When Kara Zivin was pregnant, she found herself facing a “perfect storm” of stressors. She was buried under a high-stakes work deadline, newly married and a new stepmom, and had decided to stop taking antidepressants because she hoped for a medication-free pregnancy.
Zivin is a public health researcher who teaches psychiatry and obstetrics and gynecology with the University of Michigan’s School of Public Health, but despite her background studying mental health, she began to spiral.
“Beginning in my first trimester and lasting after delivery, I battled terrible insomnia. Day blended into night and back into day,” Zivin wrote in a MedPage Today essay about her experience. She stopped eating and found herself getting lost while driving.
“One night in my eighth month of pregnancy, when I had convinced myself that my family would be better off without me, I swallowed handfuls of pills and crawled into bed, or so I thought,” Zivin wrote. “It turns out I went downstairs into the kitchen and collapsed. When my husband found me unresponsive, he called for help.”
Zivin survived. She had a baby, who is now 9 years old. And she spends much of her professional life now working to lessen the stigma that continues to shroud perinatal mental illness and suicide, not only by sharing her personal experience but through academic research.
And now she is co-author of an alarming new study that suggests suicide “near misses” during pregnancy and after childbirth, like her own, are on the rise.
The research, published in the journal JAMA Psychiatry last week, used hospital billing records from nearly 600,000 women who delivered babies between 2006 and 2017 across the United States.
“By 2017, suicidality affected 0.6% of the childbearing population that we studied, which is about 24,000 women a year,” study researcher Dr. Lindsay Admon, an OB-GYN at Michigan Medicine’s Von Voigtlander Women’s Hospital, told HuffPost.
“We believe these are underestimates,” she added.
That is because in order for a woman to have a “near miss” coded in her chart, she needed to have clear evidence of depressive symptoms or to have disclosed what she was experiencing. As such, many women are likely flying under the radar.
Admon and Zivin believe the new study highlights an immediate need to expand our collective understanding of what drives maternal mortality in this country.
Currently, national statistics on the issue specifically exclude suicide, looking instead at other physical factors like infection, hemorrhage and embolisms.
This despite the fact that suicide is known to be among the leading causes of death for women age 20 to 44.
While the new study does not attempt to explain why there has been an apparent jump in suicidal near misses among expectant women and new moms, the authors have their own hypotheses.
“There are multiple reasons why there may be upticks,” Zivin told HuffPost. “One might be greater willingness for women to disclose suicidality as discussions about mental health become more commonplace.”
In other words, women might be more open to discussing suicidal thoughts with their providers as the issue slowly continues to move from the shadows — and health care providers, including OB-GYNs and pediatricians, who see women often during the postpartum period are being urged to routinely screen for perinatal mood issues. It is estimated that one in seven women struggle with postpartum depression, and depression can be a risk factor for suicide and suicidal thoughts.
Zivin also noted that there were changes in diagnostic coding that occurred in 2015 that might have affected the records.
But the researchers also believe their findings point to the fact that thousands of women struggle with mental health concerns and suicidal thoughts during pregnancy, as well as in the grueling months after.
And that in general, suicide remains “stigmatized” and “under-discussed,” Zivin said.
As she wrote in her essay about her personal experience with depression and suicidality: “This disease cuts across race, ethnicity, class, educational attainment, and geography. Most women do not receive any treatment. My story illustrates the potential depth and severity of this disease and provides an example of someone who survived and thrived in its aftermath.”
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.