Trends in Suicidality 1 Year Before and After Birth Among Commercially Insured Childbearing Individuals in the United States, 2006-2017
Trends in Suicidality 1 Year Before and After Birth Among Commercially Insured Childbearing Individuals in the United States, 2006-2017
复制标题
DOI：
10.1001/jamapsychiatry.2020.3550
复制
发表时间：
2020-11-18
期刊：
影响因子：
25.8
通讯作者：
Zivin, Kara
中科院分区：
文献类型：
--
作者：
Admon, Lindsay K.;Dalton, Vanessa K.;Zivin, Kara
在美国，自杀死亡是孕产妇死亡的主要原因，然而，生育个体中自杀(自杀意念和/或故意自残)的流行率和趋势仍然很少被描述。目的了解育龄人群自杀倾向的发展趋势。设计、设置和参与者这项系列横断面研究分析了2006年1月至2017年12月期间美国大量商业保险人口的医疗索赔数据库中的数据。在连续参加单一商业健康保险计划的595237名15岁至44岁的人中，在分娩前一年或分娩后一年有2714人被诊断为自杀。对2019年10月至2020年9月的数据进行了分析。主要结果和指标主要结果是在至少1名住院患者或2名门诊就诊期间，根据相关的国际疾病分类、第9次修订、临床修改(ICD-9-CM)和ICD-10-CM诊断代码，在出生前或出生后1年或1年后诊断为生育个体自杀。结果595 237名育龄妇女平均分娩年龄为31.9岁(6.4岁)。共有40 568人(6.8%)为亚裔，52 613人(8.6%)为黑人，73 172人(12.1%)为西班牙裔，369 501人(63.1%)为白人，59 383人(9.5%)的种族/族裔资料不详或遗漏。共有2683人在分娩前一年或分娩后一年被诊断为自杀，总计2714例诊断。自杀意念的流行率从2006年的每100人0.1%上升到2017年的每100人0.5%(差异，0.4%；SE，0.03；P<；.001)。故意自残流行率从2006年的每百人0.1%上升到2017年的每百人0.2%(差异，0.1%；SE，0.02；P<；.001)。自杀流行率从2006年的每百人0.2%上升到2017年的每百人0.6%(差异，0.4%；SE，0.04；P<；.001)。诊断为自杀并伴有抑郁或焦虑的病例从2006年的每百人1.2%增加到2017年的每百人2.6%(差异为1.4%；SE，0.2；P<；.001)。诊断患有双相情感障碍或精神病的自杀病例从2006年的每百人6.9%上升到2017年的每百人16.9%(差异为10.1%；SE，0.2；P<；.001)。在研究期间，非西班牙裔黑人个人、收入较低的个人和较年轻的个人的自杀人数增加较多。结论和相关性在这项针对美国育龄人群的横断面研究中，在出生前一年或出生后一年发生的自杀意念和故意自残的流行率在12年期间显著增加。政策制定者、健康计划和临床医生应该确保孕妇和产后个体能够获得普遍的自杀筛查和适当的治疗，并寻求卫生系统和政策途径来缓解这一日益严重的公共健康危机，特别是对高危群体。这项横断面研究评估了商业保险生育个体在出生前和出生后一年自杀(自杀意念和/或故意自残)的流行率和趋势。问题是，在商业保险生育个体的全国大队列中，自杀意念和故意自残的趋势是什么？这一系列横断面分析发现，在2006年至2017年期间，595 237名育龄人员在生育前1年和生育后1年自杀意念和故意自残显著增加。非西班牙裔黑人个人、低收入者、年轻人以及患有焦虑、抑郁或其他严重精神疾病的人的病情有更大的上升。这意味着应对这一健康危机的临床和政策干预措施应该量身定做，以满足生育个体在出生前一年和出生后一年的独特需求，特别是在高危群体中。
Importance Suicide deaths are a leading cause of maternal mortality in the US, yet the prevalence and trends in suicidality (suicidal ideation and/or intentional self-harm) among childbearing individuals remain poorly described. Objective To characterize trends in suicidality among childbearing individuals. Design, Setting, and Participants This serial cross-sectional study analyzed data from a medical claims database for a large commercially insured population in the US from January 2006 to December 2017. There were 2714 diagnoses of suicidality 1 year before or after 698 239 deliveries among 595 237 individuals aged 15 to 44 years who were continuously enrolled in a single commercial health insurance plan. Data were analyzed from October 2019 to September 2020. Main Outcomes and Measures The primary outcome was diagnosis of suicidality in childbearing individuals 1 year before or after birth based on the identification of relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes during at least 1 inpatient or 2 outpatient visits. Results Of 595 237 included childbearing individuals, the mean (SD) age at delivery was 31.9 (6.4) years. A total of 40 568 individuals (6.8%) were Asian, 52 613 (8.6%) were Black, 73 172 (12.1%) were Hispanic, 369 501 (63.1%) were White, and 59 383 (9.5%) had unknown or missing race/ethnicity data. A total of 2683 individuals were diagnosed with suicidality 1 year before or after giving birth for a total of 2714 diagnoses. The prevalence of suicidal ideation increased from 0.1% per 100 individuals in 2006 to 0.5% per 100 individuals in 2017 (difference, 0.4%; SE, 0.03; P < .001). Intentional self-harm prevalence increased from 0.1% per 100 individuals in 2006 to 0.2% per 100 individuals in 2017 (difference, 0.1%; SE, 0.02; P < .001). Suicidality prevalence increased from 0.2% per 100 individuals in 2006 to 0.6% per 100 individuals in 2017 (difference, 0.4%; SE, 0.04; P < .001). Diagnoses of suicidality with comorbid depression or anxiety increased from 1.2% per 100 individuals in 2006 to 2.6% per 100 individuals in 2017 (difference, 1.4%; SE, 0.2; P < .001). Diagnoses of suicidality with comorbid bipolar or psychotic disorders increased from 6.9% per 100 individuals in 2006 to 16.9% per 100 individuals in 2017 (difference, 10.1%; SE, 0.2; P < .001). Non-Hispanic Black individuals, individuals with lower income, and younger individuals experienced larger increases in suicidality over the study period. Conclusions and Relevance In this cross-sectional study of US childbearing individuals, the prevalence of suicidal ideation and intentional self-harm occurring in the year preceding or following birth increased substantially over a 12-year period. Policy makers, health plans, and clinicians should ensure access to universal suicidality screening and appropriate treatment for pregnant and postpartum individuals and seek health system and policy avenues to mitigate this growing public health crisis, particularly for high-risk groups.This cross-sectional study evaluates prevalence and trends in suicidality (suicidal ideation and/or intentional self-harm) among commercially insured childbearing individuals 1 year before and following birth.Question What are the trends in suicidal ideation and intentional self-harm in a large national cohort of commercially insured childbearing individuals? Findings In this serial cross-sectional analysis of 595 237 childbearing individuals 1 year before and after giving birth, suicidal ideation and intentional self-harm increased significantly between 2006 and 2017. Non-Hispanic Black individuals, those with low-income, and younger individuals as well as those with comorbid anxiety, depression, or other serious mental illness had larger escalations. Meaning Clinical and policy interventions for addressing this health crisis should be tailored to meet the unique needs of childbearing individuals in the year before and following birth, particularly among high-risk groups.