Are new moms with postpartum medical disorders at risk of suicide?

First-time mothers with postpartum mental disorders (PPMD) are predisposed to self-harm, although the risk is lower than that seen among other psychiatric patients, a study reports. Moreover, new moms with severe PPMD who have a history of self-harm make up a vulnerable group at high risk of later suicide.

The register-based cohort study linked national Danish registers and included 1,202,292 women representing 24,053,543 person-years at risk. There were 1,554 women with severe first-onset PPMD who had a first inpatient or outpatient contact to a psychiatric facility within 90 days after giving birth to their first child. Sixty-four of them had a first-ever hospital record of self-harm.

In the group of women with first-onset PPMD and a hospital record of self-harm following their diagnosis, 20 (31.3 percent) were diagnosed with anxiety or stress-related mental disorders and 18 (28.1 percent) with affective mood disorders in the postpartum period. Six (9.4 percent) women had a schizophrenia or schizotypal disorder, five (7.81 percent) had mental and behavioural disorders associated with the puerperium, and the remaining 15 (23.43 percent) had other diagnoses including personality disorders.

PPMD was associated with a sixfold higher risk of self-harm (hazard ratio [HR], 6.2, 95 percent confidence interval [CI], 4.9–8.0). However, this risk was lower relative to mothers with non-PPMD (HR, 10.1, 95 percent CI, 9.6–10.5) and childless women with mental disorders (HR, 9.3, 95 percent CI, 8.9–9.7).

The risk of self-harm was highest within the first 12 months after PPMD diagnosis (HR, 13.5, 95 percent CI, 8.4–21.7) and decreased thereafter (HR, 5.2, 95 percent CI, 3.9–6.9).

More important was that women with PPMD and records of self-harm were at significantly greater risk of later suicide (HR, 8.7, 95 percent CI, 3.5–21.7) when compared with mothers with non-PPMD (HR, 2.7, 95 percent CI, 1.9–3.7; p=0.0104) and childless women with mental disorders (HR, 2.8, 95 percent CI, 2.1–3.8; p=0.0125).

Researchers called for additional studies aimed at developing tools for early identification of women who will develop first-onset PPMD following childbirth and those who are at risk of self-harm and suicidal behaviours.