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Esscher A, Essén B, Innala E, Papadopoulos FC, Skalkidou A, Sundström-Poromaa I, Högberg U. Suicides during pregnancy and 1 year postpartum in Sweden, 1980-2007. Br J Psychiatry 2016; 208:462-9. [PMID: 26494874 DOI: 10.1192/bjp.bp.114.161711] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 02/05/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although the incidence of suicide among women who have given birth during the past 12 months is lower than that of women who have not given birth, suicide remains one of the most common causes of death during the year following delivery in high-income countries, such as Sweden. AIMS To characterise women who died by suicide during pregnancy and postpartum from a maternal care perspective. METHOD We traced deaths (n = 103) through linkage of the Swedish Cause of Death Register with the Medical Birth and National Patient Registers. We analysed register data and obstetric medical records. RESULTS The maternal suicide ratio was 3.7 per 100 000 live births for the period 1980-2007, with small magnitude variation over time. The suicide ratio was higher in women born in low-income countries (odds ratio 3.1 (95% CI 1.3-7.7)). Violent suicide methods were common, especially during the first 6 months postpartum. In all, 77 women had received psychiatric care at some point, but 26 women had no documented psychiatric care. Antenatal documentation of psychiatric history was inconsistent. At postpartum discharge, only 20 women had a plan for psychiatric follow-up. CONCLUSIONS Suicide prevention calls for increased clinical awareness and cross-disciplinary maternal care approaches to identify and support women at risk.
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Affiliation(s)
- Annika Esscher
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Birgitta Essén
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Eva Innala
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Fotios C Papadopoulos
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Alkistis Skalkidou
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Inger Sundström-Poromaa
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Ulf Högberg
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
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Holtzman JN, Miller S, Hooshmand F, Wang PW, Chang KD, Goffin KC, Hill SJ, Ketter TA, Rasgon NL. Gender by onset age interaction may characterize distinct phenotypic subgroups in bipolar patients. J Psychiatr Res 2016; 76:128-35. [PMID: 26926801 DOI: 10.1016/j.jpsychires.2016.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/11/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although bipolar disorder (BD) is a common recurrent condition with highly heterogeneous illness course, data are limited regarding clinical implications of interactions between gender and onset age. We assessed relationships between onset age and demographic/illness characteristics among BD patients stratified by gender. METHODS Demographic and unfavorable illness characteristics, descriptive traits, and clinical correlates were compared in 502 patients from Stanford University BD Clinic patients enrolled in the Systematic Treatment Enhancement Program for BD between 2000 and 2011, stratified by gender, across pre-, peri-, and post-pubertal (<12, 13-16, and >17 years, respectively) onset-age subgroups. RESULTS Among 502 BD patients, 58.2% were female, of whom 21.9% had pre-pubertal, 30.7% peri-pubertal, and 47.4% post-pubertal onset. Between genders, although demographics, descriptive characteristics, and most clinical correlates were statistically similar, there were distinctive onset-age related patterns of unfavorable illness characteristics. Among females, rates of 6/8 primary unfavorable illness characteristics were significantly higher in pre-pubertal and peri-pubertal compared to post-pubertal onset patients. However, among males, rates of only 3/8 unfavorable illness characteristics were significantly higher in only pre-pubertal versus post-pubertal onset patients, and none between peri-pubertal versus post-pubertal onset patients. LIMITATIONS Caucasian, insured, suburban, American specialty clinic-referred sample limits generalizability, onset age based on retrospective recall. DISCUSSION We describe different phenotypic presentations across age at illness onset groups according to gender. Among females and males, peri-pubertal and post-pubertal onset age groups were more different and more similar, respectively. Further investigation is warranted to assess implications of gender-by-onset-age interactions to more accurately delineate distinctive BD phenotypes.
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Affiliation(s)
- Jessica N Holtzman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Shefali Miller
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Farnaz Hooshmand
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Po W Wang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kiki D Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kathryn C Goffin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Shelley J Hill
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Natalie L Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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Vega P, Barbeito S, de Azúa SR, Martínez-Cengotitabengoa M, González–Ortega I, Saenz M, González-Pinto A. Bipolar Disorder Differences between Genders: Special Considerations for Women. WOMENS HEALTH 2011; 7:663-74; quiz 675-6. [DOI: 10.2217/whe.11.71] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The objective of this article is to review clinical differences between men and women with bipolar disorder. The secondary objective is to analyze the differences in adherence to medication between genders. Men usually present with manic episodes and have comorbid drug abuse, while women usually present with major depressive episode, the onset is often later, comorbidity of physical pathology is common and adherence to medication is greater than in men. In women who have an earlier onset of the illness and are single, the risk of nonadherence is higher than in other groups of women. There are two time periods that are very important in women: pregnancy and postpartum. Both are critical periods and a relapse or recurrence of symptoms at either stage can have serious consequences for the woman and/or her baby. In addition, the effect of medication on the fetus is unclear. In conclusion, there is a clear need for more studies on gender differences in bipolar disorder and how to improve adherence to treatment. Moreover, a better understanding of how to treat women with bipolar disorder during pregnancy and lactation will undoubtedly lead to improved outcomes for both the mother and her child.
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Affiliation(s)
- Patricia Vega
- Department of Psychiatry, Hospital Santiago Apóstol, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of the Basque Country Olaguibel 29, 01004 Vitoria, Spain
| | - Sara Barbeito
- Department of Psychiatry, Hospital Santiago Apóstol, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of the Basque Country Olaguibel 29, 01004 Vitoria, Spain
| | - Sonia Ruiz de Azúa
- Department of Psychiatry, Hospital Santiago Apóstol, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of the Basque Country Olaguibel 29, 01004 Vitoria, Spain
| | - Mónica Martínez-Cengotitabengoa
- Department of Psychiatry, Hospital Santiago Apóstol, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of the Basque Country Olaguibel 29, 01004 Vitoria, Spain
| | - Itxaso González–Ortega
- Department of Psychiatry, Hospital Santiago Apóstol, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of the Basque Country Olaguibel 29, 01004 Vitoria, Spain
| | - Margarita Saenz
- Department of Psychiatry, Hospital Santiago Apóstol, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of the Basque Country Olaguibel 29, 01004 Vitoria, Spain
| | - Ana González-Pinto
- Department of Psychiatry, Hospital Santiago Apóstol, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of the Basque Country Olaguibel 29, 01004 Vitoria, Spain
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