Do stillbirth, miscarriage, and termination of pregnancy increase risks of attempted and completed suicide within a year? A population-based nested case–control study

Objective: To investigate the risks of attempted and completed suicide in women who experienced a stillbirth, miscarriage, or termination of pregnancy within 1 year postnatally and compare this risk with that in women who experienced a live birth. Design: A nested case–control study. Setting: Linking three nationwide population-based data sets in Taiwan: the National Health Insurance Research Database, the National Birth Registry and the National Death Registry. Sample: In all, 485 and 350 cases of attempted and completed suicide, respectively, were identified during 2001–11; for each case, ten controls were randomly selected and matched to the cases according to the age and year of delivery. Methods: Conditional logistic regression. Main outcome measures: Attempted and completed suicidal statuses were determined. Results: The rates of attempted suicide increased in the women who experienced fetal loss. The risk of completed suicide was higher in women who experienced a stillbirth [adjusted odds ratio (aOR) 5.2; 95% CI 1.77–15.32], miscarriage (aOR 3.81; 95% CI 2.81–5.15), or termination of pregnancy (aOR 3.12; 95% CI 1.77–5.5) than in those who had a live birth. Furthermore, the risk of attempted suicide was significantly higher in women who experienced a miscarriage (aOR 2.1; 95% CI 1.66–2.65) or termination of pregnancy (aOR 2.5; 95% CI 1.63–3.82). In addition to marital and educational statuses, psychological illness increased the risk of suicidal behaviour. Conclusions: The risk of suicide might increase in women who experience fetal loss within 1 year postnatally. Healthcare professionals and family members should enhance their sensitivity to care for possible mental distress, particularly for women who have experienced a stillbirth. Tweetable abstract: Suicide risk increased in women who had a stillbirth, miscarriage, or termination of pregnancy within 1 year postnatally.