美国是发达国家中孕产妇死亡率最高的国家。疾病控制和预防中心认为几乎所有这些死亡都是可以预防的,尤其是那些归因于精神健康状况的人。美国医疗保健和社会服务系统之间的协调可以帮助进一步描述与围产期自杀死亡率相关的情况和风险。
■检查与围产期自杀相关的背景和个体诱发情况和风险。
■这项横断面观察性研究使用了融合的混合方法设计,以探索导致孕产妇自杀和未确定意图死亡的因素(以下简称,未确定的死亡)在2003年1月1日至2021年12月31日的国家暴力死亡报告系统(NVDRS)数据中确定。分析包括10至50岁的死者,怀孕或产后死亡(统称,围产期组)和人口统计上匹配的女性死者,他们在死亡时未怀孕或最近怀孕(非围生期组)。在2022年12月至2023年12月之间进行了分析。
■死亡时的妊娠状态(围产期或非围产期)。
■主要结果包括死因裁判官中提到的与自杀和未确定死亡有关的促成情况,验尸官,或执法案件叙述。该研究使用匹配分析检查了组间的数量差异,并使用定性内容分析表征了突出自杀情况的关键主题。
■这项研究包括在NVDRS中确定的1150个围产期死者:456(39.6%)在死亡时怀孕,203人(17.7%)在死亡后42天内怀孕,491人(42.7%)在死前43至365天内怀孕,产生694名产后死者。非围产期对照组包括17655名10至50岁的女性死者。围产期死者的平均年龄(SD)为29.1(7.4)岁,非围产期死者的平均年龄为35.8(10.8)岁。与匹配的非围生儿相比,围产期死者在以下确定的促成情况中的几率更高:亲密伴侣问题(IPP)(优势比[OR],1.45[95%CI,1.23-1.72]),最近的论点(或,1.33[95%CI,1.09-1.61]),情绪低落(或,1.39[95%CI,1.19-1.63]),药物滥用或其他滥用(OR,1.21[95%CI,1.03-1.42]),身体健康问题(或,1.37[95%CI,1.09-1.72]),以及家庭成员或朋友的死亡(或,1.47[95%CI,1.06-2.02])。定性分析的结果强调了心理健康的重要性,并确定了128名患有产后抑郁症的死者(12.4%)。
■这项研究提供了有关孕产妇自杀的复杂因素的见解,它强调了进一步研究以了解围产期心理健康的长期后果的机会。这些发现还强调了有针对性的循证干预措施和针对精神卫生的有效政策的必要性,物质使用,和IPP,以防止产妇自杀和改善产妇健康结果。
UNASSIGNED: The US has the highest maternal mortality rate among developed countries. The Centers for Disease Control and Prevention deems nearly all of these deaths preventable, especially those attributable to mental health conditions. Coordination between US health care and social service systems could help further characterize circumstances and risks associated with perinatal suicide mortality.
UNASSIGNED: To examine contextual and individual precipitating circumstances and risks associated with perinatal suicide.
UNASSIGNED: This cross-sectional observational study used a convergent mixed methods design to explore factors contributing to maternal suicides and deaths of undetermined intent (hereinafter, undetermined deaths) identified in National Violent Death Reporting System (NVDRS) data for January 1, 2003, to December 31, 2021. Analyses included decedents who were aged 10 to 50 years and pregnant or post partum at death (collectively, the perinatal group) and demographically matched female decedents who were not pregnant or recently pregnant (nonperinatal group) at death. Analyses were performed between December 2022 and December 2023.
UNASSIGNED: Pregnancy status at death (perinatal or nonperinatal).
UNASSIGNED: The main outcomes included contributing circumstances associated with suicides and undetermined deaths cited in coroner, medical examiner, or law enforcement case narratives. The study examined quantitative differences between groups using a matched analysis and characterized key themes of salient suicide circumstances using qualitative content analysis.
UNASSIGNED: This study included 1150 perinatal decedents identified in the NVDRS: 456 (39.6%) were pregnant at death, 203 (17.7%) were pregnant within 42 days of death, and 491 (42.7%) were pregnant within 43 to 365 days before death, yielding 694 postpartum decedents. The nonperinatal comparison group included 17 655 female decedents aged 10 to 50 years. The mean (SD) age was 29.1 (7.4) years for perinatal decedents and 35.8 (10.8) years for nonperinatal decedents. Compared with matched nonperinatal decedents, perinatal decedents had higher odds of the following identified contributing circumstances: intimate partner problems (IPPs) (odds ratio [OR], 1.45 [95% CI, 1.23-1.72]), recent argument (OR, 1.33 [95% CI, 1.09-1.61]), depressed mood (OR, 1.39 [95% CI, 1.19-1.63]), substance abuse or other abuse (OR, 1.21 [95% CI, 1.03-1.42]), physical health problems (OR, 1.37 [95% CI, 1.09-1.72]), and death of a family member or friend (OR, 1.47 [95% CI, 1.06-2.02]). The findings of the qualitative analysis emphasized the importance of mental health and identified 128 decedents (12.4%) with postpartum depression.
UNASSIGNED: This study provides insights into complex factors surrounding maternal suicide, and it highlights opportunities for further research to understand long-term consequences of perinatal mental health. These findings also underscore the need for targeted evidence-based interventions and effective policies targeting mental health, substance use, and IPPs to prevent maternal suicide and enhance maternal health outcomes.