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<h5 class="section-title" id="d7057635e145">BACKGROUND:</h5>
<p id="d7057635e147">Death by suicide during the perinatal period has been understudied
in Canada. We examined
the epidemiology of and health service use related to suicides during pregnancy and
the first postpartum year.
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<h5 class="section-title" id="d7057635e150">METHODS:</h5>
<p id="d7057635e152">In this retrospective, population-based cohort study, we linked
health administrative
databases with coroner death records (1994–2008) for Ontario, Canada. We compared
sociodemographic characteristics, clinical features and health service use in the
30 days and 1 year before death between women who died by suicide perinatally, women
who died by suicide outside of the perinatal period and living perinatal women.
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<h5 class="section-title" id="d7057635e155">RESULTS:</h5>
<p id="d7057635e157">The perinatal suicide rate was 2.58 per 100 000 live births,
with suicide accounting
for 51 (5.3%) of 966 perinatal deaths. Most suicides occurred during the final quarter
of the first postpartum year, with highest rates in rural and remote regions. Perinatal
women were more likely to die from hanging (33.3% [17/51]) or jumping or falling (19.6%
[10/51]) than women who died by suicide non-perinatally (
<i>p</i> = 0.04). Only 39.2% (20/51) had mental health contact within the 30 days
before death,
similar to the rate among those who died by suicide non-perinatally (47.7% [762/1597];
odds ratio [OR] 0.71, 95% confidence interval [CI] 0.40–1.25). Compared with living
perinatal women matched by pregnancy or postpartum status at date of suicide, perinatal
women who died by suicide had similar likelihood of non–mental health primary care
and obstetric care before the index date but had a lower likelihood of pediatric contact
(64.5% [20/31] v. 88.4% [137/155] at 30 days; OR 0.24, 95% CI 0.10–0.58).
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<h5 class="section-title" id="d7057635e163">INTERPRETATION:</h5>
<p id="d7057635e165">The perinatal suicide rate for Ontario during the period 1994–2008
was comparable
to international estimates and represents a substantial component of Canadian perinatal
mortality. Given that deaths by suicide occur throughout the perinatal period, all
health care providers must be collectively vigilant in assessing risk.
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