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Admon LK, Dalton VK, Kolenic GE, et al. Trends in Suicidality 1 Year Before and After Birth Among Commercially Insured Childbearing Individuals in the United States, 2006-2017. JAMA Psychiatry. 2021;78(2):171-176doi: 10.1001/jamapsychiatry.2020.3550.
Admon, L. K., Dalton, V. K., Kolenic, G. E., Ettner, S. L., Tilea, A., Haffajee, R. L., Brownlee, R. M., Zochowski, M. K., Tabb, K. M., Muzik, M., & Zivin, K. (2021). Trends in Suicidality 1 Year Before and After Birth Among Commercially Insured Childbearing Individuals in the United States, 2006-2017. JAMA psychiatry, 78(2), 171-176. https://doi.org/10.1001/jamapsychiatry.2020.3550
Admon, Lindsay K, et al. "Trends in Suicidality 1 Year Before and After Birth Among Commercially Insured Childbearing Individuals in the United States, 2006-2017." JAMA psychiatry vol. 78,2 (2021): 171-176. doi: https://doi.org/10.1001/jamapsychiatry.2020.3550
Admon LK, Dalton VK, Kolenic GE, Ettner SL, Tilea A, Haffajee RL, Brownlee RM, Zochowski MK, Tabb KM, Muzik M, Zivin K. Trends in Suicidality 1 Year Before and After Birth Among Commercially Insured Childbearing Individuals in the United States, 2006-2017. JAMA Psychiatry. 2021 Feb 01;78(2):171-176. doi: 10.1001/jamapsychiatry.2020.3550. PMID: 33206140; PMCID: PMC7675215.
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JAMA Psychiatry. 2021 Feb 01;78(2):171-176. doi: 10.1001/jamapsychiatry.2020.3550.

Trends in Suicidality 1 Year Before and After Birth Among Commercially Insured Childbearing Individuals in the United States, 2006-2017.

JAMA psychiatry

Lindsay K Admon, Vanessa K Dalton, Giselle E Kolenic, Susan L Ettner, Anca Tilea, Rebecca L Haffajee, Rebecca M Brownlee, Melissa K Zochowski, Karen M Tabb, Maria Muzik, Kara Zivin

Affiliations

  1. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor.
  2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
  3. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, University of California, Los Angeles.
  4. Department of Health Policy and Management, Fielding UCLA School of Public Health, University of California, Los Angeles.
  5. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor.
  6. RAND Corporation, Boston, Massachusetts.
  7. Department of Psychiatry, University of Michigan, Ann Arbor.
  8. University of Illinois at Urbana-Champaign School of Social Work, Urbana.
  9. VA Ann Arbor Healthcare System, Ann Arbor, Michigan.

PMID: 33206140 PMCID: PMC7675215 DOI: 10.1001/jamapsychiatry.2020.3550

Abstract

IMPORTANCE: Suicide deaths are a leading cause of maternal mortality in the US, yet the prevalence and trends in suicidality (suicidal ideation and/or intentional self-harm) among childbearing individuals remain poorly described.

OBJECTIVE: To characterize trends in suicidality among childbearing individuals.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study analyzed data from a medical claims database for a large commercially insured population in the US from January 2006 to December 2017. There were 2714 diagnoses of suicidality 1 year before or after 698 239 deliveries among 595 237 individuals aged 15 to 44 years who were continuously enrolled in a single commercial health insurance plan. Data were analyzed from October 2019 to September 2020.

MAIN OUTCOMES AND MEASURES: The primary outcome was diagnosis of suicidality in childbearing individuals 1 year before or after birth based on the identification of relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes during at least 1 inpatient or 2 outpatient visits.

RESULTS: Of 595 237 included childbearing individuals, the mean (SD) age at delivery was 31.9 (6.4) years. A total of 40 568 individuals (6.8%) were Asian, 52 613 (8.6%) were Black, 73 172 (12.1%) were Hispanic, 369 501 (63.1%) were White, and 59 383 (9.5%) had unknown or missing race/ethnicity data. A total of 2683 individuals were diagnosed with suicidality 1 year before or after giving birth for a total of 2714 diagnoses. The prevalence of suicidal ideation increased from 0.1% per 100 individuals in 2006 to 0.5% per 100 individuals in 2017 (difference, 0.4%; SE, 0.03; P < .001). Intentional self-harm prevalence increased from 0.1% per 100 individuals in 2006 to 0.2% per 100 individuals in 2017 (difference, 0.1%; SE, 0.02; P < .001). Suicidality prevalence increased from 0.2% per 100 individuals in 2006 to 0.6% per 100 individuals in 2017 (difference, 0.4%; SE, 0.04; P < .001). Diagnoses of suicidality with comorbid depression or anxiety increased from 1.2% per 100 individuals in 2006 to 2.6% per 100 individuals in 2017 (difference, 1.4%; SE, 0.2; P < .001). Diagnoses of suicidality with comorbid bipolar or psychotic disorders increased from 6.9% per 100 individuals in 2006 to 16.9% per 100 individuals in 2017 (difference, 10.1%; SE, 0.2; P < .001). Non-Hispanic Black individuals, individuals with lower income, and younger individuals experienced larger increases in suicidality over the study period.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US childbearing individuals, the prevalence of suicidal ideation and intentional self-harm occurring in the year preceding or following birth increased substantially over a 12-year period. Policy makers, health plans, and clinicians should ensure access to universal suicidality screening and appropriate treatment for pregnant and postpartum individuals and seek health system and policy avenues to mitigate this growing public health crisis, particularly for high-risk groups.

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