RESEARCH WEEKLY: Suicide Risk and Prevention in Women with Serious Mental Illness
By Elizabeth Sinclair Hancq
The U.S. Centers for Disease Control and Prevention (CDC) made headlines last week with newly released data showing that suicide deaths decreased overall in 2020, despite dire predictions of the impact on COVID-19 on suicide due to the increased stress, grief, loneliness and economic difficulties associated with the pandemic.
44,834 individuals died by suicide in 2020, according to data from the CDC, a 6% decrease from 2019. By contrast, 345,323 individuals died from complications of COVID-19 in 2020, according to the same data.
While the news that suicide deaths in the United States are trending downward is a step in the right direction, suicide rates are still at a 30-year high. As we wrote in this blog this past February, people with serious mental illness, including schizophrenia and bipolar disorder, are at a significantly increased risk of death by suicide than the general population. Experts agree that suicide prevention strategies must be tailored to address the unique needs of people with serious mental illness.
Suicide risk prediction in women with serious mental illness
Researchers from the Semel Institute for Neuroscience & Human Behavior at the David Geffen School of Medicine at UCLA developed a machine learning algorithm that identified risk factors for self-harm or suicide attempts in women with serious mental illness after having been hospitalized for a physical medical illness. Because women with serious mental illness are at significantly increased risk of suicidal behavior and most women who die by suicide have had a recent contact with a healthcare provider, exploring factors that may predict self-harm among women after a medical hospitalization could help identify who may need further psychiatric care.
The researchers used electronic health records from 1,628 women with serious mental illness from UCLA Medical Center who had a general hospitalization between 2006 and 2017. Obstetric hospitalizations, those due to child birth, were excluded from the analysis to focus the study on risk profiles of women outside of the antenatal or postpartum periods. A machine learning classification model was implemented to determine predictive features and identify risk groups, which the researchers also applied to a data set of patients from New York City to ensure its replicability. The researchers published their findings in Medical Care earlier this year.
Risk groups for self-harm in women with serious mental illness
The researchers found multiple predictors of suicide-related hospital readmissions in women with serious mental illness who had previously been medically hospitalized. The strongest predictor was previous medical illness, however this relationship differed depending on the severity of the medical comorbidity prior to hospitalization. For example, women with more severe comorbid medical illness were at higher risk for self-harm if they also had previous suicidal behavior. Conversely, women with less severe medical illness were at increased risk for self-harm if they were younger than 55 years old.
A history of pregnancy-related mental illness was associated with a significantly increased risk of self-harm after general hospitalization, according to the study results. This finding is important because although there has been a lot of work focused on suicide risk during pregnancy and postpartum, little has been examined following this period. The sample from this study was predominantly postmenopausal women with a mean age of 58 years old, which suggests there are additional risk mechanisms for self-harm in women with a history of pregnancy-related mental illness, according to the authors.
“Women who experienced psychological trauma associated with hospitalization for childbirth may retain vulnerability to trauma reminders during subsequent hospitalizations,” the study authors write. Prevention of self-harm and suicide attempt among women with serious mental illness following acute medical illness could be improved by screening for sex-specific predictors, such as pregnancy-related psychiatric illness. Considering more than 700,000 women attempt suicide each year, increased attention to the unique factors that contribute to self-harm in women with serious mental illness is warranted.
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Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741741.
