-sectional study. PLoS One 2024; 19:e0300417. [PMID: 38547179 PMCID: PMC10977762 DOI: 10.1371/journal.pone.0300417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Suicide is a global issue. It is the third responsible for death among the reproductive age group. Pregnancy is a complicated event and crucial in the life of a woman with considerable physiological, hormonal changes, social, and mental changes. However, third-world countries like Ethiopia have not been investigated well. Therefore, the study planned to assess the magnitude and factors associated with suicidal ideation. Furthermore, it will identify the role of hyperemesis gravidarum on suicidal ideation. METHOD A Cross-sectional study was employed for 543 pregnant participants attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal General Hospital, Harari regional state, eastern Ethiopia from June 1 to August 1, 2022. The recruited participants were selected by systematic random sampling method. Suicide was assessed using Composite International Diagnostic by interview methods data collection. Epi data and STATA version 14.1 were used for data entry and analysis respectively. Candidate variables were entered into a multivariate logistic regression then those variables that have p-value < 0.05 were considered as significantly associated. RESULTS The magnitude of suicidal ideation in this study was found to be 11.15% at (95% CI: 8.75-14.11). Regarding the associated factor, unwanted pregnancy (AOR = 3.39: at 95% CI = 1.58-7.27), Hyperemesis gravidarum (AOR = 3.65: at 95% CI = 1.81-7.34), having depressive symptoms (AOR = 2.79: at 95% CI = 1.49-5.23), having anxiety symptoms (AOR = 3.37; at 95% CI = 1.69-6.68), experiencing intimate partner violence (AOR = 2.88: at 95% CI = 1.11-7.46), and having stress (AOR = 3.46; at 95% CI = 1.75-6.86) were significantly associated variable with suicidal ideation among pregnant women. CONCLUSION AND RECOMMENDATION This study revealed that suicidal ideation is common among pregnant women. Regarding the associated factors unwanted pregnancy, hyperemesis gravidarum, having depressive and anxiety symptoms, experiencing intimate partner violence, and stress were significantly associated with suicidal ideation. Thus, giving awareness and early screening and interferences for antenatal suicide should be warranted.
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Affiliation(s)
- Tilahun Bete
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Ali
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Misgana
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Negash
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teklu Abraham
- Department of Psychiatry, School Medicine, College of Health and Medical Sciences, Arsi University, Assella, Ethiopia
| | - Dekeba Teshome
- Department of Psychiatry, School Medicine, College of Health and Medical Sciences, Arsi University, Assella, Ethiopia
| | - Addisu Sirtsu
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdulkerim Amano
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Roddy Mitchell A, Gordon H, Atkinson J, Lindquist A, Walker SP, Middleton A, Tong S, Hastie R. Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2343711. [PMID: 37976063 PMCID: PMC10656650 DOI: 10.1001/jamanetworkopen.2023.43711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Anxiety disorders are associated with poor maternal and neonatal outcomes. Women in low- and middle-income countries (LMICs) are thought to be disproportionally burdened by these disorders, yet their prevalence is unclear. Objective To conduct a systematic review and meta-analysis to determine the prevalence of 6 anxiety and related disorders among perinatal women in LMICs. Data Sources Embase, MEDLINE, PsycINFO, Cochrane Library, CINAHL, and Web of Science databases were searched from inception until September 7, 2023. Study Selection Studies conducted in World Bank-defined LMICs and reporting prevalence of generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, posttraumatic stress disorder, panic disorder, or adjustment disorder during the perinatal period (conception to 12 months post partum) using a validated method were included. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Study eligibility, extracted data, and risk of bias of included studies were assessed by 2 independent reviewers. Random-effects meta-analysis was used to estimate pooled point prevalence. Subgroup analyses were performed by specific anxiety disorder. Main Outcomes and Measures Main outcomes were prevalence estimates of each anxiety disorder, measured as percentage point estimates and corresponding 95% CIs. Results At total of 10 617 studies were identified, 203 of which met the inclusion criteria and reported the outcomes of 212 318 women from 33 LMICs. Generalized anxiety disorder was the most reported (184 studies [90.6%]) and most prevalent disorder at 22.2% (95% CI, 19.4%-25.0%; n = 173 553). Posttraumatic stress disorder was the second most prevalent (8.3%; 95% CI, 5.0%-12.2%; 33 studies; n = 22 452). Adjustment disorder was least prevalent (2.9%; 95% CI, 0.0%-14.1%; 2 studies; n = 475). The prevalence of generalized anxiety varied by country income status, with the highest prevalence among lower-middle-income countries (27.6%; 95% CI, 21.6%-33.9%; 59 studies; n = 25 109), followed by low-income (24.0%; 95% CI, 15.3%-33.8%; 11 studies; n = 4961) and upper-middle-income (19.1%; 95% CI, 16.0%-22.4%; 110 studies; n = 138 496) countries. Conclusions and Relevance These findings suggest that 1 in 5 women living in LMICs experience anxiety disorders during pregnancy and post partum. Targeted action is needed to reduce this high burden.
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Affiliation(s)
- Alexandra Roddy Mitchell
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Hannah Gordon
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Jessica Atkinson
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anthea Lindquist
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan P. Walker
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anna Middleton
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Dudeney E, Coates R, Ayers S, McCabe R. Measures of suicidality in perinatal women: A systematic review. J Affect Disord 2023; 324:210-231. [PMID: 36584713 DOI: 10.1016/j.jad.2022.12.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Suicide is a leading cause of death for perinatal women. Identifying women at risk of suicide is critical. Research on the validity and/or reliability of measures assessing suicidality in perinatal women is limited. This review sought to: (1) identify; and (2) evaluate the psychometric properties of suicidality measures validated in perinatal populations. METHODS Nine electronic databases were systematically searched from inception to January 2022. Additional articles were identified through citation tracking. Study quality was assessed using an adapted tool, and the psychometric properties of measures were reviewed and presented using a narrative synthesis. RESULTS A total of 208 studies were included. Thirty-five studies reported psychometric data on ten suicidality measures. Fifteen studies reported both validity and reliability data, 12 reported more than one type of validity, seven validated more than one measure and four only reported reliability. Nearly all measures primarily screened for depression, with an item or subscale assessing suicidal ideation and/or behaviours. Three measures were specifically developed for perinatal women, but only two were validated in more than one study. The Postpartum Depression Screening Scale (PDSS), suicidal thoughts subscale, was validated most frequently. LIMITATIONS Methodological differences and variability between the measures (e.g., suicidality construct assessed, number of items and administration) precluded direct comparisons. CONCLUSION Further validation of suicidality measures is needed in perinatal women. Screening for perinatal suicidality often occurs in the context of depression. The development of a standalone measure specifically assessing suicidality in perinatal women may be warranted, particularly for use in maternity care settings.
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Affiliation(s)
- Elizabeth Dudeney
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK.
| | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Rose McCabe
- Centre for Mental Health Research, School of Health and Psychological Sciences, University of London, UK
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Akaishi T, Tarasawa K, Fushimi K, Hamada H, Saito M, Kobayashi N, Kikuchi S, Tomita H, Ishii T, Fujimori K, Yaegashi N. Risk Factors Associated With Peripartum Suicide Attempts in Japan. JAMA Netw Open 2023; 6:e2250661. [PMID: 36633845 PMCID: PMC9857025 DOI: 10.1001/jamanetworkopen.2022.50661] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Peripartum suicide attempt is a major psychiatric complication associated with pregnancy, but the risk factors remain largely uncertain. OBJECTIVE To identify the demographic characteristics and predisposing risks for peripartum suicide attempts and postpartum depression. DESIGN, SETTING, AND PARTICIPANTS This cohort study used retrospective data on pregnant women who delivered children between April 1, 2016, and March 31, 2021, at 712 hospitals in Japan. The nationwide Diagnosis Procedure Combination database was used. EXPOSURES Psychiatric and nonpsychiatric medical history, age, alcohol and tobacco use, and obstetric complications and procedures. MAIN OUTCOMES AND MEASURES Data on admissions for prepartum suicide attempt and delivery during the same hospital stay and readmissions for depression or suicide attempt within 1 year post partum were collected. Comparisons of prevalence of each study variable were performed, and multivariable logistic regression analyses were used to determine risk factors. RESULTS From a total of 39 908 649 hospitalization episodes, 804 617 cumulative pregnant women (median [IQR] age at childbirth, 33 [29-36] years) who delivered at the enrolled hospitals were identified, including 1202 who were admitted for suicide attempt and delivery during the same hospital stay and 111 readmitted for suicide attempt within 1 year post partum. Risk factors associated with prepartum suicide attempts included younger age (adjusted odds ratio [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). Risk factors associated with postpartum suicide attempts 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). On sensitivity analysis, risk factors associated with postpartum depression after excluding those with prenatal depression included histories of personality disorder, adjustment disorder, bipolar disorder, insomnia, and anxiety disorders. CONCLUSIONS AND RELEVANCE 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.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Hirotaka Hamada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Natsuko Kobayashi
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Saya Kikuchi
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Bauer A, Knapp M, Matijasevich A, Osório A, de Paula CS. The lifetime costs of perinatal depression and anxiety in Brazil. J Affect Disord 2022; 319:361-369. [PMID: 36162663 DOI: 10.1016/j.jad.2022.09.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Each year, an estimated 860,000 Brazilian women experience depression and anxiety perinatally. Despite well-known devastating impacts of these conditions on mothers and children, they remain neglected in low- and middle-income countries. Knowing the costs of untreated perinatal depression and anxiety can inform decision-making. METHODS Simulation modelling is used to examine lifetime costs of perinatal depression and anxiety for a hypothetical cohort of women and their children, followed until children are aged 40 years. Costs are measured from a societal perspective, including healthcare expenditure, productivity and health-related quality of life losses; 2017 data are taken from country-specific sources. Present values are calculated using a discount rate of 3 %. RESULTS Lifetime cost of perinatal depression and anxiety in Brazil are USD 4.86 billion or R$ 26.16 billion, including costs linked to poorer quality of life (USD 2.65 billion), productivity loss (USD 2.16 billion) and hospital care (USD 0.05 billion). When the costs associated with maternal suicide are included, total costs increase to USD 4.93 billion. LIMITATIONS Several costs could not be included in the analysis because of a lack of data. The study is reliant of longitudinal data on associations between perinatal depression and anxiety and impacts on mothers and children. Therefore, no causality can be inferred. CONCLUSION Our findings illustrate the economic rationale for investment in this area. This is the first study that estimates the costs of perinatal mental health problems in a low- or middle-income country setting.
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Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Martin Knapp
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, SP, Brazil.
| | - Ana Osório
- Developmental Disorders Program and Mackenzie Center for Research in Childhood and Adolescence, Universidade Presbiteriana Mackenzie, São Paulo, SP, Brazil.
| | - Cristiane Silvestre de Paula
- Developmental Disorders Program and Mackenzie Center for Research in Childhood and Adolescence, Universidade Presbiteriana Mackenzie, São Paulo, SP, Brazil.
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Sánchez ODR, Tanaka Zambrano E, Dantas-Silva A, Bonás MK, Grieger I, Machado HC, Surita FG. Domestic violence: A cross-sectional study among pregnant and postpartum women. J Adv Nurs 2022; 79:1525-1539. [PMID: 35855530 DOI: 10.1111/jan.15375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
Abstract
AIM To assess the prevalence of domestic violence/intimate partner violence, aggressors, types of violence and associated factors in women who attend an antenatal and postnatal care service in a public hospital in Brazil. DESIGN Cross-sectional study. METHODS We interviewed women attending antenatal and postpartum care services in a Brazilian public tertiary woman's hospital in Campinas, São Paulo, between July 2019 and September 2021. Data were collected through interviewer-administered questionnaires previously used in healthcare settings: Abuse Assessment Screen (AAS); Woman Abuse Screening Tool (WAST); Hurt, Insulted, Threatened with Harm and Screamed (HITS). We evaluated the relationship between the sociodemographic characteristics of women and domestic/intimate violence using bivariate and multivariable logistic regression analyses. RESULTS Of the 600 pregnant and postpartum women interviewed, 138 (23%) had suffered any abuse. Some participants disclosed physical violence during pregnancy (2.3%) and during the last 12 months (5.3%). The partner was identified as the main aggressor in most of the cases (60%). When women had a partner, 3.5% reported domestic violence and 6.7% disclosed intimate partner violence during pregnancy or postpartum period. Women with non-white skin colour (OR = 1.53; 95% CI 1.01-2.34; p = .048), gestational age ≤ 13 weeks (OR = 3.41; 95% CI 1.03-11.25; p = .044) and in postpartum period (OR = 2.81; 95% CI 1.32-5.99; p = .008) were more likely to experience domestic violence at some time in their lives. Women interviewed before the COVID-19 pandemic were more likely to disclose that they had suffered any abuse. CONCLUSION Experience of violence during pregnancy and postpartum period was more frequent in women with non-white skin colour, in their first gestational trimester and in the postpartum period, and was more reported before the COVID-19 pandemic. Antenatal and postpartum care services could be safe places to support violence survivors. IMPACT Pregnant and postpartum women are a vulnerable group to experiencing domestic violence/intimate partner violence. Violence can negatively affect women's and children's health and well-being. Antenatal and postpartum care should be considered as a moment to routinely inquiry women about past and current violence experiences. Regular contact among healthcare professionals and women during this period offers a window of opportunities for implementing psychosocial interventions among women at risk of violence. Healthcare providers (i.e., physicians, psychologists, social workers, nurses and midwives) have an important role in identifying survivors, offering support and providing quality information to women.
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Affiliation(s)
- Odette Del Risco Sánchez
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Amanda Dantas-Silva
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Isabella Grieger
- School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Fernanda Garanhani Surita
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Abstract
Importance Suicide is a leading cause of death in the United States, with increasing rates among women. Women are more likely to experience suicidal ideation and engage in suicide behavior than men, and risk is elevated at key points where they may engage in care with a women's health care provider. Objective This review describes the prevalence of and risk factors for suicide among women and highlights the role of obstetrician-gynecologists in suicide prevention. Evidence Acquisition A PubMed, MEDLINE, and PsycINFO search was completed for English-language publications about suicide among women, including subtopics (eg, perinatal suicide, suicide during perimenopause). Results There are overlapping risk factors that contribute to suicide among women, including intimate partner violence and substance use. Specific groups of women may present with unique risk factors, such as women veterans, women in rural areas, and women with preexisting mental health diagnoses, particularly serious mental illnesses. Some women at risk for suicide are not seen in clinical settings, and thus community interventions may be beneficial. There are roles for obstetrician-gynecologists within and outside of the clinic to prevent suicide. Conclusions and Relevance Obstetrician-gynecologists can save lives by being aware of the prevalence of suicide ideation and behavior among women, understanding risk factors for suicide over the lifespan, regularly screening for these factors, asking directly about suicide ideation and intent, and being aware of clinical and community resources. Outside of the clinic, they can advocate for increased health care access and community-based interventions. These efforts can contribute to the reduction of preventable death and maternal mortality.
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Prevalence and associated factors of suicidal behavior among pregnant mothers in southern Ethiopia: a cross-sectional study. BMC Public Health 2022; 22:490. [PMID: 35279113 PMCID: PMC8918309 DOI: 10.1186/s12889-022-12957-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background Suicidal behavior among pregnant mothers is one of the most common psychiatric emergencies that require a major public health concern by researchers and mental health task forces. Pregnant mothers experience suicidal attempt, which is a fatal problem to end life. Therefore, there was a need to assess the prevalence and associated factors of suicidal behavior among pregnant mothers to integrate mental health care, particularly suicide, with maternal management. Methods A cross-sectional study was conducted among 504 pregnant mothers in the Gedeo zone, southern Ethiopia. Suicidal behavior was assessed using revised suicidal behavior questionnaire (SBQ-R) with a total score of 3-18; those scoring ≥7 were considered as having Suicidal behavior. Data were entered into Epi-data 3.1 and analyzed using SPSS version 20. Bivariate and multivariate binary logistic regression analysis was performed to identify associated factors of suicidal behavior. Variables with a P-value less than 0.05 with 95% CI were considered statistically significant. Results In this study, the overall prevalence of suicidal behavior among pregnant mothers was 47(9.3%) with 95% CI (7.1- 11.9). Regarding the factors; being unmarried [AOR = 5.69, 95% CI, (1.19, 27.23)], gestation age greater than 27 weeks, [AOR = 4.92, 95% CI (1.67, 14.53)], history of having chronic medical illness [AOR = 4.47, 95% CI (1.35, 14.85)], depression [AOR = 4.20, 95% CI (1.90, 9.28], and intimate partner violence [AOR = 7.60, 95% CI (3.27, 17.67)] were significantly associated with suicidal behavior at P value less than 0.05 and corresponding 95% CI. Conclusion Pregnant mothers in the community had a high prevalence of suicidal behavior compared to studies conducted among general populations. It is better to include and implement the assessment of suicidal risk factors as a primary treatment package for pregnant mothers, training of health extension workers and other primary health workers on how to assess the risk of suicide among pregnant mothers is warranted.
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Faisal-Cury A, Oliveira Rodrigues DM, Matijasevich A, Tarpinian F, Tabb K. Prevalence and Associated Risk Factors of Suicidal Ideation Among Brazilian Pregnant Women: A Population-Based Study. Front Psychiatry 2022; 13:779518. [PMID: 35392386 PMCID: PMC8981206 DOI: 10.3389/fpsyt.2022.779518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Suicide is a leading cause of death during the perinatal period in high-income countries (HIC). There remains a lack of population-based studies about suicidal ideation (SI) during pregnancy among low and middle income countries (LMIC). OBJECTIVES Using the case of Brazil, we aim to estimate the prevalence of SI during pregnancy and its association with antenatal depression (AD) and sociodemographic factors in a LMIC. METHOD We used data from the Brazilian National Survey (PNS-2019), a population-based study, with a complex and probabilistic sampling method. Of the 27,136 women of reproductive age (15 to 49 years old) who participated in the PNS, a total of 769 women reported being pregnant at the time of the interview. All PNS participants answered the Patient Health Questionnaire-9 (PHQ-9) and a questionnaire with sociodemographic data. SI was defined as any answer to the PHQ-9 item 9 other than 0 (not at all). Logistic regression models were performed to obtain crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the association between explanatory variables and SI during pregnancy. RESULTS Among 769 women, 33 (3.9%, 95% CI: 3.0-5.1%) reported SI during pregnancy. In the adjusted analysis, higher odds of SI were associated with being 20 to 34 years old (aOR:0.24, 95% CI: 0.08-0.74) or 35 to 49 years old (aOR:0.15; 95% CI: 0.04-0.50), having 9 to 11 years of education (aOR 0.23, 95% CI: 0.61-0.86), acheiving the highest family income category (aOR:0.08, 95% CI: 0.01-0.58), not living in the South/Southeast regions of Brazil (aOR:5.52, 95% CI: 2.36-12.9), and having probable mild AD (aOR:10.5 95% CI: 2.3-47.9) or moderate AD (aOR:241.3, 95% CI: 58.4-996.7). CONCLUSIONS In Brazil, SI affects almost 4% of pregnant women and is associated with sociodemographic vulnerability. Clinically, women with mild symptoms of depression may also experience SI during pregnancy. These findings are important for designing effective perinatal mental health interventions in LMICs.
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Affiliation(s)
- Alexandre Faisal-Cury
- Departamento de Medicina Preventiva da, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva da, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | | | - Karen Tabb
- University of Illinois at Urbana-Champaign, Champaign, IL, United States
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Bedaso A, Adams J, Peng W, Sibbritt D. The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reprod Health 2021; 18:162. [PMID: 34321040 PMCID: PMC8320195 DOI: 10.1186/s12978-021-01209-5] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 07/19/2021] [Indexed: 01/11/2023] Open
Abstract
Background Pregnancy is a time of profound physical and emotional change as well as an increased risk of mental illness. While strengthening social support is a common recommendation to reduce such mental health risk, no systematic review or meta-analysis has yet examined the relationship between social support and mental problems during pregnancy. Methods The PRISMA checklist was used as a guide to systematically review relevant peer-reviewed literature reporting primary data analyses. PubMed, Psych Info, MIDIRS, SCOPUS, and CINAHL database searches were conducted to retrieve research articles published between the years 2000 to 2019. The Newcastle–Ottawa Scale tool was used for quality appraisal and the meta-analysis was conducted using STATA. The Q and the I2 statistics were used to evaluate heterogeneity. A random-effects model was used to pool estimates. Publication bias was assessed using a funnel plot and Egger’s regression test and adjusted using trim and Fill analysis. Result From the identified 3760 articles, 67 articles with 64,449 pregnant women were part of the current systematic review and meta-analysis. From the total 67 articles, 22 and 45 articles included in the narrative analysis and meta-analysis, respectively. From the total articles included in the narrative analysis, 20 articles reported a significant relationship between low social support and the risk of developing mental health problems (i.e. depression, anxiety, and self-harm) during pregnancy. After adjusting for publication bias, based on the results of the random-effect model, the pooled odds ratio (POR) of low social support was AOR: 1.18 (95% CI: 1.01, 1.41) for studies examining the relationship between low social support and antenatal depression and AOR: 1.97 (95% CI: 1.34, 2.92) for studies examining the relationship between low social support and antenatal anxiety. Conclusion Low social support shows significant associations with the risk of depression, anxiety, and self-harm during pregnancy. Policy-makers and those working on maternity care should consider the development of targeted social support programs with a view to helping reduce mental health problems amongst pregnant women. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01209-5. Pregnancy is a significant event for reproductive-age women. It is supplemented by hormonal changes and can represent a time of increased risk for the occurrence of mental illness like depression, anxiety and self-harm. Providing good social support for the pregnant mother reduce this risk and prevent pregnancy complication and adverse birth outcome. However, no systematic review and/or meta-analysis has explored the associations between social support and mental illness (depression, anxiety, self-harm) among pregnant women. Therefore, this systematic review and meta-analysis aimed to examine the association between social support and mental illness (anxiety, depression, and self-harm) during pregnancy. The review identified 67 relevant articles with 64,449 pregnant women, from PubMed, Psych Info, MIDIRS, SCOPUS, and CINAHL database. Of the total 67 articles, 22 articles included in the narrative review and 45 articles included in the meta-analysis. Among studies included in the narrative synthesis, a majority of them reported significant positive associations between low social support and antenatal depression, antenatal anxiety and self-harm during pregnancy. Further, the pooled estimates of the meta-analysis show that low social support had a significant positive association with antenatal depression (AOR: 1.18 (95% CI: 1.01, 1.41)) and antenatal anxiety (AOR: 1.97 (95% CI: 1.34, 2.92)). Therefore, maternal health professionals need to have discussions with pregnant women regarding the level and source of social support they receive. Maternal health professionals may also need to consider encouraging the social network of pregnant women to improve social support being given. Policy-makers and those working on maternity care should consider the development of targeted social support programs with a view to helping reduce mental health problems amongst pregnant women.
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Affiliation(s)
- Asres Bedaso
- College of Medicine and Health Sciences, School of Nursing, Hawassa University, Hawassa, Ethiopia. .,Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Jon Adams
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Wenbo Peng
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - David Sibbritt
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Li J, Imam SZ, Jing Z, Wang Y, Zhou C. Suicide attempt and its associated factors amongst women who were pregnant as adolescents in Bangladesh: a cross-sectional study. Reprod Health 2021; 18:71. [PMID: 33789699 PMCID: PMC8011090 DOI: 10.1186/s12978-021-01127-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/21/2021] [Indexed: 01/13/2023] Open
Abstract
Background Adolescent pregnancy is a risk factor for suicide. We aimed to assess the prevalence of suicide attempts among young women with adolescent pregnancy in Bangladesh and to explore its associated factors. Methods In this cross-sectional study, we surveyed young women with adolescent pregnancy in urban and rural areas in Bangladesh to assess suicide attempts, socio-demographic and pregnancy-related characteristics, perceived health status, and perceived social support. Binary logistic regression analysis was conducted to explore the relationship between potentially related factors and suicide attempts. Results Of the participants, 6.5% (61/940) reported suicide attempts in the past 12 months, and the majority (88.5%) of the attempts happened within one year after the pregnancy. Participants with more years after first pregnancy (odds ratio (OR) = 0.47, 95% CI: 0.37–0.61) and more perceived social support from friends (OR = 0.69, 95% CI: 0.55–0.86) were less likely to have suicide attempts, and those perceived bad health status compared with good/fair health status (OR = 8.38, 95% CI: 3.08–22.76) were more likely to attempt suicide. Conclusions Women with adolescent pregnancy were at high risk of suicide attempts, especially those during the first postnatal year. The risk of suicide attempts attenuated with the time after pregnancy, and perceived social support from friends was a protective factor and perceived bad health status was a risk factor for suicide attempts among young women who have experienced adolescent pregnancy.
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Affiliation(s)
- Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Syeda Zerin Imam
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhengyue Jing
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China. .,NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China.
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12
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Vanderkruik R, Gonsalves L, Kapustianyk G, Allen T, Say L. Mental health of adolescents associated with sexual and reproductive outcomes: a systematic review. Bull World Health Organ 2021; 99:359-373K. [PMID: 33958824 PMCID: PMC8061667 DOI: 10.2471/blt.20.254144] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To systematically review the literature on the mental health of adolescents associated with sexual and reproductive outcomes, and compare the mental health outcomes with that of other age groups. Methods We searched seven databases for relevant peer-reviewed articles published between 1 January 2010 and 25 April 2019. Our inclusion criteria required that the study included age-disaggregated data on adolescents, and focused and assessed mental health outcomes associated with pregnancy or sexually transmitted infections. We extracted data on the specific health event, the mental health outcome and the method of measuring this, and comparisons with other age groups. Findings After initially screening 10 818 articles by title and abstract, we included 96 articles in our review. We observed that a wide-ranging prevalence of mental ill-health has been reported for adolescents. However, most studies of mental health during pregnancy did not identify an increased risk of depression or other mental disorders among adolescents compared with other age groups. In contrast, the majority of studies conducted during the postpartum period identified an increased risk of depression in adolescents compared with other age groups. Three studies reported on mental health outcomes following abortion, with varying results. We found no studies of the effect of sexually transmitted infections on mental health among adolescents. Conclusion We recommend that sexual and reproductive health services should be accessible to adolescents to address their needs and help to prevent any adverse mental health outcomes.
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Affiliation(s)
- Rachel Vanderkruik
- Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America
| | - Lianne Gonsalves
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Tomas Allen
- Department of Quality, Norms and Standards, World Health Organization, Geneva, Switzerland
| | - Lale Say
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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13
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Suicide attempts during pregnancy and perinatal outcomes. J Psychiatr Res 2021; 133:101-105. [PMID: 33338731 DOI: 10.1016/j.jpsychires.2020.12.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/19/2020] [Accepted: 12/09/2020] [Indexed: 11/24/2022]
Abstract
Maternal and fetal outcomes of suicide attempts during pregnancy have rarely been examined. We examined the clinical characteristics (maternal age, gestational age in pregnancy, psychoneurological comorbidities, methods of suicide attempts) and critical perinatal outcomes among hospitalized pregnant women who attempted suicide. The current study was a nationwide retrospective cohort study using the Diagnosis Procedure Combination database, a national database for acute-care inpatients in Japan. We identified all pregnant women who were admitted to participating hospitals because of suicide attempts from January 2016 to March 2018. Main composite outcome was defined as critical perinatal outcomes including any of the following: induced or spontaneous abortion, intrauterine fetal death and maternal death. There were 319 eligible patients, of whom 126 (39.5%) had mental and behavioral disorders on admission. Blood transfusion for mother, intrauterine fetal death, and maternal death were more likely to occur in women with violent methods of suicide attempts than in women with non-violent methods. A multivariable logistic regression analysis showed that violent methods of suicide attempts (OR = 3.57 [95% CI = 1.15-11.1]) were significantly associated with critical perinatal outcomes. Healthcare providers should pay attention to mental health among pregnant women, regardless of complications of mental and behavioral disorders. The finding of associations between violent methods of suicide attempts and critical perinatal outcomes may be helpful for healthcare providers.
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Islam MJ, Broidy L, Mazerolle P, Baird K, Mazumder N, Zobair KM. Do Maternal Depression and Self-Esteem Moderate and Mediate the Association Between Intimate Partner Violence After Childbirth and Postpartum Suicidal Ideation? Arch Suicide Res 2020; 24:609-632. [PMID: 31462186 DOI: 10.1080/13811118.2019.1655507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Intimate partner violence (IPV) during the perinatal period is believed to have an adverse effect on maternal mental health. Given the risks of suicide and related public health concerns, the aim of this study is to examine (1) the association of experiencing physical, psychological, and sexual IPV after childbirth on postpartum suicidal ideation (SI), and (2) whether postpartum depression and self-esteem act to mediate or moderate the relationship between IPV and postpartum SI. A cross-sectional survey was conducted from October 2015 to January 2016 in the Chandpur District of Bangladesh among 426 new mothers, aged 15 to 49 years, who were in the first 6 months postpartum. Multivariate logistic regression models were used to examine the association between experiencing IPV and postpartum SI, controlling for a range of other known influences. The prevalence of postpartum SI was 30.8%. Accounting the influence of other confounders, the odds of postpartum SI were significantly higher among women who reported physical IPV victimization (adjusted odds ratio: 2.65; 95% confidence interval = 1.36, 5.18) at any point during the first 6 months following childbirth as opposed to those who did not. In addition, postpartum depression increased postpartum SI, while high self-esteem significantly reduced reports of SI. Both postpartum depression and maternal self-esteem notably mediate and moderate the effect of physical IPV after childbirth on postpartum SI. The findings illuminate that IPV victimization after childbirth significantly increases the odds of postpartum SI. This study reinforces the need to detect women with a history of IPV who may be at risk for SI, not only to offer them help and support but also to prevent or reduce SI.
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Teodoro M, de Souza RSB, Martins CDC, Sediyama CYN, Alvares-Teodoro J, Chang OD, Chang EC. Validity of the Frequency of Suicidal Ideation Inventory in Brazilian adults. DEATH STUDIES 2020; 46:1840-1844. [PMID: 32972332 DOI: 10.1080/07481187.2020.1824201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We examined the validity of the Brazilian Frequency of Suicidal Ideation Inventory (FSII-Br), an adaptation of the Frequency of Suicidal Ideation Inventory (FSII), in 946 Brazilian undergraduates. Confirmatory factor analysis of the FSII-Br demonstrated a one-factor model accounting for 62.39% of the variance in FSII-Br scores with a good FIT index. Correlation analyses demonstrated that the FSII-Br was positively correlated with both measures of suicide ideation and suicide risk (viz., depressive symptoms, anxious symptoms, and hopelessness), providing construct validity. Thus, the FSII-Br was found to be a promising tool in assessing suicide risk among Brazilian adults.
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Affiliation(s)
- Maycoln Teodoro
- Department of Psychology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | - Olivia D Chang
- Department of Psychology, University of Michigan, Arbor, Michigan, USA
| | - Edward C Chang
- Department of Psychology, University of Michigan, Arbor, Michigan, USA
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Musyimi CW, Mutiso VN, Nyamai DN, Ebuenyi I, Ndetei DM. Suicidal behavior risks during adolescent pregnancy in a low-resource setting: A qualitative study. PLoS One 2020; 15:e0236269. [PMID: 32697791 PMCID: PMC7375578 DOI: 10.1371/journal.pone.0236269] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Suicide is one of the most common causes of death among female adolescents. A greater risk is seen among adolescent mothers who become pregnant outside marriage and consider suicide as the solution to unresolved problems. We aimed to investigate the factors associated with suicidal behavior among adolescent pregnant mothers in Kenya. Methods A total of 27 Focus Group Discussions (FGDs) and 8 Key Informant Interviews (KIIs) were conducted in a rural setting (Makueni County) in Kenya. The study participants consisted of formal health care workers and informal health care providers (traditional birth attendants and community health workers), adolescent and adult pregnant and post-natal (up to six weeks post-delivery) women including first-time adolescent mothers, and caregivers (husbands and/or mothers-in-law of pregnant women) and local key opinion leaders. The qualitative data was analyzed using Qualitative Solution for Research (QSR) NVivo version 10. Results Five themes associated with suicidal behavior risk among adolescent mothers emerged from this study. These included: (i) poverty, (ii) intimate partner violence (IPV), (iii) family rejection, (iv) social isolation and stigma from the community, and (v) chronic physical illnesses. Low economic status was associated with hopelessness and suicidal ideation. IPV was related to drug abuse (especially alcohol) by the male partner, predisposing the adolescent mothers to suicidal ideation. Rejection by parents and isolation by peers at school; and diagnosis of a chronic illness such as HIV/AIDS were other contributing factors to suicidal behavior in adolescent mothers. Conclusion Improved social relations, economic and health circumstances of adolescent mothers can lead to reduction of suicidal behaviour. Therefore, concerted efforts by stakeholders including family members, community leaders, health care workers and policy makers should explore ways of addressing IPV, economic empowerment and access to youth friendly health care centers for chronic physical illnesses. Prevention strategies should include monitoring for suicidal behavior risks during pregnancy in both community and health care settings. Additionally, utilizing lay workers in conducting dialogue discussions and early screening could address some of the risk factors and reduce pregnancy- related suicide mortality in LMICs.
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Affiliation(s)
| | | | - Darius N. Nyamai
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Ikenna Ebuenyi
- Department of Psychology and Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland
| | - David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- University of Nairobi, Nairobi, Kenya
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Martini J, Bauer M, Lewitzka U, Voss C, Pfennig A, Ritter D, Wittchen HU. Predictors and outcomes of suicidal ideation during peripartum period. J Affect Disord 2019; 257:518-526. [PMID: 31323593 DOI: 10.1016/j.jad.2019.07.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Suicide belongs to the leading causes of maternal perinatal mortality and suicidal ideation is one of the strongest predictors for suicide attempt and completion and thus represents an opportunity for early intervention prior to self and infant harm. This post-hoc analysis aims to investigate predictors of peripartum suicidality (PS) and potential maternal and infant outcomes of PS. METHODS In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) study, n = 306 women were repeatedly examined from early pregnancy until 16 months postpartum using interviews (Composite International Diagnostic Interview for Women) and questionnaires (Edinburgh Postnatal Depression Scale, Brief Symptom Inventory) to obtain sociodemographic, gynecological and offspring characteristics as well as information about PS (thoughts of death/self-harm, suicide plans, suicide attempt). RESULTS PS was indicated by n = 15 women. A stepwise multivariate logistic regression revealed a history of suicide attempt (OR = 17.84, 95%CI: 4.61-69.05), living together with the partner (OR = 0.14, 95%CI: 0.03-0.63), and social support (OR = 0.35, 95%CI: 0.13-0.91) as significant predictors for PS (model fit: AUC = 0.7926). As compared to women with no PS, infants of women with PS presented lower scores in neuropsychological development (p = 0.020). LIMITATIONS This post-hoc analysis was conducted with the aim of generating hypotheses for future research. The small number of women who indicated PS limits the statistical power. CONCLUSION PS is an important perinatal complication that requires clinical attention. Larger prospective studies are warranted to verify the findings. This will lead to improved preventive and therapeutic approaches and a better understanding of the motives behind maternal suicide and infanticide.
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Affiliation(s)
- Julia Martini
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| | - Michael Bauer
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Ute Lewitzka
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Catharina Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
| | - Andrea Pfennig
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Dirk Ritter
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Hans-Ulrich Wittchen
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; Department of Psychiatry & Psychotherapy, Ludwig Maximilans Universitaet Munich, Germany.
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18
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Shephard E, Fatori D, Mauro LR, de Medeiros Filho MV, Hoexter MQ, Chiesa AM, Fracolli LA, Brentani H, Ferraro AA, Nelson CA, Miguel EC, Polanczyk GV. Effects of Maternal Psychopathology and Education Level on Neurocognitive Development in Infants of Adolescent Mothers Living in Poverty in Brazil. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:925-934. [PMID: 31345780 PMCID: PMC6863387 DOI: 10.1016/j.bpsc.2019.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adolescent motherhood remains common in developing countries and is associated with risk factors that adversely impact infant neurodevelopment, including poverty, low maternal education, and increased maternal psychopathology. Yet, no published work has assessed how these factors affect early brain development in developing countries. METHODS This pilot study examined effects of maternal psychopathology and education on early neurocognitive development in a sample of adolescent mothers (N = 50, final n = 31) and their infants living in poverty in São Paulo, Brazil. Maternal symptoms of anxiety, depression, and attention-deficit/hyperactivity disorder and education level were assessed during pregnancy. Infant neurocognitive development was assessed at 6 months of age, with oscillatory power and functional connectivity in the theta (4-6 Hz), alpha (6-9 Hz), and gamma (30-50 Hz) frequencies derived from resting-state electroencephalography; temperament (negative affect, attention, and regulation); and cognitive, language, and motor skills. Cluster-based permutation testing and graph-theoretical methods were used to identify alterations in oscillatory power and connectivity that were associated with maternal psychopathology and education. Correlations between power and connectivity alterations were examined in relation to infants' overt cognitive behavioral abilities. RESULTS Increased maternal anxiety and lower maternal education were associated with weaker oscillatory connectivity in alpha-range networks. Infants with the weakest connectivity in the alpha network associated with maternal anxiety also showed the lowest cognitive ability. Greater maternal anxiety and attention-deficit/hyperactivity disorder were associated with increased absolute and relative theta power. CONCLUSIONS Our findings highlight the importance of addressing maternal psychopathology and improving education in poor adolescent mothers to prevent negative effects on infant neurodevelopment.
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Affiliation(s)
- Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
| | - Daniel Fatori
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Larissa Rezende Mauro
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Marcelo Q Hoexter
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Anna M Chiesa
- School of Nursing, Universidade de São Paulo, São Paulo, Brazil
| | | | - Helena Brentani
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre A Ferraro
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Charles A Nelson
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Graduate School of Education, Harvard University, Cambridge, Massachusetts
| | - Euripedes C Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Suicidalité en période périnatale. Presse Med 2017; 46:565-571. [DOI: 10.1016/j.lpm.2017.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/25/2017] [Accepted: 05/11/2017] [Indexed: 01/23/2023] Open
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20
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Mento C, Le Donne M, Crisafulli S, Rizzo A, Settineri S. BMI at early puerperium: Body image, eating attitudes and mood states. J OBSTET GYNAECOL 2017; 37:428-434. [DOI: 10.1080/01443615.2016.1250727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Carmela Mento
- Department of Neurosciences, University of Messina, Italy
| | - Maria Le Donne
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Messina, Italy
| | | | - Amelia Rizzo
- Psychological Sciences, University of Messina, Italy
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Gressier F, Guillard V, Cazas O, Falissard B, Glangeaud-Freudenthal NMC, Sutter-Dallay AL. Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. J Psychiatr Res 2017; 84:284-291. [PMID: 27810668 DOI: 10.1016/j.jpsychires.2016.10.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 11/18/2022]
Abstract
Suicide is a major public health concern worldwide, and mental disorders have been identified as a main risk factor. Suicide is also one of the leading causes of perinatal maternal mortality, but very few studies have focused on suicide attempts (SA) in the perinatal period. This work aims to assess risk factors associated with SA in pregnancy and in the post-partum period in women with mental health disorders. Women (n = 1439) with psychiatric disorders jointly admitted with their infant to 16 psychiatric Mother-Baby Units over 10 years (2001-2010) were assessed retrospectively for the occurrence of SA in pregnancy or the postpartum period. Multinomial logistic regression was used to explore the independent impact of maternal sociodemographic characteristics, history of childhood maltreatment and abuse, current mental illness and pregnancy data on SA in pregnancy and/or postpartum. One hundred and fifty-four women (11.68%) attempted suicide: 49 in pregnancy (3.71%) and 105 (7.97%) in the post-partum period. SA in pregnancy was related to alcohol use (OR = 2.37[1.02-5.53]; p = 0.04) and smoking during pregnancy (OR = 1.87[1.01-3.49]; p = 0.04) and also to a history of miscarriage (OR = 2.29[1.18-4.41]; p = 0.01). SA in the post-partum period was associated with major depressive episode (OR = 2.72[1.40-5.26]; p = 0.003) or recurrent depression (OR = 4.12[2.25-7.51], p < 0.001) and younger age (OR = 0.96[0.93-0.99], p = 0.03). SAs in the course of pregnancy and the postpartum period have different risk factors. Special attention to risk of suicide is needed during pregnancy for women with severe mental illness and a history of miscarriage, alcohol or cigarette use, young age and depression in the perinatal period.
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Affiliation(s)
- Florence Gressier
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Bicêtre University Hospital, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France.
| | - Virginie Guillard
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Odile Cazas
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Bruno Falissard
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Department of Biostatistics, Maison de Solenn, 97 Bld de Port-Royal, 75679 Paris Cedex 14, France
| | - Nine M-C Glangeaud-Freudenthal
- INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France
| | - Anne-Laure Sutter-Dallay
- Research Center Inserm 1219, Bordeaux Population Health Bordeaux University, University Department of Adult Psychiatry, Charles-Perrens Hospital, 33000 Bordeaux, France
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22
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Supraja TA, Thennarasu K, Satyanarayana VA, Seena TK, Desai G, Jangam KV, Chandra PS. Suicidality in early pregnancy among antepartum mothers in urban India. Arch Womens Ment Health 2016; 19:1101-1108. [PMID: 27565804 DOI: 10.1007/s00737-016-0660-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 08/12/2016] [Indexed: 11/29/2022]
Abstract
This study assessed the prevalence and predictors of suicidality among 462 pregnant women in South India. Women in early pregnancy (<20 weeks) attending an urban public hospital antenatal center were assessed for suicidality using a modified version of the Suicide Behaviors Questionnaire-Revised (SBQR) and a single-item (item 10) from the Edinburgh Postnatal Depression Scale (EPDS). Severity of depressive symptoms, family violence, and perceived social support were also measured. The prevalence of suicidality in pregnancy was 7.6 % (35/462). Eleven women (2.4 %) reported having had suicidal plans, and 8 (1.7 %) had made a suicidal attempt during the current pregnancy. Younger age, belonging to a middle socioeconomic status, poor perceived support, domestic violence, depressive symptoms, and having a past history of suicidality predicted suicidal ideation during the current pregnancy. Multivariate analysis revealed depression severity and a life time history of suicidal ideation as being the strongest predictors. The findings underscore the need for assessment of psychiatric and psychosocial factors that confer risk among women in this vulnerable period. The results of the study however may be specific to low-income urban women from this geographical location limiting the external validity of our findings.
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Affiliation(s)
- T A Supraja
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - K Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Veena A Satyanarayana
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - T K Seena
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Kavita V Jangam
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
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23
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Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry 2016; 3:973-982. [PMID: 27650773 PMCID: PMC5155709 DOI: 10.1016/s2215-0366(16)30284-x] [Citation(s) in RCA: 609] [Impact Index Per Article: 76.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 12/11/2022]
Abstract
Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Marta B Rondon
- Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Ricardo Araya
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michelle A Williams
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
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24
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Zhong QY, Gelaye B, Miller M, Fricchione GL, Cai T, Johnson PA, Henderson DC, Williams MA. Suicidal behavior-related hospitalizations among pregnant women in the USA, 2006-2012. Arch Womens Ment Health 2016; 19:463-72. [PMID: 26680447 PMCID: PMC4871736 DOI: 10.1007/s00737-015-0597-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
Suicide is one of the leading causes of maternal mortality in many countries, but little is known about the epidemiology of suicide and suicidal behavior among pregnant women in the USA. We sought to examine trends and provide nationally representative estimates for suicidal behavior (including suicidal ideation and suicide and self-inflicted injury) among pregnant women from 2006 to 2012 in the USA. Pregnant women aged 12-55 years were identified through pregnancy- and delivery-related hospitalization records from the National (Nationwide) Inpatient Sample. Suicidal behavior was identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Annual, nationwide estimates and trends were determined using discharge and hospital weights. The prevalence of suicidal ideation more than doubled from 2006 to 2012 (47.5 to 115.0 per 100,000 pregnancy- and delivery-related hospitalizations), whereas the prevalence of suicide and self-inflicted injury remained stable. Nearly 10 % of suicidal behavior occurred in the 12-18-year group, showing the highest prevalence per 100,000 pregnancy- and delivery-related hospitalizations (158.8 in 2006 and 308.7 in 2012) over the study period. For suicidal ideation, blacks had higher prevalence than whites; women in the lowest income quartile had the highest prevalence. Although the prevalence of suicidal behavior was higher among hospitalizations with depression diagnoses, more than 30 % of hospitalizations were for suicidal behavior without depression diagnoses. Our findings highlight the increasing burden and racial differences in suicidal ideation among US pregnant women. Targeted suicide prevention efforts are needed for high-risk pregnant women including teens, blacks, and low-income women.
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Affiliation(s)
- Qiu-Yue Zhong
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Matthew Miller
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
,Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Gregory L. Fricchione
- Division of Psychiatry and Medicine, Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tianxi Cai
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Paula A. Johnson
- Mary Horrigan Connors Center for Women’s Health and Gender Biology, Boston, Massachusetts, USA
,Brigham and Women’s Hospital, Division of Women’s Health, Boston, Massachusetts, USA
| | - David C. Henderson
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
,Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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25
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Weng SC, Chang JC, Yeh MK, Wang SM, Chen YH. Factors influencing attempted and completed suicide in postnatal women: A population-based study in Taiwan. Sci Rep 2016; 6:25770. [PMID: 27173845 PMCID: PMC4865942 DOI: 10.1038/srep25770] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/22/2016] [Indexed: 11/27/2022] Open
Abstract
The aims of study were to investigate risk factors associated with attempted and completed suicide. This nested case–control study was conducted using the medical and death data of nearly all pregnant women for the period 2002–2012 in Taiwan. A total of 139 cases of attempted suicide and 95 cases of completed suicide were identified; for each case, 10 controls were randomly selected and matched to the cases according to age and year of delivery. A conditional logistic regression model was used. The mean attempted and completed suicide rates were 9.91 and 6.86 per 100,000 women with live births, respectively. Never having married and postpartum depression also increased the risk of attempted suicide (OR = 2.06; 95% CI = 1.09–3.88 and OR = 2.51; 95% CI = 1.10–5.75, respectively) and completed suicide (OR = 20.27; 95% CI = 8.99–45.73 and OR = 21.72; 95% CI = 8.08–58.37, respectively). Other factors for attempted suicide included being widowed or divorced, and having a caesarean delivery or suicide history. Other factors for completed suicide included lower education level, low infant birth weight, and diagnosis of anxiety or mood disorder. These results suggest that people should appropriately assess potential risk factors and provide assistance for postnatal women to reduce the occurrence of suicide events.
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Affiliation(s)
- Shu-Chuan Weng
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Jung-Chen Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Kung Yeh
- School of Pharmacy, Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Shun-Mu Wang
- Department of Public Health, China Medical University, Taichung, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Department of Health Care Administration, Oriental Institute of Technology, New Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
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26
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Suicidality among pregnant women in Brazil: prevalence and risk factors. Arch Womens Ment Health 2016; 19:343-8. [PMID: 26189445 DOI: 10.1007/s00737-015-0552-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/08/2015] [Indexed: 12/25/2022]
Abstract
Suicide is one of the major causes of preventable death. We evaluated suicidality among pregnant women who participated in prenatal care in Brazil. A total of 255 patients were assessed using semi-structured interviews as well as the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and Mini-International Neuropsychiatric Interview (MINI) Plus. Thereafter, Stata 12 was used to identify the significant predictors of current suicide risk (CSR) among participants using univariate and multivariate analyses (p < 0.05). According to MINI Plus module C, the lifetime suicide attempt rate was 12.55%. The overall CSR was 23.53%, distributed across risk levels of low (12.55%), moderate (1.18%), and high (9.80%). Our rates approximate those found in another Brazilian study (18.4%). Antenatal depression (AD), lifetime bipolar disorder, and any current anxiety disorder (as measured using the MINI) as well as BDI scores ≥15 and EPDS scores ≥11 were identified as positive risk factors in a univariate analysis (p < 0.001). These factors changed after a multivariate analysis was employed, and only years of education [odds ratio (OR) = 0.45; 95% confidence intervals (CIs) = 0.21-0.99], AD (OR = 3.42; 95% CIs = 1.37-8.53), and EPDS scores ≥11 (OR = 4.44; 95% CIs = 1.97-9.97) remained independent risk factors. AD and other psychiatric disorders were the primary risk factors for suicidality, although only the former remained an independent factor after a multivariate analysis. More than 10 years of education and EPDS scores ≥11 were also independent factors; the latter can be used as a screening tool for suicide risk.
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27
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Fletcher TM, Markley LA, Nelson D, Crane SS, Fitzgibbon JJ. Pregnant Adolescents Admitted to an Inpatient Child and Adolescent Psychiatric Unit: An Eight-Year Review. J Pediatr Adolesc Gynecol 2015; 28:477-80. [PMID: 26233293 DOI: 10.1016/j.jpag.2015.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/03/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To assess patient outcomes and describe demographic data of pregnant adolescents admitted to an inpatient child and adolescent psychiatric unit, as well as to determine if it is safe to continue to admit pregnant adolescents to such a unit. DESIGN, SETTING, AND PARTICIPANTS A descriptive retrospective chart review conducted at a free-standing pediatric hospital in northeast Ohio of all pregnant adolescents aged 13 to 17 years admitted to the inpatient child and adolescent psychiatric unit from July 2005 to April 2013. MAIN OUTCOME MEASURES Data collection included details on demographic, pregnancy status, and psychiatric diagnoses. RESULTS Eighteen pregnant adolescents were admitted to the psychiatric unit during the time frame. Sixteen of those were in the first trimester of pregnancy. Pregnancy was found to be a contributing factor to the adolescent's suicidal ideation and admission in 11 of the cases. Admission to an inpatient psychiatric facility did not lead to adverse effects in pregnancy. CONCLUSION Pregnant adolescents did not have negative pregnancy outcomes related to admission to an inpatient psychiatric unit. Results of this study suggest that it is safe to continue to admit uncomplicated pregnant adolescents in their first trimester to an inpatient child and adolescent psychiatric unit for an acute stay.
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Affiliation(s)
- Teresa M Fletcher
- Department of Adolescent Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio.
| | - Laura A Markley
- Department of Psychiatry, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
| | - Dana Nelson
- Department of Maternal Fetal Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
| | - Stephen S Crane
- Department of Maternal Fetal Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
| | - James J Fitzgibbon
- Department of Adolescent Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
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28
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Miller AB, Adams LM, Esposito-Smythers C, Thompson R, Proctor LJ. Parents and friendships: a longitudinal examination of interpersonal mediators of the relationship between child maltreatment and suicidal ideation. Psychiatry Res 2014; 220:998-1006. [PMID: 25454119 PMCID: PMC4312180 DOI: 10.1016/j.psychres.2014.10.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 08/29/2014] [Accepted: 10/05/2014] [Indexed: 01/21/2023]
Abstract
This study examined parental relationship quality, friendship quality, and depression as mediators of the association between child maltreatment (CM) and adolescent suicidal ideation (SI). Participants were 674 adolescents (46% female; 55% African American) involved in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Data were collected via youth self-report at ages 12, 16, and 18. CM before age 12 predicted poor parental relationships and depression, but not poor friendships, at age 16. Age 16 depression was negatively associated with parental relationship quality and positively associated with SI at age 18. An indirect path from CM to SI via depression was significant, suggesting that the early CM affects depression severity, which in turn is associated with SI. Strong friendship quality (age 16) was associated with SI at age 18; however, there was no significant indirect path from CM to SI via friendships. Results suggest that: 1) CM before age 12 affects parental relationships in adolescence; 2) depression and friendships are related to suicide ideation in later adolescence; and 3) depression partially mediates the association between CM and SI. Results highlight the importance of assessing for a history of CM, quality of interpersonal relationships, and depression severity among youth reporting SI.
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Affiliation(s)
- Adam B. Miller
- George Mason University,Correspondence concerning this article should be addressed to Adam B. Miller, Department of Psychology, MS 3F5, George Mason University, Fairfax, VA 22030.
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29
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Psychological health and life experiences of pregnant adolescent mothers in Jamaica. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4729-44. [PMID: 24785743 PMCID: PMC4053888 DOI: 10.3390/ijerph110504729] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/03/2014] [Accepted: 04/17/2014] [Indexed: 11/17/2022]
Abstract
A recent Jamaican school-based survey revealed that 23.1% of 13–15 year-olds, had attempted suicide one or more times during the last 12 months. Research that links adolescent pregnancy and suicidal behaviour is lacking in Jamaica. Psychological distress and suicidal behaviours amongst pregnant adolescents elsewhere in the Americas has been documented at prevalence of between 13.3%–20%. The purpose of the study was to explore the experiences and the impact of pregnancy on pregnant adolescent psychological health. Individual interviews and focus groups were conducted with adolescents in two Jamaican antenatal clinics. One clinic was designed as a ‘Teen Pregnancy Clinic’ and the other used the standard antenatal clinic design. The following themes were identified: decision-making, resilience, social support, community support system, distress, and perceptions of service. Participants reported positively on the specific interventions tailored to their needs at the Teen Clinic. Although motherhood is valued, none of the pregnancies in this study were planned by the mother. Of the 30 adolescents interviewed, seven cases were referred for counseling due to their need for emotional and psychological support. One of the adolescents reported recent sexual violence and another reported having experienced childhood sexual abuse. Historically, Jamaican adolescent mothers faced barriers to education, self determination, and family planning. Empowering, adolescent-centred healthcare and comprehensive reproductive health education may mitigate psychosocial distress.
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30
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Vaz JS, Kac G, Nardi AE, Hibbeln JR. Omega-6 fatty acids and greater likelihood of suicide risk and major depression in early pregnancy. J Affect Disord 2014; 152-154:76-82. [PMID: 23726775 PMCID: PMC4239694 DOI: 10.1016/j.jad.2013.04.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/26/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the prevalence of suicide risk (SR) and major depressive episodes (MDEs) in early pregnancy, as well as the relationship of serum fatty acid status to these outcomes. METHODS Cross-sectional analyses were performed on data from 234 pregnant women enrolled in a prospective cohort study in Rio de Janeiro, Brazil. SR and MDE were defined according to the Mini International Neuropsychiatric Interview. Fatty acid compositions were determined for serum samples obtained between the 6th and 13th gestational week. Fatty acid data were expressed as the percent of total fatty acids, converted to Z scores and then entered as continuous variables in logistic regression models. RESULTS The prevalence of SR was 19.6% and that of MDE was 17.0%. In the adjusted logistic regressions, a higher likelihood of SR was observed among women with higher arachidonic acid levels [AA (20:4, n-6): OR=1.45, 95%CI 1.02-2.07] and adrenic acid levels [AdA (22:4, n-6): OR=1.43, 95%CI 1.01-2.04]. A higher likelihood of MDE was also observed among women with higher AA levels [OR=1.47, 95%CI 1.03-2.10] and AdA levels [OR=1.59, 95%CI 1.09-2.32]. CONCLUSION Higher serum levels of AA and AdA were associated with a greater likelihood of SR and MDE among pregnant Brazilian women.
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Affiliation(s)
- Juliana S. Vaz
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Antonio E. Nardi
- National Institute for Science and Technology - Translational Medicine, Laboratory of Panic and Respiration, Institute of Psychiatry, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Joseph R. Hibbeln
- Section of Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, USA
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Farias DR, Pinto TDJP, Teofilo MMA, Vilela AAF, Vaz JDS, Nardi AE, Kac G. Prevalence of psychiatric disorders in the first trimester of pregnancy and factors associated with current suicide risk. Psychiatry Res 2013; 210:962-8. [PMID: 24090486 DOI: 10.1016/j.psychres.2013.08.053] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 08/06/2013] [Accepted: 08/29/2013] [Indexed: 11/26/2022]
Abstract
This study aimed to describe the prevalence of psychiatric disorders and to identify the factors associated with Current Suicide Risk (CSR) in the first trimester of pregnancy. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was employed to diagnose mental disorders in 239 women enrolled in a prospective cohort in Rio de Janeiro, Brazil. Serum lipids, leptin and socio-economic status were the independent variables. CSR, the dependent variable, was entered as binary (yes/no) variable into crude and adjusted Poisson regression models with robust variances. CSR was found to be the main psychiatric syndrome (18.4%), followed by agoraphobia (17.2%), major depressive disorder (15.1%) and generalized anxiety disorder (10.5%). Women with CSR showed higher mean levels of cholesterol (169.2 vs. 159.2; p=0.017), high density lipoprotein (50.4 vs. 47.7; p=0.031) and low density lipoprotein (102.8 vs. 95.6; p=0.022) when compared to women without CSR. The adjusted regression model showed a higher prevalence ratio (PR) of CSR among pregnant women with generalized anxiety disorder (PR=2.70, 95% CI: 1.36-5.37), with ≥ two parturitions (PR=2.46, 95% CI: 1.22-4.93), and with major depressive disorder (PR=2.11, 95% CI: 1.08-4.12). We have shown that generalized anxiety disorder, major depressive disorder and higher parity are associated with CSR in the first trimester of pregnancy.
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Affiliation(s)
- Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, RJ, Brazil; Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, RJ, Brazil
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32
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Mendez-Bustos P, Lopez-Castroman J, Baca-García E, Ceverino A. Life cycle and suicidal behavior among women. ScientificWorldJournal 2013; 2013:485851. [PMID: 23533350 PMCID: PMC3603326 DOI: 10.1155/2013/485851] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/23/2013] [Indexed: 11/17/2022] Open
Abstract
It is nowadays accepted that, independently of methodological issues, women commit fewer suicides than men but make more frequent attempts. Yet, female suicidal risk varies greatly along the lifetime and is linked to the most significant moments in it. A wide analysis of the existing literature was performed to provide a narrative description on the evolution of female suicidal rates from childhood to old age, considering the milestones in their life history. A detailed analysis of gender differences in suicidal behavior is key to establish preventive measures and priorities. More specific studies are needed to adapt future interventions on female suicide.
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Affiliation(s)
- Pablo Mendez-Bustos
- Department of Psychology, Catholic University of Maule, Avenida San Miguel 3605, Talca, Chile
| | - Jorge Lopez-Castroman
- Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Autonoma University, CIBERSAM Avenida Reyes Catolicos 2, 28040 Madrid, Spain
| | - Enrique Baca-García
- Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Autonoma University, CIBERSAM Avenida Reyes Catolicos 2, 28040 Madrid, Spain
- Department of Psychiatry, New York State Psychiatric Institute Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
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