title: Suicidal behavior-related hospitalizations among pregnant women in the USA, 2006-2012.
abstract: Suicide is one of the leading causes of maternal mortality in many countries, but little is known about the epidemiology of suicide and suicidal behavior among pregnant women in the USA. We sought to examine trends and provide nationally representative estimates for suicidal behavior (including suicidal ideation and suicide and self-inflicted injury) among pregnant women from 2006 to 2012 in the USA. Pregnant women aged 12-55 years were identified through pregnancy- and delivery-related hospitalization records from the National (Nationwide) Inpatient Sample. Suicidal behavior was identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Annual, nationwide estimates and trends were determined using discharge and hospital weights. The prevalence of suicidal ideation more than doubled from 2006 to 2012 (47.5 to 115.0 per 100,000 pregnancy- and delivery-related hospitalizations), whereas the prevalence of suicide and self-inflicted injury remained stable. Nearly 10 % of suicidal behavior occurred in the 12-18-year group, showing the highest prevalence per 100,000 pregnancy- and delivery-related hospitalizations (158.8 in 2006 and 308.7 in 2012) over the study period. For suicidal ideation, blacks had higher prevalence than whites; women in the lowest income quartile had the highest prevalence. Although the prevalence of suicidal behavior was higher among hospitalizations with depression diagnoses, more than 30 % of hospitalizations were for suicidal behavior without depression diagnoses. Our findings highlight the increasing burden and racial differences in suicidal ideation among US pregnant women. Targeted suicide prevention efforts are needed for high-risk pregnant women including teens, blacks, and low-income women.
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. qyzhong@mail.harvard.edu.
authors.forename: Qiu-Yue
authors.initials: QY
authors.lastname: Zhong
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
authors.forename: Bizu
authors.initials: B
authors.lastname: Gelaye
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.|Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
authors.affiliation: Division of Psychiatry and Medicine, Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Fricchione
authors.affiliation: Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Tianxi
authors.initials: T
authors.lastname: Cai
authors.affiliation: Mary Horrigan Connors Center for Women's Health and Gender Biology, Boston, Massachusetts, USA.|Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Johnson
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.|Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Henderson
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D003863:Depression / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D015995:Prevalence; D044469:Racial Groups / Q000523:psychology / Q000706:statistics & numerical data*; D012042:Registries; D016728:Self-Injurious Behavior / Q000208:ethnology / Q000523:psychology*; D012959:Socioeconomic Factors; D059020:Suicidal Ideation; D013405:Suicide / Q000208:ethnology* / Q000523:psychology / Q000639:trends*; D013406:Suicide, Attempted / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: National (Nationwide) Inpatient Sample; Pregnant women; Suicidal ideation; Suicide and self-inflicted injury