Are Pregnant and Postpartum Women: At Increased Risk for Violent Death? Suicide and Homicide Findings from North Carolina

Abstract

The purpose of this study is to estimate rates of suicide and homicide death among pregnant, postpartum and non-pregnant/non-postpartum women ages 14–44, and to determine comparative rates of violent death for pregnant and/or postpartum women compared to non-pregnant/non-postpartum women. North Carolina surveillance and vital statistics data from 2004 to 2006 were used to examine whether pregnant or postpartum women have higher (or lower) rates of suicide and homicide compared to other reproductive-aged women. The suicide rate for pregnant women was 27% of the rate for non-pregnant/non-postpartum women (rate ratio = 0.27, 95% CI = 0.11–0.66), and the suicide rate for postpartum women was 54% of the rate for non-pregnant/non-postpartum women (rate ratio = 0.54, 95% CI = 0.31–0.95). Homicide rates also were lower for pregnant and postpartum women, with the homicide rate for pregnant women being 73% of the rate for non-pregnant/non-postpartum women (rate ratio = 0.73, 95% CI = 0.39–1.37), and the homicide rate for postpartum women being half the rate for non-pregnant/non-postpartum women (rate ratio = 0.50, 95% CI = 0.26–0.98). Although pregnant and postpartum women are at risk for homicide and suicide death, the highest risk group is non-pregnant/non-postpartum women. Violence prevention efforts should target all women of reproductive age, and pay particular attention to non-pregnant/non-postpartum women, who may have less access to health care services than pregnant and postpartum women.

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References

  1. 1.

    Centers for Disease Control. (2009). Web-based injury statistics query and reporting system. Retrieved from: http://www.cdc.gov/injury/wisqars/index.html. Accessed on-line April 23, 2009.

  2. 2.

    Fox, J. A., & Zawitz, M. W. (2007). Homicide trends in the United States. U. S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Accessed on-line June 30, 2009 at http://www.ojp.gov/bjs/homicide/homtrnd.htm.

  3. 3.

    Anderson, L., Sundstrom-Poromaa, I., Wulff, M., Astrom, M., & Bixo, M. (2003). Point prevalence of psychiatric disorders during the second trimester of pregnancy: A population-based study. American Journal of Obstetrics and Gynecology, 189, 148–154.

    Article  Google Scholar 

  4. 4.

    De Tychey, C., Spitz, E., Briancon, S., Lighezzolo, J., Girvan, F., Rosati, A., et al. (2005). Pre- and postnatal depression and coping: A comparative approach. Journal of Affective Disorders, 85, 323–326.

    PubMed  Article  Google Scholar 

  5. 5.

    Marcus, S. M., Flynn, H. A., Blow, F. C., & Barry, K. L. (2004). Depressive symptoms among pregnant women screened in obstetrics settings. Women’s Health, 12, 373–380.

    Article  Google Scholar 

  6. 6.

    Stowe, Z. N., Hostetter, A. L., & Newport, D. J. (2005). The onset of postpartum depression: Implications for clinical screening obstetrical and primary case. American Journal of Obstetrics and Gynecology, 192, 522–526.

    PubMed  Article  Google Scholar 

  7. 7.

    Zuckerman, B., Amaro, H., Baucher, H., & Cabral, H. (1989). Depressive symptoms during pregnancy: Relationship to poor health behaviour. American Journal of Obstetrics and Gynecology, 160, 1170–1181.

    Google Scholar 

  8. 8.

    Gold, L. H. (2002). Postpartum disorders in primary care: Diagnosis and treatment. Primary Care, 29, 27–41.

    PubMed  Google Scholar 

  9. 9.

    Hoffman, S., & Hatch, M. C. (2000). Depressive symptomatology during pregnancy: Evidence for an association with decreased fetal growth in pregnancies of lower social class women. Health Psychology, 19(6), 535–543.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Miller, L. J. (2002). Postpartum depression. Journal of the American Medical Association, 287, 762–765.

    PubMed  Article  Google Scholar 

  11. 11.

    Wisner, K. L., & Wheeler, S. B. (1994). Prevention of recurrent postpartum major depression. Hospital & Community Psychiatry, 45, 1191–1196.

    CAS  Google Scholar 

  12. 12.

    Luoma, I., Tamminen, T., Kaukonen, P., Laippala, P., Puura, K., Salmelin, R., et al. (2001). Longitudinal study of maternal depressive symptoms and child well-being. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1367–1374.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Patel, V., Rodrigues, M., & DeSouza, N. (2002). Gender, poverty, and postnatal depression: A study of mothers in Goa, India. American Journal of Psychiatry, 159, 43–47.

    PubMed  Article  Google Scholar 

  14. 14.

    Cooper, P. J., Tomlinson, M., Swartz, L., Woolgar, M., Murray, L., & Molteno, C. (1999). Postpartum depression and the mother-infant relationship in a South African peri-urban settlement. British Journal of Psychology, 175, 554–558.

    Article  CAS  Google Scholar 

  15. 15.

    Appleby, L., & Turnbull, G. (1995). Parasuicide in the first postnatal year. Psychological Medicine, 25, 1087–1090.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Lindahl, V., Pearson, J. L., & Colpe, L. (2005). Prevalence of suicidality during pregnancy and the postpartum. Archives of Women’s Mental Health, 8, 77–87.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Samandari, G. & Schiro, S. (2009). Suicide risk among pregnant and postpartum women: A critical review of the literature. Under review for publication by the Archives of Women’s Mental Health.

  18. 18.

    Barno, A. D. (1967). Criminal abortion deaths, illegitimate pregnancy, and suicides in pregnancy. American Journal of Obstetrics and Gynecology, 98(3), 356–367.

    PubMed  CAS  Google Scholar 

  19. 19.

    Chang, J., Berg, C. J., Saltzman, L. E., & Herndon, J. (2005). Homicide: a leading cause of injury deaths among pregnant and postpartum women in the United States, 1991–1999. American Journal of Public Health, 95(3), 471–477.

    PubMed  Article  Google Scholar 

  20. 20.

    Dannenberg, A. L., Carter, D. M., Lawson, H. W., Ashton, D. M., Dorfman, S. F., & Graham, E. H. (1995). Homicide and other injuries as causes of maternal death in New York City, 1987 through 1991. American Journal of Obstetrics and Gynecology, 172(5), 1557–1564.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Dorfman, S. F. (1990). Maternal mortality in New York City, 1981–1983. Obstetrics and Gynecology, 76(3), 317–323.

    PubMed  CAS  Google Scholar 

  22. 22.

    Dye, T., Gordon, H., Held, B., Tolliver, N. J., & Holmes, A. P. (1992). Retrospective maternal mortality case ascertainment in West Virginia, 1985 to 1989. American Journal of Obstetrics and Gynecology, 167(1), 72–76.

    PubMed  CAS  Google Scholar 

  23. 23.

    Fauveau, V., & Blanchet, T. (1989). Deaths from injuries and induced abortion among rural Bangladeshi women. Social Science and Medicine, 29, 1121–1127.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Fildes, J., Reed, L., Jones, N., Martin, M., & Barrett, J. (1992). Trauma: The leading cause of maternal death. The Journal of Trauma, 32(5), 643–645.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Harper, M., & Parsons, L. (1997). Maternal deaths due to homicide and other injuries in North Carolina: 1992–1994. Obstetrics and Gynecology, 90(6), 920–923.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Ho, E. M., Brown, J., Graves, W., & Lindsay, M. K. (2002). Maternal death at an inner-city hospital, 1949–2000. American Journal of Obstetrics and Gynecology, 187(5), 1213–1216.

    PubMed  Article  Google Scholar 

  27. 27.

    Horon, I. L., & Cheng, D. (2001). Enhanced surveillance for pregnancy-associated mortality: Maryland, 1993–1998. Journal of the American Medical Association, 285(11), 1455–1459.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Jocums, S. B., Berg, C. J., Entman, S. S., & Mitchell, E. F. (1998). Postdelivery mortality in Tennessee, 1989–1991. Obstetrics and Gynecology, 91(5), 766–770.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Kaunitz, A., Hughes, J. M., Grimes, D. A., Smith, J. C., Rochat, R. W., & Kafrissen, M. E. (1985). Causes of maternal mortality in the United States. Obstetrics and Gynecology, 65(5), 605–612.

    PubMed  CAS  Google Scholar 

  30. 30.

    Krulewitch, C. J., Pierre-Louis, M. L., de Leon-Gomez, R., Guy, R., & Green, R. (2001). Hidden from view: Violent deaths among pregnant women in the District of Columbia, 1988–1996. Journal of Midwifery & Women’s Health, 46(1), 4–10.

    Article  CAS  Google Scholar 

  31. 31.

    Nannini, A., Weiss, J., Goldstein, R., & Fogerty, S. (2002). Pregnancy-associated mortality at the end of the twentieth century: Massachusetts, 1990–1999. Journal of the American Medical Women’s Association, 57(3), 140–143.

    PubMed  Google Scholar 

  32. 32.

    Syverson, C., Chavkin, W., Atrash, H. K., Rochat, R. W., Sharp, E. S., & King, G. E. (1991). Pregnancy-related mortality in New York City, 1980 to 1984: causes of death and associated risk factors. American Journal of Obstetrics and Gynecology, 164(2), 603–608.

    PubMed  CAS  Google Scholar 

  33. 33.

    Varner, M. (1989). Maternal mortality in Iowa from 1952 to 1986. Surgery, Gynecology and Obstetrics, 168(6), 555–562.

    PubMed  CAS  Google Scholar 

  34. 34.

    Marzuk, P. M., Tardiff, K., Leon, A. C., Hirsch, C. S., Portera, L., Hartwell, N., et al. (1997). Lower risk of suicide during pregnancy. American Journal of Psychiatry, 154(1), 122–123.

    PubMed  CAS  Google Scholar 

  35. 35.

    Gazmararian, J. A., Lazorick, S., Spitz, A. M., Ballard, T. J., Saltzman, L. E., & Marks, J. S. (1996). Prevalence of violence against pregnant women. Journal of the American Medical Association, 275(24), 1915–1920.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Jasinski, J. L. (2004). Pregnancy and domestic violence: A review of the literature. Trauma Violence Abuse, 5(1), 47–64.

    PubMed  Article  Google Scholar 

  37. 37.

    Martin, S. L., Mackie, L., Kupper, L. L., Buescher, P. A., & Moracco, K. E. (2001). Physical abuse of women before, during, and after pregnancy. Journal of the American Medical Association, 285(12), 1581–1584.

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Martin, S. L., Macy, R. J., Sullivan, K., & Magee, M. (2007). Pregnancy-associated violent deaths: The role of intimate partner violence. Trauma. Violence & Abuse, 8(2), 135–148.

    Article  Google Scholar 

  39. 39.

    Shadigian, E. M., & Bauer, S. T. (2005). Pregnancy-associated death: A qualitative systematic review of homicide and suicide. Obstetrical and Gynecological Survey, 60(3), 183–190.

    PubMed  Article  Google Scholar 

  40. 40.

    Samandari, G., Martin, S. L., & Schiro, S. (2009). Homicide among pregnant and postpartum women in the United States: A review of the literature. Currently under review for publication in Trauma, Violence, and Abuse.

  41. 41.

    Coker, A. L., Davis, K. E., Arias, I., Desai, S., Sanderson, M., Brandt, H. M., et al. (2002). Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventive Medicine, 23(4), 260–268.

    PubMed  Article  Google Scholar 

  42. 42.

    Rodrigues, T., Rocha, L., & Barros, H. (2008). Physical abuse during pregnancy and preterm delivery. American Journal of Obstetrics and Gynecology, 198, 171.e1–171.e6.

    Article  Google Scholar 

  43. 43.

    Widding Hedin, L. (1999). Postpartum, also a risk period for domestic violence. European Journal of Obstetrics & Gynecology and Reproductive Biology, 89, 41–45.

    Article  Google Scholar 

  44. 44.

    Gielen Carlson, A., O’Campo, P., Faden, R., Kass, N., & Xue, X. (1994). Interpersonal conflict and physical violence during the childbearing year. Social Science and Medicine, 39, 782–787.

    Google Scholar 

  45. 45.

    Krulewitch, C. J., Roberts, D. W., & Thompson, L. S. (2003). Adolescent pregnancy and homicide: Findings from the Maryland Office of the Chief Medical Examiner, 1994–1998. Child Maltreatment, 8(2), 122–128.

    PubMed  Article  Google Scholar 

  46. 46.

    Panting-Kemp, A., Geller, S. E., Nguyen, T., Simonson, L., Nuwayhid, B., & Castro, L. (2000). Maternal deaths in an urban perinatal network, 1992–1998. American Journal of Obstetrics and Gynecology, 183(5), 1207–1212.

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Dietz, P. M., Rochat, R. W., Thompson, B. L., Berg, C. J., & Griffin, G. W. (1998). Differences in the risk of homicide and other fatal injuries between postpartum women and other women of childbearing age: Implications for prevention. American Journal of Public Health, 88(4), 641–643.

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Centers for Disease Control and Prevention. (2004). National Center for Health Statistics, 2004, data definition: Fetal death. Retrieved from: http://www.cdc.gov/nchs/datawh/nchsdefs/fetaldeath.htm.

  49. 49.

    North Carolina State Center for Health Statistics. (2009). North Carolina State Center for Health Statistics queryable data. Retrieved June 25, 2009 from http://www.schs.state.nc.us/SCHS/data/dms/dms.cfm.

  50. 50.

    Leung, T. W., Leung, W. C., Chan, P. L., & Ho, P. C. (2002). A comparison of the prevalence of domestic violence between patients seeking termination of pregnancy and other general gynecology patients. International Journal of Gynecology and Obstetrics, 77, 47–54.

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    Office of the Chief Medical Examiner, North Carolina. (2000). Retrieved from http://www.ocme.unc.edu/.

  52. 52.

    Jewkes, R. (2002). Intimate partner violence: causes and prevention. The Lancet, 359, 1423–1429.

    Article  Google Scholar 

  53. 53.

    Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., et al. (2005). Suicide prevention strategies: a systematic review. Journal of the American Medical Association, 294(16), 2064–2074.

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

This research was supported, in part, by contract #01507-09 from the North Carolina Department of Health and Human Services, Division of Public Health as part of the evaluation of the North Carolina Violent Death Reporting System. The authors thank Ms. Kay Sanford, Ms. Zewde Demissie, Dr. Margaret Harper, Mr. Pedro Luna-Orea and Mr. Scott Proescholdbell, all of whom were instrumental in the conduct of this research.

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Correspondence to Ghazaleh Samandari.

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Samandari, G., Martin, S.L., Kupper, L.L. et al. Are Pregnant and Postpartum Women: At Increased Risk for Violent Death? Suicide and Homicide Findings from North Carolina. Matern Child Health J 15, 660–669 (2011). https://doi.org/10.1007/s10995-010-0623-6

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Keywords

  • Violence
  • Pregnancy
  • Postpartum
  • Homicide
  • Suicide