Maternal suicide in Italy

Abstract

Suicide has been identified as one of the most common causes of death among women within 1 year after the end of pregnancy in several high-income countries. The aim of this study was to provide the first estimate of the maternal suicide ratio and a description of the characteristics of women who died by suicide during pregnancy or within 1 year after giving birth, induced abortion or miscarriage (i.e., maternal suicide) in 10 Italian regions, covering 77% of total national births. Maternal suicides were identified through the linkage between regional death registries and hospital discharge databases. Background population data was collected from the national hospital discharge, abortion and mortality databases. The previous psychiatric history of the women who died by maternal suicide was retrieved from the regionally available data sources. A total of 67 cases of maternal suicide were identified, corresponding to a maternal suicide ratio of 2.30 per 100,000 live births in 2006–2012. The suicide rate was 1.18 per 100,000 after giving birth (n = 2,876,193), 2.77 after an induced abortion (n = 650,549) and 2.90 after a miscarriage (n = 379,583). The majority of the women who died by maternal suicide (34/57) had a previous psychiatric history; 15/18 previously diagnosed mental disorders were not registered along with the index pregnancy obstetric records. Suicide is a relevant cause of maternal death in Italy. The continuity of care between primary, mental health and maternity care were found to be critical. Clinicians should be aware of the issue, as they may play an important role in preventing suicide in their patients.

This is a preview of subscription content, access via your institution.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Fig. 1
Fig. 2

References

  1. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lépine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martínez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacín C, Romera B, Taub N, Vollebergh WA, ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project (2004) Use of mental services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 420:47–54

    Google Scholar 

  2. Appleby L (1991) Suicide during pregnancy and in the first postnatal year. BMJ 302:137–140

    CAS  Article  Google Scholar 

  3. Arsenault-Lapierre G, Kim C, Turecki G (2004) Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 4:37

    Article  Google Scholar 

  4. Beautrais AL (2006) Women and suicidal behavior. Crisis 27:153–156

    Article  Google Scholar 

  5. Cantwell R, Knight M, Oates M, Shakespeare J, on behalf of the MBRRACE-UK mental health chapter writing group (2015) Lessons on maternal mental health. In Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ (eds) on behalf of MBRRACE-UK. Saving lives, improving mothers’ care - surveillance of maternal deaths in the UK 2011–13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–13. National Perinatal Epidemiology Unit, University of Oxford, Oxford, p 22–41. ISBN 978-0-9931267-3-4

  6. Cicchetti A, Gasbarrini A (2016) The healthcare service in Italy: regional variability. Eur Rev Med Pharmacol Sci 20:1–3

    CAS  PubMed  Google Scholar 

  7. Davis KA, Sudlow CL, Hotopf M (2016) Can mental health diagnoses in administrative data be used for research? A systematic review of the accuracy of routinely collected diagnoses. BMC Psychiatry 16:263

    Article  Google Scholar 

  8. Donati S, Maraschini A, Lega I, D’aloja P, Buoncristiano M, Manno V, Regional Maternal Mortality Working Group (2018) Maternal mortality in Italy: results and perspectives of record-linkage analysis. Acta Obstet Gynecol Scand 97:1317–1324

    Article  Google Scholar 

  9. Esscher A, Essén B, Innala E, Papadopoulos FC, Skalkidou A, Sundström-Poromaa I, Högberg U (2016) Suicides during pregnancy and 1 year postpartum in Sweden, 1980-2007. Br J Psychiatry 208:462–469

    Article  Google Scholar 

  10. Gissler M, Hemminki E, Lönnqvist J (1996) Suicides after pregnancy in Finland, 1987-94: register linkage study. BMJ 313:1431–1434

    CAS  Article  Google Scholar 

  11. Gissler M, Berg C, Bouvier-Colle MH, Buekens P (2005) Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. Eur J Pub Health 15:459–463

    Article  Google Scholar 

  12. Gissler M, Karalis E, Ulander VM (2015) Decreased suicide rate after induced abortion, after the Current Care Guidelines in Finland 1987-2012. Scand J Public Health 43:99–101

    Article  Google Scholar 

  13. Guillard V, Gressier F (2017) Suicidality during perinatal period. Presse Med 46:565–571

    Article  Google Scholar 

  14. Hawton K, van Heeringen K (2009) Suicide. Lancet 373:1372–1381

    Article  Google Scholar 

  15. Humphrey MD (2016) Maternal mortality trends in Australia. Med J Aust 205:344–346

    Article  Google Scholar 

  16. ISTAT National Institute of Statistics (2017) Popolazione e famiglie [Population and families] (in Italian) https://www.istat.it/it/popolazione-e-famiglie?dati. Accessed 5 December 2018

  17. Italian Ministry of Health (2018) Salute della donna [Woman’s health] (in Italian) http://www.salute.gov.it/portale/donna/archivioPubblicazioniDonna.jsp. Accessed 5 December 2018

  18. Knight M, Nair M, Tuffnell D, Kenyon S, Shakespeare J, Brocklehurst P, Kurinczuk JJ, on behalf of MBRRACE-UK (eds) (2016) Saving lives, improving mothers’ care - surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity. National Perinatal Epidemiology Unit, University of Oxford, Oxford, pp 2009–2014 ISBN: 978-0-9931267-7-2

    Google Scholar 

  19. Lewis G (ed) (2007) The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer - 2003-2005. The seventh report on Confidential Enquiries into Maternal Deaths in the United Kingdom. CEMACH, London. ISBN: 978–0–9533536-8-2

  20. Lindahl V, Pearson JL, Colpe L (2005) Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health 8:77–87

    CAS  Article  Google Scholar 

  21. Lysell H, Dahlin M, Viktorin A, Ljungberg E, D’Onofrio BM, Dickman P, Runeson B (2018) Maternal suicide - register based study of all suicides occurring after delivery in Sweden 1974-2009. PLoS One 13:e0190133

    Article  Google Scholar 

  22. Masocco M, Pompili M, Vanacore N, Innamorati M, Lester D, Girardi P, Tatarelli R, Vichi M (2010) Completed suicide and marital status according to the Italian region of origin. Psychiatry Q 81:57–71

    Article  Google Scholar 

  23. NICE National Institute for Health and Care Excellence (2014) CG192: antenatal and postnatal mental health: clinical management and service guidance. https://www.nice.org.uk/guidance/cg192. Accessed 3 December 2018

  24. Oates M (2003a) Suicide: the leading cause of maternal death. Br J Psychiatry 183:279–281

    Article  Google Scholar 

  25. Oates M (2003b) Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. Br Med Bull 67:219–229

    Article  Google Scholar 

  26. Oates M, Cantwell R, on behalf of the Centre for Maternal and Child Enquiries (2011) Deaths from psychiatric causes. Centre for Maternal and Child Enquiries (CMACE). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 118:132–142

    Google Scholar 

  27. Reardon DC (2017) Missed opportunities and overstated results in anxiety and quality of life study following termination of pregnancy. Acta Obstet Gynecol Scand 96:38

    Article  Google Scholar 

  28. van den Akker T, Nair M, Goedhart M, Schutte J, Schaap T, Knight M, Netherlands Audit Committee Maternal Mortality Morbidity; UK Confidential Enquiry into Maternal Deaths (2017) Maternal mortality: direct or indirect has become irrelevant. Lancet Glob Health 5:e1181–e1182

    Article  Google Scholar 

  29. Vangen S, Bødker B, Ellingsen L, Saltvedt S, Gissler M, Geirsson RT, Nyfløt LT (2017) Maternal deaths in the Nordic countries. Acta Obstet Gynecol Scand 96:1112–1119

    Article  Google Scholar 

  30. Weng SC, Chang JC, Yeh MK, Wang SM, Chen YH (2016) Factors influencing attempted and completed suicide in postnatal women: a population-based study in Taiwan. Sci Rep 6:25770

    CAS  Article  Google Scholar 

  31. World Health Organization for Europe (2018) European health for all family of databases. https://gateway.euro.who.int/. Accessed 5 December 2018

Download references

Acknowledgements

This research was supported by the Italian Ministry of Health.

We thank Laura Lauria for assistance with methodology, Marina Pediconi for her valuable technical assistance, Gianpaolo Coscia and Claudia Ferraro for the English language revision. We are grateful to Emanuele Caroppo (MD PhD, Università Cattolica del Sacro Cuore, Rome) for comments that greatly improved the manuscript.

The authors thank the Italian Ministry of Health and the National Institute of Statistics (ISTAT) for sharing the national data files.

Author information

Affiliations

Authors

Consortia

Corresponding author

Correspondence to Ilaria Lega.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lega, I., Maraschini, A., D’Aloja, P. et al. Maternal suicide in Italy. Arch Womens Ment Health 23, 199–206 (2020). https://doi.org/10.1007/s00737-019-00977-1

Download citation

Keywords

  • Suicide
  • Maternal mortality
  • Pregnancy
  • Abortion
  • Postpartum