The U.S. has the highest maternal mortality rate among developed nations, with mental health conditions playing a significant role, according to a recent study.

The cross-sectional observational study published in JAMA Network Open investigated the specific contextual and individual risk factors associated with suicide during the perinatal period. Researchers utilized data from the National Violent Death Reporting System from January 1, 2003, to December 31, 2021. The analysis focused on female decedents aged 10 to 50 years who were pregnant or postpartum at the time of death (n=1,150 perinatal group) and a demographically matched group of nonpregnant female decedents (n=17,655 nonperinatal group).

Among the perinatal decedents, 456 (39.6%) were pregnant at death, 203 (17.7%) were within 42 days postpartum, and 491 (42.7%) were between 43 to 365 days postpartum. The mean age was 29.1 (7.4) years for perinatal decedents and 35.8 (10.8) years for nonperinatal decedents. Perinatal decedents had higher odds of experiencing intimate partner problems (IPP) (OR, 1.45; 95% CI, 1.23-1.72), recent arguments (OR, 1.33; 95% CI, 1.09-1.61), depressed mood (OR, 1.39; 95% CI, 1.19-1.63), substance abuse (OR, 1.21; 95% CI, 1.03-1.42), physical health problems (OR, 1.37; 95% CI, 1.09-1.72), and recent bereavement (OR, 1.47; 95% CI, 1.06-2.02) compared to nonperinatal decedents. Qualitative analysis highlighted postpartum depression in 128 (12.4%) perinatal decedents.

The primary outcomes included circumstances contributing to suicides and undetermined deaths documented in coroner, medical examiner, or law enforcement case narratives. Researchers noted quantitative findings to include that perinatal decedents were younger, less likely to be White, had lower educational attainment, and were more likely to be married. Postpartum decedents also had higher odds of depression and multiple mental illness diagnoses compared to pregnant decedents. No differences in substance use problems were noted.

Qualitative analysis revealed key mental health and substance use challenges among perinatal decedents, with 40.1% diagnosed with depression and 26.5% using prescription drugs, including misuse. Relationship conflicts, such as intimate partner problems and arguments, were found to be common. Miscarriage, stillbirth, and abortion were also highlighted themes. This analysis provided “richer and more nuanced insights” compared to quantitative data alone, noted the researchers.

“Suicide death remains the leading cause of maternal mortality, and preventing maternal suicides represents an unmet public health need,” stated researchers. They concluded clinicians and policymakers should implement evidence-based interventions and reduce stigma around mental health, substance use, and IPPs to decrease maternal suicide mortality.

The authors reported no conflicts of interest.