Pregnancy-related suicide deaths between 2004-2014 in Antioquia (Colombia)
DOI:
https://doi.org/10.18597/rcog.3125Keywords:
Maternal health, suicide, maternal mortalityAbstract
Objective: To characterise the population of women who died as a result of suicide during pregnancy, delivery and the postpartum period in the Department of Antioquia between 2004 and 2014, and to estimate the proportion of deaths due to suicide.
Materials and methods: Descriptive study of suicide deaths during pregnancy, delivery and the postpartum period in women living in the Department of Antioquia, in central Colombia, identified between 2004 and 2014. All the cases identified from the National Public Health Surveillance (SIVIGILA) reporting system and death certificates were included. Data were taken from clinical records and charts. Clinical and sociodemographic characteristics were assessed. Risk factors taken into consideration included a personal or family history of mental disorder, the use of psychoactive substances, attempted suicide, domestic violence and intimate partner violence. Categorical variables were grouped according to frequency in terms of proportions and percentages; medians and inter-quartile ranges were calculated for continuous variables. The proportion of suicide deaths was calculated over the total number of maternal deaths which occurred in the Department during the study period, and the mortality ratio was calculated specifically by age groups taking into consideration the number of deaths identified in the research by age group and the total number of live births reported by DANE in women of that age during the 11-year period, expressed as number of maternal deaths/1000 live births.
Results: Between 2004 and 2014 there were a total of 476 maternal deaths and 24 cases of suicide death, for a proportion of 4.8%. Data were available for descriptions in 18 cases. The highest number of suicide deaths occurred in the age group between 20 and 29 years, single women, housewives or students, living in rural areas, affiliated to the subsidised healthcare regime and with less than complete secondary education and one-half of the patients had attended prenatal care visits. Deaths were due to poisoning and 30% were suicide by hanging. There was a similar distribution between the deaths that occurred in the first two trimesters of pregnancy and the late postpartum period. Here were no data in the personal history of risk factors for suicide in 44.4% of cases, or in the family history in 72.2% of cases.
Conclusions: Pregnancy-related suicide deaths are an important cause of potentially avoidable maternal mortality. Identification of vulnerable patients is required in order to offer active treatment and reinforce follow-up. Greater commitment is needed in terms of event documentation, notification, follow-up and analysis.Author Biographies
Natalia Sofía Aguirre-Martínez
Especialista en Obstetricia y Ginecología, Universidad de Antioquia, Medellín (Colombia).
Gladis Adriana Vélez-Álvarez
Especialista en Obstetricia y Ginecología, magíster en Salud Pública. Docente, NACER, Salud Sexual y Reproductiva - Departamento de Obstetricia y Ginecología, Universidad de Antioquia, Medellín
(Colombia).
John Jairo Zuleta-Tobón
Especialista en Obstetricia y Ginecología, magíster en Epidemiología. Docente, NACER, Salud Sexual y Reproductiva - Departamento de Obstetricia y Ginecología, Universidad de Antioquia, Medellín (Colombia). jjzuleta@une.net.co
MO
References
Organización Mundial de la Salud. Prevención del suicidio: un imperativo global. Washington, DC: OPS; 2014 (visitado 2018 oct 17). Disponible en: http://apps.who.int/iris/bitstream/10665/136083/1/9789275318508_spa.pdf
Ministerio de Salud y Protección Social. Boletín de salud mental. Conducta suicida. Subdirección de Enfermedades No Transmisibles. Boletín 2, julio de 2017 (visitado 2018 oct 17). Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ENT/boletin-conducta-suicida.pdf
Rodríguez Navarrete JM. Comportamiento del suicidio. Colombia, 2016. Forensis 2016. Datos para la vida. 2017 (visitado 2018 oct 17);18:402-38. Disponible en: http://www.medicinalegal.gov.co/documents/10180/34616/6-F-11-Suicidio.pdf/6b2966e7-cbcb-4618-a3c3-af5cd111629e
Salas Zapata C, Galeano López LD. La vigilancia epidemiológica de la conducta suicida en Medellín. Revista del Observatorio Nacional de Salud Mental Colombia. 2012;2:16-22.
Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk J. MBRRACE - UK. Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-13. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2015 (visitado 2018 oct 17):1-116. Disponible en: https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202015.pdf
CMACE. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006-08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. Centre for Maternal and Child Enquiries. BJOG. 2011;118(Suppl. 1):1-203. https://doi.org/10.1111/j.1471-0528.2010.02847.x
Sixth annual report of the perinatal and maternal mortality review committee. Reporting mortality 2010. Wellington: The perinatal and maternal mortality review committee. Health quality and safety commission New Zealand; 2012. p. 1-160. https://www.hqsc.govt.nz/assets/PMMRC/Publications/PMMRC-6th-Report-2010-Lkd.pdf
Equipo Maternidad Segura. Subdirección de Prevención, Vigilancia y Control en Salud Pública, Instituto Nacional de Salud. Protocolo de vigilancia y control de mortalidad materna. 2016 (visitado 2018 oct 17). Disponible en: http://www.ins.gov.co/buscadoreventos/ZIKA%20Lineamientos/PRO%20Mortalidad%20materna.pdf
Palladino CL, Singh V, Campbell J, Flynn H, Gold KJ. Homicide and suicide during the perinatal period: Findings from the National Violent Death Reporting System. Obstet Gynecol. 2011(visitado 2018 oct 17);118:1056-63. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428236/pdf/nihms330068.pdf
Guía de la OMS para la aplicación de la CIE-10 a las muertes ocurridas durante el embarazo, parto y puerperio: CIE-MM. Organización Mundial de la Salud; 2012. p. 1-77. http://www.paho.org/clap/index.php?option=com_docman&view=download&category_slug=sip&alias=308-guia-de-la-oms-para-laaplicacion-de-la-cie10-a-las-muertes-ocurridasdurante-el-embarazo-parto-y-puerperio-ciemm-5&Itemid=219&lang=es
Gobernación de Antioquia, Secretaría Seccional de Salud y Protección Social de Antioquia. Diagnóstico de situación de salud del departamento de Antioquia 2014 (visitado 2018 oct 17). Disponible en: diagnosticosalud.dssa.gov.co/0-5-sexualidad-y-derechos-sexuales-yreproductivos/5-sexualidad-y-derechos-sexuales-yreproductivos/12. WHO. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD MM. World Health Organization 2012 (visitado 2018 oct 17). Disponible en: http://www.who.int/reproductivehealth/publications/monitoring/9789241548458/en/
WHO. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD MM. World Health Organization 2012 (visitado 2018 oct 17). Disponible en: http://www.who.int/reproductivehealth/publications/monitoring/9789241548458/en/
Velásquez J, Gómez J. Muertes por suicidio. En: Gobernación de Antioquia, Dirección Seccional de Salud de Antioquia. La salud de las madres en Antioquia: un reto, un derecho, un compromiso. Medellín: Multigráficas; 2007. p. 257-64.
International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10): World Health Organization; 2016. (visitado 2018 oct 17). Disponible en: http://apps.who.int/classifications/icd10/browse/2016/en#/V
Velásquez-Penagos J, Vélez-Álvarez GA, Gómez-Dávila JG, Escobar-Osorio SM, Garay-Vásquez HK, Zuleta-Tobón JJ. Estudio de mortalidad materna por sepsis en Antioquia, Colombia, entre los años 2004-2014: una mirada al desafío de la identificación y el tratamiento oportunos. Rev Colomb Obstet Ginecol. 2017 (visitado 2018 oct 17);68:228-38. Disponible en: https://revista.fecolsog.org/index.php/rcog/article/view/1043/3192
Oates M. Perinatal psychiatric disorders: A leading cause of maternal morbidity and mortality. Br Med Bull. 2003;67:219-29. Disponible en: https://academic.oup.com/bmb/article/67/1/219/330390
Shadigian E, Bauer ST. Pregnancy-associated death: A qualitative systematic review of homicide and suicide. Obstet Gynecol Surv. 2005 (visitado 2018 oct 17);60(3):183-90. Disponible en: https://www.researchgate.net/publication/7209688_Pregnancy-Associated_Death_A_Qualitative_Systematic_Review_of_Homicide_and_Suicide
Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health. 2005;8:77-87. Disponible en: https://link.springer.com/article/10.1007%2Fs00737-005-0080-1
Khalifeh H, Hunt IM, Appleby L, Howard LM. Suicide in perinatal and non-perinatal women in contact with psychiatric services: 15 year findings from a UK national inquiry. Lancet Psychiatry. 2016 (visitado 2018 oct 17);3:233-42. Disponible en: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)00003-1/fulltext
Fuhr DC, Calvert C, Ronsmans C, Chandra PS, Sikander S, De Silva MJ, et al. Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: A systematic review and meta-analysis. Lancet Psychiatry. 2014 (visitado 2018 oct 17);1:213-25. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567698/pdf/nihms708669.pdf
Appleby L. Suicide during pregnancy and in the first postnatal year. BMJ. 1991 (visitado 2018 oct 17);302:137-40. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1668816/pdf/bmj00109-0019.pdf
Gold KJ, Singh V, Marcus SM, Palladino CL. Mental health, substance use and intimate partner problems among pregnant and postpartum suicide victims in the National Violent Death Reporting System. Gen Hosp Psychiatry. 2012 (visitado 2018 oct 17);34:139-45. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275697/pdf/nihms329274.pdf
Gissler M, Berg C, Bouvier-Colle MH, Buekens P. Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. Eur J Public Health. 2005 (visitado 2018 oct 17);15:459-63. Disponible en: https://academic.oup.com/eurpub/article/15/5/459/526248
Primary prevention of mental, neurological and psychosocial disorders. World Health Organization; 1998 (visitado 2018 oct 17). Disponible en: http://apps.who.int/iris/bitstream/10665/42043/1/924154516X_eng.pdf
Högberg U, Innala E, Sandström A. Maternal mortality in Sweden, 1980-1988. Obstet Gynecol. 1994;84:240-4.
Vigod SN, Wilson CA, Howard LM. Depression in pregnancy. BMJ. 2016 (visitado 2018 oct 17);352:i1547. Disponible en: http://www.bmj.com/content/352/bmj.i1547
How to Cite
Downloads
Downloads
Published
Issue
Section
Article metrics | |
---|---|
Abstract views | |
Galley vies | |
PDF Views | |
HTML views | |
Other views |