The contribution of suicide to maternal mortality: A nationwide population-based cohort study.

OBJECTIVE: To identify the incidence and characteristics of maternal suicide. DESIGN: Nationwide population-based cohort study. SETTING: The Netherlands, 2006-2020. POPULATION: Women who died during pregnancy or within 1 year postpartum, and a reference population of women aged 25-45 years. METHODS: The Cause of Death Register and Medical Birth Register were linked to identify women who died within 1 year postpartum. Data were combined with deaths reported to the Audit Committee for Maternal Mortality and Morbidity (ACMMM), which performs confidential enquiries. Maternal suicides were compared with a previous period (1996-2005). Risk factors were obtained by combining vital statistics databases. MAIN OUTCOME MEASURES: Comparison of incidence and proportion of maternal suicides among all maternal deaths over time, sociodemographic and patient-related risk factors and underreporting of postpartum suicides. RESULTS: The maternal suicide rate remained stable with 68 deaths: 2.6 per 100 000 live births in 2006-2020 versus 2.5 per 100 000 in 1996-2005. The proportion of suicides among all maternal deaths increased from 18% to 28%. Most suicides occurred throughout the first year postpartum (64/68); 34 (53%) of the women who died by suicide postpartum were primiparous. Compared with mid-level, low educational level was a risk factor (odds ratio 4.2, 95% confidence interval 2.3-7.9). Of 20 women reported to the ACMMM, 11 (55%) had a psychiatric history and 13 (65%) were in psychiatric treatment at the time of death. Underreporting to ACMMM was 78%. CONCLUSIONS: Although the overall maternal mortality ratio declined, maternal suicides did not and are now the leading cause of maternal mortality if late deaths up to 1 year postpartum are included. Data collection and analysis of suicides must improve.

[Suicidal behavior in emergency care: 10 tips for an active, empathetic and preventative approach]. / Suïcidaal gedrag op de SEH.

Patients with suicidal behaviour are frequently seen in A&E departments. Providing care for this patient group can be challenging and medical staff have often not received specialized training to improve their knowledge and skills. An empathetic approach combined with brief interventions such as safety planning, collaborating with carers and partnership with local organizations can help A&E professionals to optimize care for these patients and contribute to the prevention of future suicide attempts.