Study data published in JAMA Psychiatry outline trends in suicidality among childbearing individuals in the United States. In a 12-year study that followed commercially insured individuals in the year immediately preceding and immediately following childbirth, the prevalence of suicidal ideation and intentional self-harm increased significantly. These results emphasize the necessity of mental health screening and resources for pregnant and postpartum individuals.
Investigators extracted medical claims data from Optum Clinformatics Data Mart, a commercial insurance database with national coverage. Standardized International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis and procedure codes were used to identify hospital deliveries that took place between January 2006 and December 2017. Demographic and clinical characteristics were extracted from each hospital delivery claim.
The outcome of interest was suicidality, defined as a diagnosis of suicidal ideation and/or intentional self-harm occurring in either 2 outpatient visits or 1 inpatient visit. Generalized estimating equations were used to assess changes in suicidality between 2006 and 2017 in both the overall sample and in subgroups defined by demographic characteristics and psychiatric comorbidities.
The study sample included 698,239 deliveries among 595,237 commercially insured individuals. Mean age at delivery was 31.9 ± 6.4 years. The majority of patients were White (63.1%); 12.1% were Hispanic; 8.6% were Black; 6.8% were Asian; and 9.5% had unknown or missing race/ethnicity data. 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%; P <.001). The prevalence of intentional self-harm increased from 0.1% per 100 individuals in 2006 to 0.2% per 100 individuals in 2017 (difference, 0.1%; P <.001). Suicidality prevalence increased from 0.2% per 100 individuals in 2006 to 0.6% per 100 individuals in 2017 (difference, 0.4%; P <.001).
In subgroup analyses, suicidality was more prevalent among patients with comorbid psychiatric disorders. Suicidality among these diagnostic groups also increased over time. Among patients with comorbid anxiety or depression, the prevalence of suicidality increased from 1.2% per 100 individuals in 2006 to 2.6% per 100 individuals in 2017 (difference, 1.4%; P <.001). Among patients with comorbid bipolar or psychotic disorders, suicidality diagnoses increased from 6.9% to 16.9% per 100 individuals between 2007 and 2016 (difference, 10.1%; P <.001).
Suicidality also increased over time in nearly all demographic subgroups. The most pronounced increases in suicidality by racial/ethnic group were observed among non-Hispanic Black individuals, from 0.2% per 100 individuals in 2006 to 0.9% per 100 individuals in 2017 (difference, 0.7%; P <.001). Diagnoses of suicidality also increased significantly among patients with low income (+0.6% per 100 people; P <.001) and patients between the ages of 15 and 18 years (+7.9%; P <.001).
These results underline the growing burden of suicidality among childbearing individuals in the United States. However, it remains unclear whether this trend is related to increased disease burden or better disease detection. As study limitations, investigators noted that results may not be generalizable to patients without insurance or with non-commercial insurance. In fact, the risk of suicidality among Medicaid populations is estimated to be higher, given the greater prevalence of many risk factors. Additionally, the use of medical claims data prevented assertion of family history, which is known to affect mental health and suicidality.
“In this cross-sectional study of US childbearing individuals, identification of suicidal ideation and intentional self-harm occurring in the year preceding or following birth increased substantially over the 12-year study period,” the investigators wrote. “[P]olicy 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 public health crisis, particularly for high-risk groups.”
Admon LK, Dalton VK, Kolenic GE, et al. Trends in suicidality 1 year before and after birth among commercially insured childbearing individuals in the United States, 2006-2017. JAMA Psychiatry. Published online November 18, 2020. doi:10.1001/jamapsychiatry.2020.3550