Suicides during pregnancy and 1 year postpartum in Sweden, 1980-2007.
Although the incidence of suicide among women who have given birth during the past 12 months is lower than that of women who have not given birth, suicide remains one of the most common causes of death during the year following delivery in high-income countries, such as Sweden.



To characterise women who died by suicide during pregnancy and postpartum from a maternal care perspective.



We traced deaths (n = 103) through linkage of the Swedish Cause of Death Register with the Medical Birth and National Patient Registers. We analysed register data and obstetric medical records.



The maternal suicide ratio was 3.7 per 100 000 live births for the period 1980-2007, with small magnitude variation over time. The suicide ratio was higher in women born in low-income countries (odds ratio 3.1 (95% CI 1.3-7.7)). Violent suicide methods were common, especially during the first 6 months postpartum. In all, 77 women had received psychiatric care at some point, but 26 women had no documented psychiatric care. Antenatal documentation of psychiatric history was inconsistent. At postpartum discharge, only 20 women had a plan for psychiatric follow-up.



Suicide prevention calls for increased clinical awareness and cross-disciplinary maternal care approaches to identify and support women at risk.
Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden annika.esscher@kbh.uu.se.
Annika
A
Esscher
Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
Birgitta
B
Essén
Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
Eva
E
Innala
Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
Fotios C
FC
Papadopoulos
Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
Alkistis
A
Skalkidou
Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
Inger
I
Sundström-Poromaa
Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
Ulf
U
Högberg
D000328:Adult; D002423:Cause of Death; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011644:Puerperal Disorders / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data*; D013405:Suicide / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult