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Suicide the top cause of death among pregnant and postnatal women: study

About double the number of expecting and nursing mothers in Tokyo's 23 central wards died of suicide than from bleeding or other non-psychiatric medical reasons in the decade between 2005 and 2014, a first-of-its-kind study has revealed.

    The study -- which looked into the suicide rate among pregnant women and women who had given birth in the recent past -- was carried out by the Tokyo Medical Examiner's Office of the Tokyo Metropolitan Government, along with Juntendo University professor of obstetrics and gynecology Satoru Takeda, at the request of the Japan Society of Obstetrics and Gynecology (JSOG).

    The researchers found that among those who had killed themselves between 2005 and 2014, 23 were pregnant women and 40 were women who had given birth less than a year before their suicides. Twelve suicide deaths occurred among women who were two months pregnant, and nine among those who had given birth four months' prior.

    Some 60 percent of women who had given birth less than a year before their suicides had received outpatient medical care for psychiatric conditions such as depression and schizophrenia. About half of those women had postpartum depression, which is said to develop by around six months after giving birth. Around 40 percent of women who had given birth less than a year before their suicides -- as well as some 60 percent of pregnant women who killed themselves -- had no record of receiving outpatient psychiatric care. However, this latter group of women included those who were troubled by child-rearing but refused to seek psychiatric care.

    There were 740,951 births in Tokyo's central 23 wards between 2005 and 2014. The rate of deaths among expecting and nursing mothers between 2005 and 2013 tallied by the Tokyo Metropolitan Government was 4.1 in every 100,000 births -- down from 84 in every 100,000 births half a century ago, thanks to improvements in medicine and other fields. The number of suicide deaths among expecting and nursing mothers between 2005 and 2014, however, was 8.5 in every 100,000 births -- over double the number of non-suicide deaths.

    Specific measures for checking on the emotional states of pregnant and nursing women and quickly identifying those who may be at risk for postpartum depression will be incorporated into JSOG's guidelines for obstetrical practice in Japan, which are set to be updated next year.

    "It's shocking that the suicide rate is this high (among women who are pregnant or have just given birth)," Takeda said. "There is a need to identify the numbers nationwide, and for administrative agencies and medical institutions to provide support for women who may be at high risk of suicide."

    According to the study, one in three of the women who killed themselves after giving birth had postpartum depression. About one in 10 women who give birth in Japan are said to develop the condition, which can be caused by hormonal imbalances and difficulties faced in child-rearing.

    Women tend to become isolated from the rest of society during pregnancy and shortly after birth, and there are cases in which women who are on psychiatric drugs go off their medications out of concern for possible negative effects on the fetus or their breast milk -- thereby putting their mental health at risk. It is possible that lives could have been saved had psychiatrists and ob-gyn doctors worked together in prescribing medications.

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