Goldman-Mellor Sidra, Olfson Mark, Gemmill Alison, Margerison Claire
Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California.
Health Sciences Research Institute, University of California, Merced, California.
J Clin Psychiatry. 2025 Mar 5;86(2):24m15633. doi: 10.4088/JCP.24m15633.
In the United States, suicide accounts for 1 out of every 20 deaths that occur during pregnancy and the first 12 months postpartum. Although nonfatal suicide attempts are the strongest known predictor of death by suicide, there are no prior population based estimates of the incidence of and clinical risk factors for pregnancy associated suicide attempts. This retrospective cohort study used statewide, all-payer, longitudinally linked hospital and emergency department (ED) patient records from California. Participants included all California residents with an index hospital delivery of a live infant between 2010 and 2020. Outcomes included ED presentation for nonfatal suicide attempt during pregnancy or up to 12 months postpartum. Clinical risk factors of interest included healthcare utilization patterns during pregnancy and behavioral health diagnoses recorded at index delivery. Among delivering patients with an index delivery (N = 3,737,792), 0.13% (n = 4,968) had a suicide attempt during pregnancy or the postpartum period. After adjusting for background demographic characteristics, risks of a postpartum suicide attempt were increased 4- to 30-fold by several clinical factors, including prenatal suicide attempt ED visits, psychiatric ED visits, and assault ED visits, and by psychotic disorders, bipolar disorder, alcohol use disorder, recurrent and single-episode major depressive disorder, and anxiety disorders recorded at delivery. Risks of postpartum suicide attempt were substantially elevated for patients who had behavioral health related ED visits during pregnancy and by several psychiatric disorders at delivery. Clinical consideration should be given to monitoring these patients for suicide attempt risk.
在美国，自杀占孕期及产后头12个月发生的每20例死亡中的1例。尽管非致命自杀未遂是已知最强的自杀死亡预测因素，但此前尚无基于人群的孕期相关自杀未遂发生率及临床风险因素的估计。这项回顾性队列研究使用了加利福尼亚州全州范围内、所有付费方、纵向关联的医院和急诊科（ED）患者记录。参与者包括2010年至2020年间在加利福尼亚州有过活产婴儿的首次住院分娩的所有居民。结局包括孕期或产后长达12个月内因非致命自杀未遂到急诊科就诊。感兴趣的临床风险因素包括孕期的医疗保健利用模式以及首次分娩时记录的行为健康诊断。在有首次分娩记录的分娩患者中（N = 3,737,792），0.13%（n = 4,968）在孕期或产后有过自杀未遂。在调整了背景人口统计学特征后，几种临床因素使产后自杀未遂风险增加了4至30倍，这些因素包括产前自杀未遂到急诊科就诊、精神科急诊科就诊和攻击伤急诊科就诊，以及首次分娩时记录的精神分裂症、双相情感障碍、酒精使用障碍、复发性和单次发作的重度抑郁症和焦虑症。孕期有行为健康相关急诊科就诊以及首次分娩时有几种精神疾病的患者产后自杀未遂风险大幅升高。应从临床角度考虑对这些患者进行自杀未遂风险监测。
