Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
JAMA Psychiatry. 2021 Feb 1;78(2):171-176. doi: 10.1001/jamapsychiatry.2020.3550.
Suicide deaths are a leading cause of maternal mortality in the US, yet the prevalence and trends in suicidality (suicidal ideation and/or intentional self-harm) among childbearing individuals remain poorly described.
To characterize trends in suicidality among childbearing individuals.
DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study analyzed data from a medical claims database for a large commercially insured population in the US from January 2006 to December 2017. There were 2714 diagnoses of suicidality 1 year before or after 698 239 deliveries among 595 237 individuals aged 15 to 44 years who were continuously enrolled in a single commercial health insurance plan. Data were analyzed from October 2019 to September 2020.
The primary outcome was diagnosis of suicidality in childbearing individuals 1 year before or after birth based on the identification of relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes during at least 1 inpatient or 2 outpatient visits.
Of 595 237 included childbearing individuals, the mean (SD) age at delivery was 31.9 (6.4) years. A total of 40 568 individuals (6.8%) were Asian, 52 613 (8.6%) were Black, 73 172 (12.1%) were Hispanic, 369 501 (63.1%) were White, and 59 383 (9.5%) had unknown or missing race/ethnicity data. A total of 2683 individuals were diagnosed with suicidality 1 year before or after giving birth for a total of 2714 diagnoses. The prevalence of suicidal ideation increased from 0.1% per 100 individuals in 2006 to 0.5% per 100 individuals in 2017 (difference, 0.4%; SE, 0.03; P < .001). Intentional self-harm prevalence increased from 0.1% per 100 individuals in 2006 to 0.2% per 100 individuals in 2017 (difference, 0.1%; SE, 0.02; P < .001). Suicidality prevalence increased from 0.2% per 100 individuals in 2006 to 0.6% per 100 individuals in 2017 (difference, 0.4%; SE, 0.04; P < .001). Diagnoses of suicidality with comorbid depression or anxiety increased from 1.2% per 100 individuals in 2006 to 2.6% per 100 individuals in 2017 (difference, 1.4%; SE, 0.2; P < .001). Diagnoses of suicidality with comorbid bipolar or psychotic disorders increased from 6.9% per 100 individuals in 2006 to 16.9% per 100 individuals in 2017 (difference, 10.1%; SE, 0.2; P < .001). Non-Hispanic Black individuals, individuals with lower income, and younger individuals experienced larger increases in suicidality over the study period.
In this cross-sectional study of US childbearing individuals, the prevalence of suicidal ideation and intentional self-harm occurring in the year preceding or following birth increased substantially over a 12-year period. Policy makers, health plans, and clinicians should ensure access to universal suicidality screening and appropriate treatment for pregnant and postpartum individuals and seek health system and policy avenues to mitigate this growing public health crisis, particularly for high-risk groups.
在美国，自杀死亡是孕产妇死亡的一个主要原因，但围产期个体的自杀意念（自杀意念和/或故意自残）的流行程度和趋势仍描述不足。
描述围产期个体自杀意念的趋势。
设计、地点和参与者：本研究采用美国一家大型商业保险人群的医疗索赔数据库进行了一项连续的横断面研究，从 2006 年 1 月至 2017 年 12 月期间对 595237 名年龄在 15 至 44 岁之间、连续参加单一商业健康保险计划的个体进行了 698239 次分娩前后一年的自杀意念诊断分析。数据分析于 2019 年 10 月至 2020 年 9 月进行。
主要结局是基于至少 1 次住院或 2 次门诊就诊期间识别到相关的国际疾病分类，第九版临床修正（ICD-9-CM）和 ICD-10-CM 诊断代码，确定分娩前后一年儿童期个体的自杀意念诊断。
在纳入的 595237 名围产期个体中，分娩时的平均（SD）年龄为 31.9（6.4）岁。共有 40568 名（6.8%）个体为亚洲人，52613 名（8.6%）为黑人，73172 名（12.1%）为西班牙裔，369501 名（63.1%）为白人，59383 名（9.5%）为种族/民族数据未知或缺失。共有 2683 名个体在分娩前后一年内被诊断为自杀意念，共诊断出 2714 例。自杀意念的患病率从 2006 年的每 100 人 0.1%上升到 2017 年的每 100 人 0.5%（差异，0.4%；SE，0.03；P<.001）。自伤的患病率从 2006 年的每 100 人 0.1%上升到 2017 年的每 100 人 0.2%（差异，0.1%；SE，0.02；P<.001）。自杀意念的患病率从 2006 年的每 100 人 0.2%上升到 2017 年的每 100 人 0.6%（差异，0.4%；SE，0.04；P<.001）。伴有抑郁或焦虑共病的自杀意念诊断从 2006 年的每 100 人 1.2%上升到 2017 年的每 100 人 2.6%（差异，1.4%；SE，0.2；P<.001）。伴有双相或精神病共病的自杀意念诊断从 2006 年的每 100 人 6.9%上升到 2017 年的每 100 人 16.9%（差异，10.1%；SE，0.2；P<.001）。非西班牙裔黑人个体、收入较低的个体和年轻个体在研究期间自杀意念的增加幅度更大。
在这项对美国围产期个体的横断面研究中，分娩前或后一年发生自杀意念和故意自残的流行率在 12 年内大幅上升。政策制定者、健康计划和临床医生应确保为孕妇和产后个体提供普遍的自杀意念筛查和适当的治疗，并寻求卫生系统和政策途径，以减轻这一日益严重的公共卫生危机，特别是对高风险群体。
