{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:22:33Z","timestamp":1790839353280,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T00:00:00Z","timestamp":1707696000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify the incidence and characteristics of maternal suicide.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Nationwide population\u2010based cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The Netherlands, 2006\u20132020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women who died during pregnancy or within 1\u2009year postpartum, and a reference population of women aged 25\u201345\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Cause of Death Register and Medical Birth Register were linked to identify women who died within 1\u2009year postpartum. Data were combined with deaths reported to the Audit Committee for Maternal Mortality and Morbidity (ACMMM), which performs confidential enquiries. Maternal suicides were compared with a previous period (1996\u20132005). Risk factors were obtained by combining vital statistics databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Comparison of incidence and proportion of maternal suicides among all maternal deaths over time, sociodemographic and patient\u2010related risk factors and underreporting of postpartum suicides.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The maternal suicide rate remained stable with 68 deaths: 2.6 per 100\u2009000 live births in 2006\u20132020 versus 2.5 per 100\u2009000 in 1996\u20132005. The proportion of suicides among all maternal deaths increased from 18% to 28%. Most suicides occurred throughout the first year postpartum (64\/68); 34 (53%) of the women who died by suicide postpartum were primiparous. Compared with mid\u2010level, low educational level was a risk factor (odds ratio 4.2, 95% confidence interval 2.3\u20137.9). Of 20 women reported to the ACMMM, 11 (55%) had a psychiatric history and 13 (65%) were in psychiatric treatment at the time of death. Underreporting to ACMMM was 78%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although the overall maternal mortality ratio declined, maternal suicides did not and are now the leading cause of maternal mortality if late deaths up to 1\u2009year postpartum are included. Data collection and analysis of suicides must improve.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17784","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T05:12:14Z","timestamp":1707714734000},"page":"1392-1398","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["The contribution of suicide to maternal mortality: A nationwide population\u2010based cohort study"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3801-6866","authenticated-orcid":false,"given":"Kinke M.","family":"Lommerse","sequence":"first","affiliation":[{"name":"Department of Psychiatry Haaglanden Medisch Centrum  The Hague The Netherlands"},{"name":"Research Department 113 Suicide Prevention  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia","family":"M\u00e9relle","sequence":"additional","affiliation":[{"name":"Research Department 113 Suicide Prevention  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna L.","family":"Rietveld","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Amsterdam University Medical Centre  Amsterdam The Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guus","family":"Berkelmans","sequence":"additional","affiliation":[{"name":"Research Department 113 Suicide Prevention  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Leiden University Medical Centre  Leiden The Netherlands"},{"name":"Athena Institute VU University  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The Netherlands Audit Committee Maternal Mortality and Morbidity","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,12]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"The WHO application of ICD\u201010 to deaths during pregnancy childbirth and puerperium: ICD MM. [cited 2023 Oct 30]. Available from:https:\/\/www.who.int\/publications\/i\/item\/9789241548458"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2022-070621","article-title":"Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study","volume":"379","author":"Diguisto C","year":"2022","journal-title":"BMJ"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15215"},{"key":"e_1_2_11_5_1","volume-title":"Saving lives, improving mothers' care\u2014lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2017\u201319","author":"Knight M","year":"2021"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(16)00003-1"},{"issue":"16","key":"e_1_2_11_7_1","first-page":"913","article-title":"Mortality in pregnant and newly delivered women due to psychiatric disorders","volume":"152","author":"Hink E","year":"2008","journal-title":"Ned Tijdschr Geneeskd"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14312"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00737-021-01161-0"},{"key":"e_1_2_11_10_1","unstructured":"CBS Microdata. [cited 2023 Oct 30]. Available from:https:\/\/www.cbs.nl\/nl\u2010nl\/onze\u2010diensten\/maatwerk\u2010en\u2010microdata\/microdata\u2010zelf\u2010onderzoek\u2010doen"},{"key":"e_1_2_11_11_1","unstructured":"ICD\u201010 version: 2019. [cited 2023 Oct 30]. Available from:https:\/\/icd.who.int\/browse10\/2019\/en"},{"key":"e_1_2_11_12_1","unstructured":"CBS definition on educational level. [cited 2023 Oct 30]. Available from:https:\/\/www.cbs.nl\/en\u2010gb\/news\/2018\/20\/well\u2010being\u2010not\u2010distributed\u2010equally\/education\u2010level"},{"key":"e_1_2_11_13_1","unstructured":"Statline. [cited 2023 Oct 30]. Available from:https:\/\/opendata.cbs.nl\/statline#\/CBS\/nl\/"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.114.161711"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00737-019-00977-1"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.170088"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.173.3.209"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2015.14121510"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.02.056"},{"key":"e_1_2_11_20_1","first-page":"138","article-title":"Suicide during perinatal period: epidemiology, risk factors, and clinical correlates","volume":"7","author":"Orsolini L","year":"2016","journal-title":"Front Psych"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-02985-x"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02290-0"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494814560844"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0238031"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.17784","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T08:32:35Z","timestamp":1758011555000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.17784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,12]]},"references-count":23,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1111\/1471-0528.17784"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.17784","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,12]]},"assertion":[{"value":"2023-10-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}