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Perinatal suicide in Ontario, Canada: a 15-year population-based study.

Abstract Death by suicide during the perinatal period has been understudied in Canada. We examined the epidemiology of and health service use related to suicides during pregnancy and the first postpartum year.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title cmaj : canadian medical association journal = journal de l'association medicale canadienne
Publication Year Start




PMID- 28847780
OWN - NLM
STAT- MEDLINE
DA  - 20170829
DCOM- 20170906
LR  - 20170908
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 189
IP  - 34
DP  - 2017 Aug 28
TI  - Perinatal suicide in Ontario, Canada: a 15-year population-based study.
PG  - E1085-E1092
LID - 10.1503/cmaj.170088 [doi]
AB  - BACKGROUND: Death by suicide during the perinatal period has been understudied in
      Canada. We examined the epidemiology of and health service use related to
      suicides during pregnancy and the first postpartum year. METHODS: In this
      retrospective, population-based cohort study, we linked health administrative
      databases with coroner death records (1994-2008) for Ontario, Canada. We compared
      sociodemographic characteristics, clinical features and health service use in the
      30 days and 1 year before death between women who died by suicide perinatally,
      women who died by suicide outside of the perinatal period and living perinatal
      women. RESULTS: The perinatal suicide rate was 2.58 per 100 000 live births, with
      suicide accounting for 51 (5.3%) of 966 perinatal deaths. Most suicides occurred 
      during the final quarter of the first postpartum year, with highest rates in
      rural and remote regions. Perinatal women were more likely to die from hanging
      (33.3% [17/51]) or jumping or falling (19.6% [10/51]) than women who died by
      suicide non-perinatally (p = 0.04). Only 39.2% (20/51) had mental health contact 
      within the 30 days before death, similar to the rate among those who died by
      suicide non-perinatally (47.7% [762/1597]; odds ratio [OR] 0.71, 95% confidence
      interval [CI] 0.40-1.25). Compared with living perinatal women matched by
      pregnancy or postpartum status at date of suicide, perinatal women who died by
      suicide had similar likelihood of non-mental health primary care and obstetric
      care before the index date but had a lower likelihood of pediatric contact (64.5%
      [20/31] v. 88.4% [137/155] at 30 days; OR 0.24, 95% CI 0.10-0.58).
      INTERPRETATION: The perinatal suicide rate for Ontario during the period
      1994-2008 was comparable to international estimates and represents a substantial 
      component of Canadian perinatal mortality. Given that deaths by suicide occur
      throughout the perinatal period, all health care providers must be collectively
      vigilant in assessing risk.
CI  - (c) 2017 Canadian Medical Association or its licensors.
FAU - Grigoriadis, Sophie
AU  - Grigoriadis S
AD  - Women's Mood and Anxiety Clinic: Reproductive Transitions (Grigoriadis) and
      Evaluative Clinical Sciences, Sunnybrook Research Institute (Grigoriadis,
      VonderPorten, Levitt, Cheung), Sunnybrook Health Sciences Centre; Department of
      Psychiatry (Grigoriadis, Kurdyak, Levitt, Cheung, Vigod), University of Toronto; 
      Institute for Clinical Evaluative Sciences (Wilton, Kurdyak, Vigod); Health
      Outcomes and Performance Evaluation, Institute for Mental Health Policy Research 
      (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont.; The Offord
      Centre for Child Studies (Rhodes), Hamilton, Ont.; Women's College Hospital and
      Research Institute (Vigod), Toronto, Ont. [email protected]
FAU - Wilton, Andrew S
AU  - Wilton AS
AD  - Women's Mood and Anxiety Clinic: Reproductive Transitions (Grigoriadis) and
      Evaluative Clinical Sciences, Sunnybrook Research Institute (Grigoriadis,
      VonderPorten, Levitt, Cheung), Sunnybrook Health Sciences Centre; Department of
      Psychiatry (Grigoriadis, Kurdyak, Levitt, Cheung, Vigod), University of Toronto; 
      Institute for Clinical Evaluative Sciences (Wilton, Kurdyak, Vigod); Health
      Outcomes and Performance Evaluation, Institute for Mental Health Policy Research 
      (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont.; The Offord
      Centre for Child Studies (Rhodes), Hamilton, Ont.; Women's College Hospital and
      Research Institute (Vigod), Toronto, Ont.
FAU - Kurdyak, Paul A
AU  - Kurdyak PA
AD  - Women's Mood and Anxiety Clinic: Reproductive Transitions (Grigoriadis) and
      Evaluative Clinical Sciences, Sunnybrook Research Institute (Grigoriadis,
      VonderPorten, Levitt, Cheung), Sunnybrook Health Sciences Centre; Department of
      Psychiatry (Grigoriadis, Kurdyak, Levitt, Cheung, Vigod), University of Toronto; 
      Institute for Clinical Evaluative Sciences (Wilton, Kurdyak, Vigod); Health
      Outcomes and Performance Evaluation, Institute for Mental Health Policy Research 
      (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont.; The Offord
      Centre for Child Studies (Rhodes), Hamilton, Ont.; Women's College Hospital and
      Research Institute (Vigod), Toronto, Ont.
FAU - Rhodes, Anne E
AU  - Rhodes AE
AD  - Women's Mood and Anxiety Clinic: Reproductive Transitions (Grigoriadis) and
      Evaluative Clinical Sciences, Sunnybrook Research Institute (Grigoriadis,
      VonderPorten, Levitt, Cheung), Sunnybrook Health Sciences Centre; Department of
      Psychiatry (Grigoriadis, Kurdyak, Levitt, Cheung, Vigod), University of Toronto; 
      Institute for Clinical Evaluative Sciences (Wilton, Kurdyak, Vigod); Health
      Outcomes and Performance Evaluation, Institute for Mental Health Policy Research 
      (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont.; The Offord
      Centre for Child Studies (Rhodes), Hamilton, Ont.; Women's College Hospital and
      Research Institute (Vigod), Toronto, Ont.
FAU - VonderPorten, Emily H
AU  - VonderPorten EH
AD  - Women's Mood and Anxiety Clinic: Reproductive Transitions (Grigoriadis) and
      Evaluative Clinical Sciences, Sunnybrook Research Institute (Grigoriadis,
      VonderPorten, Levitt, Cheung), Sunnybrook Health Sciences Centre; Department of
      Psychiatry (Grigoriadis, Kurdyak, Levitt, Cheung, Vigod), University of Toronto; 
      Institute for Clinical Evaluative Sciences (Wilton, Kurdyak, Vigod); Health
      Outcomes and Performance Evaluation, Institute for Mental Health Policy Research 
      (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont.; The Offord
      Centre for Child Studies (Rhodes), Hamilton, Ont.; Women's College Hospital and
      Research Institute (Vigod), Toronto, Ont.
FAU - Levitt, Anthony
AU  - Levitt A
AD  - Women's Mood and Anxiety Clinic: Reproductive Transitions (Grigoriadis) and
      Evaluative Clinical Sciences, Sunnybrook Research Institute (Grigoriadis,
      VonderPorten, Levitt, Cheung), Sunnybrook Health Sciences Centre; Department of
      Psychiatry (Grigoriadis, Kurdyak, Levitt, Cheung, Vigod), University of Toronto; 
      Institute for Clinical Evaluative Sciences (Wilton, Kurdyak, Vigod); Health
      Outcomes and Performance Evaluation, Institute for Mental Health Policy Research 
      (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont.; The Offord
      Centre for Child Studies (Rhodes), Hamilton, Ont.; Women's College Hospital and
      Research Institute (Vigod), Toronto, Ont.
FAU - Cheung, Amy
AU  - Cheung A
AD  - Women's Mood and Anxiety Clinic: Reproductive Transitions (Grigoriadis) and
      Evaluative Clinical Sciences, Sunnybrook Research Institute (Grigoriadis,
      VonderPorten, Levitt, Cheung), Sunnybrook Health Sciences Centre; Department of
      Psychiatry (Grigoriadis, Kurdyak, Levitt, Cheung, Vigod), University of Toronto; 
      Institute for Clinical Evaluative Sciences (Wilton, Kurdyak, Vigod); Health
      Outcomes and Performance Evaluation, Institute for Mental Health Policy Research 
      (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont.; The Offord
      Centre for Child Studies (Rhodes), Hamilton, Ont.; Women's College Hospital and
      Research Institute (Vigod), Toronto, Ont.
FAU - Vigod, Simone N
AU  - Vigod SN
AD  - Women's Mood and Anxiety Clinic: Reproductive Transitions (Grigoriadis) and
      Evaluative Clinical Sciences, Sunnybrook Research Institute (Grigoriadis,
      VonderPorten, Levitt, Cheung), Sunnybrook Health Sciences Centre; Department of
      Psychiatry (Grigoriadis, Kurdyak, Levitt, Cheung, Vigod), University of Toronto; 
      Institute for Clinical Evaluative Sciences (Wilton, Kurdyak, Vigod); Health
      Outcomes and Performance Evaluation, Institute for Mental Health Policy Research 
      (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont.; The Offord
      Centre for Child Studies (Rhodes), Hamilton, Ont.; Women's College Hospital and
      Research Institute (Vigod), Toronto, Ont.
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale
      canadienne
JID - 9711805
SB  - AIM
SB  - IM
MH  - Adult
MH  - Databases, Factual
MH  - Female
MH  - Humans
MH  - Logistic Models
MH  - Mental Disorders/*epidemiology
MH  - Ontario/epidemiology
MH  - Postpartum Period/*psychology
MH  - Pregnancy
MH  - Pregnancy Complications/*epidemiology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Rural Population
MH  - Suicide/*statistics & numerical data
MH  - Young Adult
PMC - PMC5573543
COI - Competing interests: Sophie Grigoriadis has received personal fees from Sage, Eli
      Lilly Canada, Allergan/Actavis, Pfizer and Bristol Myers Squibb for activities
      unrelated to the current manuscript. No other competing interests were declared.
EDAT- 2017/08/30 06:00
MHDA- 2017/09/07 06:00
CRDT- 2017/08/30 06:00
PHST- 2017/05/31 [accepted]
AID - 189/34/E1085 [pii]
AID - 10.1503/cmaj.170088 [doi]
PST - ppublish
SO  - CMAJ. 2017 Aug 28;189(34):E1085-E1092. doi: 10.1503/cmaj.170088.