Suicide is a leading cause of pregnancy-related deaths in the USA, and new research shows that the number of people having suicidal thoughts after giving birth increased from 2006 to 2017, the biggest spikes among people who are Black, lower income or younger.
The study, published Wednesday in the journal JAMA Psychiatry, looked at almost 600,000 privately insured people. Researchers analyzed the data to track cases of suicidality – suicidal ideation and deliberate self-harm – within a year either before or after giving birth.
From 2006 to 2017, suicidality diagnoses increased from 0.2% per 100 people to 0.6% per 100. In the same period, cases of self-harm went up from 0.1% per 100 in 2006 to 0.2% per 100 in 2017. When applied to the approximately 4 million births each year, that means an increase in tens of thousands of suicidal cases and self-harm.
“Suicidality is something we don’t think about or talk about as much, and it’s a lot more common than I had realized,” said Kara Zivin, a professor at the University of Michigan and the paper’s senior author.
Zivin pursued the research based on her own experience – 10 years ago, after giving birth to her son, her postpartum depression made her suicidal. She said she wants to shine light on an under-discussed topic in public health that has profound consequences.
The U.S. rate of pregnancy-related deaths is higher than any other wealthy nation. According to a report by the federal Centers for Disease Control and Prevention in 2017, suicide accounted for about 6.5% of all pregnancy-related deaths.
It’s not clear what is behind the trend, though the researchers said it’s probably a combination of doctors more often catching cases of suicidality – which is typically under-diagnosed – and the problem growing more common.
Zivin said the study makes a strong case for policy interventions that ensure people can access mental health care during and after pregnancy. People who have Medicaid as their insurance when pregnant will lose that eligibility after 60 days post-birth in most states – even though suicide a year after giving birth is still considered pregnancy-related. Zivin suggested states or the federal government could extend Medicaid to guarantee insurance for a year postpartum, making sure people can see mental health specialists.
The study found that Black people experienced the largest increase in perinatal suicidality of any single racial group – increasing from 0.2% per 100 in 2006 to 0.9% in 2017. The nation’s pregnancy-related death rate is far higher for Black people than for white people.
That’s probably an undercount of the gap, said Katy Kozhimannil, an associate professor at the University of Minnesota and director of its rural health research center. Black women are disproportionately covered through Medicaid, not private insurance. (Kozhimannil was not involved in the study.)
The study authors said it’s not clear why Black people experienced such a dramatic increase in diagnoses. Experiences of racism have been linked to physical stress and mental illness symptoms, Kozhimannil noted. She said the data emphasizes why health policymakers need to emphasize the impact of systemic racism when crafting pregnancy-related health interventions.
“It’s not about race, it’s about racism,” she said. “Thinking about it in that way would point to the common root and might get us in policy discussions further toward valuing the health of Black people in pregnancy.”
Experts said pregnancy-related suicide is a problem that is likely to grow, especially in the wake of the COVID-19 pandemic, which has added new strains to perinatal mental health.
They sounded the alarm about a potential spike in suicides. That’s especially a concern for people who have access to firearms, Kozhimannil said; the majority of gun deaths each year are suicides. More women are buying firearms for the first time.
“This is more important than ever in the COVID-19 era,” said Lindsay Admon, an OB-GYN at the University of Michigan and the study’s lead author. “The postpartum isolation people feel will have been compounded by this epidemic.”
The study looked only at people with private insurance, who tend to be wealthier. It does not include the almost half of all American births insured through Medicaid, which covers lower-income people. People on Medicaid are more likely to experience external stressors that can trigger symptoms of depression and anxiety, and more likely not to have a doctor diagnose or help them access treatment.
The study tracked official diagnoses.
“It shows a big problem and probably undercounts the magnitude of the problem and the magnitude of the potential disparity,” Kozhimannil said.
This story was published in partnership with The 19th, a nonprofit, nonpartisan newsroom reporting on gender, politics and policy.
If you or a loved one are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 74174.
This article originally appeared on USA TODAY: Study finds spike in suicidal thoughts, self-harm during, after pregnancy