Do stillbirth, miscarriage, and termination of pregnancy increase risks of attempted and completed suicide within a year? A population‐based nested case–control study

• Published in: BJOG : an international journal of obstetrics and gynaecology 2018-07, Vol.125 (8), p.983-990
• Main Authors: Weng, S‐C, Chang, J‐C, Yeh, M‐K, Wang, S‐M, Lee, C‐S, Chen, Y‐H
• Format: Article
• Language: English
• Subjects: Abortion, Induced - psychology; Abortion, Spontaneous - psychology; Attempted suicide; Case-Control Studies; completed suicide; Female; Fetuses; Health risk assessment; Humans; Live Birth - psychology; Logistic Models; Miscarriage; Odds Ratio; Population-based studies; Pregnancy; Registries; Risk Factors; Stillbirth; Stillbirth - psychology; Suicide; Suicide - psychology; Suicide - statistics & numerical data; Suicide, Attempted - psychology; Suicide, Attempted - statistics & numerical data; Suicides & suicide attempts; Taiwan - epidemiology; termination of pregnancy
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.15105

Objective To investigate the risks of attempted and completed suicide in women who experienced a stillbirth, miscarriage, or termination of pregnancy within 1 year postnatally and compare this risk with that in women who experienced a live birth. Design A nested case–control study. Setting Linking three nationwide population‐based data sets in Taiwan: the National Health Insurance Research Database, the National Birth Registry and the National Death Registry. Sample In all, 485 and 350 cases of attempted and completed suicide, respectively, were identified during 2001–11; for each case, ten controls were randomly selected and matched to the cases according to the age and year of delivery. Methods Conditional logistic regression. Main outcome measures Attempted and completed suicidal statuses were determined. Results The rates of attempted suicide increased in the women who experienced fetal loss. The risk of completed suicide was higher in women who experienced a stillbirth [adjusted odds ratio (aOR) 5.2; 95% CI 1.77–15.32], miscarriage (aOR 3.81; 95% CI 2.81–5.15), or termination of pregnancy (aOR 3.12; 95% CI 1.77–5.5) than in those who had a live birth. Furthermore, the risk of attempted suicide was significantly higher in women who experienced a miscarriage (aOR 2.1; 95% CI 1.66–2.65) or termination of pregnancy (aOR 2.5; 95% CI 1.63–3.82). In addition to marital and educational statuses, psychological illness increased the risk of suicidal behaviour. Conclusions The risk of suicide might increase in women who experience fetal loss within 1 year postnatally. Healthcare professionals and family members should enhance their sensitivity to care for possible mental distress, particularly for women who have experienced a stillbirth. Tweetable Suicide risk increased in women who had a stillbirth, miscarriage, or termination of pregnancy within 1 year postnatally. Tweetable Suicide risk increased in women who had a stillbirth or abortion within 1 year postnatally.