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All-Cause Mortality in Women With Severe Postpartum Psychiatric Disorders
Open accessAbstract
OBJECTIVE: The postpartum period is associated with a high risk of psychiatric episodes. The authors studied mortality in women with first-onset severe psychiatric disorders following childbirth and compared their mortality rates with those in women from the background population including other female psychiatric patients (mothers and childless women). METHOD: In a register-based cohort study with linked information from Danish population registers, the authors identified women with first psychiatric inpatient or outpatient contacts 0-3 months postpartum. The main outcome measure was mortality rate ratios (MRRs): deaths from natural causes (diseases and medical conditions) or unnatural causes (suicides, accidents, and homicides). The cohort included 1,545,857 women representing 68,473,423 person-years at risk. RESULTS: In total, 2,699 women had first-onset psychiatric disorders 0-3 months postpartum, and 96 of these died during follow-up. Women with postpartum psychiatric disorders had a higher MRR (3.74; 95% CI=3.06-4.57) than non-postpartum-onset mothers (MRR=2.73; 95% CI=2.67-2.79) when compared with mothers with no psychiatric history. However, childless women with psychiatric diagnoses had the highest MRR (6.15; 95% CI=5.94-6.38). Unnatural cause of death represented 40.6% of fatalities among women with postpartum psychiatric disorders, and within the first year after diagnosis, suicide risk was drastically increased (MRR=289.42; 95% CI=144.02-581.62) when compared with mothers with no psychiatric history. CONCLUSIONS: Women with severe postpartum psychiatric disorders had increased MRRs compared with mothers without psychiatric diagnoses, and the first year after diagnosis represents a time of particularly high relative risk for suicide in this vulnerable group.
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“Additionally, suicide risks are substantial after delivery and cannot be ignored [4].”
BackgroundSelf-citationSuicides and Suicidal Ideation During the Perinatal Period: Clinical and Demographic Data
Bazoukis, X., Eskitzis, P., Orovou, E., Arampatzi, C., & Spyropoulou, A. C. (2022) · International Journal of Innovative Research in Medical Science · doi:10.23958/ijirms/vol07-i12/1564 · Cited by 4
Moran, L. R., Sheehan, J. D., Roddy, D., & Duffy, R. M. (2023) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2023.12 · Cited by 4
“In industrialised countries, suicide has been reported as a leading cause of death in post-natal women (Centre for Maternal and Child Enquiries, 2011; Fuhr et al. 2014; Esscher et al. 2016; Johannsen et al. 2016).”
BackgroundAnke, T. M. S., & Skjelstad, D. V. (2025) · International Journal of Bipolar Disorders · doi:10.1186/s40345-025-00374-x · Cited by 6
“…perinatal suicides are rare in the general population, perinatal suicidal ideation is considered a risk factor for suicidal behaviour (Orsolini et al. 2016), and postpartum women with severe depression and psychosis are at particular risk (Johannsen et al. 2016; Khalifeh et al. 2016; Oates 2003).”
Brown, H. K., Barrett, K., & Scime, N. V. (2021) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2021.100975 · Cited by 3
Genetic liability to posttraumatic stress disorder and its association with postpartum depression
Madsen, K. B., Liu, X., Albiñana, C., Vilhjálmsson, B. J., Agerbo, E., Mortensen, P. B., HOUGAARD, D. M., Nordentoft, M., Werge, T. M., Mors, O. N., et al. (2022) · Psychological Medicine · doi:10.1017/s0033291722002045 · Cited by 3
Self-citationSleep disturbance as a marker of postpartum psychosis risk: a prospective actigraphy study
Petrosellini, C., Eriksson, S. H., Meyer, N., Antony, E., Protti, O., Donaldson, L., van Hees, V. T., Petrie, A., McQuillin, A., & Siassakos, D. M. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07017-6 · Cited by 3
“Thoughts of self-harm are common [1] and delusions are often centred around the baby [6], increasing the risks of suicide and infanticide [7–9].”
Clinical phenotypes of peripartum depression and time of onset
Guintivano, J., Putnam, K. T., Sullivan, P. F., & Meltzer-Brody, S. E. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815508-0.00001-1 · Cited by 3
Self-citationXu, J., Xiao, Y., Li, F., Cui, Y., Shi, C., Shi, J., Yu, C., Qi, S., Lu, C., Li, G., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.01.041 · Cited by 4
Sun, Y., Liu, L., Bu, C., Jiang, M., & Zheng, X. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1802534 · Cited by 3
“Studies have found that the suicide rate within one year postpartum among mothers with postpartum psychiatric disorders is signi fi cantly higher than that among healthy mothers (3), establishing PND as a major risk factor for maternal suicide.”
Perinatal Dönemde Ruh Sağlığı Sorunları, Yaygınlığı, Neden ve Sonuçları: Derleme
Fındıklı, E. (2022) · Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi · doi:10.17517/ksutfd.1111035 · Cited by 2
Kang, Z., Wu, Q., Cao, J., Zhu, M., You, Z., Li, D., & Liu, W. (2024) · Frontiers in Genetics · doi:10.3389/fgene.2024.1434762 · Cited by 3
Najafi, T. F., Dashti, S., Naghsh, A., & Parsa, M. S. (2024) · Archives of Public Health · doi:10.1186/s13690-024-01466-3 · Cited by 2
Perinatal psychiatric emergencies in rural Australia: In urgent need of attention
Cribb, E., Spring, B., Galbally, M., Gardiner, F. W., & Coleman, M. (2024) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674241308689 · Cited by 3
“As with severe peri-natal depressive disorders, co-admis-sion to specialist Mother and Baby Units (MBUs) for women experiencing PPP is recommended (Johannsen et al., 2016; Jones et al., 2014).”
Maternal Mortality in Slovakia in the Years 2007–2023
Kotríková, D., Adamec, A., Vargová, M., Krištúfková, A., McCullough, L., Štrbová, D., Goldbergerová, A., Danis, J., Nižňanská, Z., & Korbeľ, M. (2025) · Bratislavské lekárske listy/Bratislava medical journal · doi:10.1007/s44411-025-00094-9 · Cited by 2
“When suicides were reclassified as direct maternal deaths, the MMR results varied depending on whether the deaths were categorized as early or late MM [21, 22].”
Novel Neurosteroid Pharmaceuticals
Susser, L. C., Swanson, C., & Hermann, A. D. (2021) · Advances in Psychiatry and Behavioral Health · doi:10.1016/j.ypsc.2021.05.017 · Cited by 2
Acute Psychiatric Conditions in Pregnancy
Puryear, L. J. (2018) · Wiley eBooks · doi:10.1002/9781119129400.ch33 · Cited by 2
Antepartum Psychosis in the Setting of Preeclampsia With Severe Features: A Case Report
Moy, M. I., Truonghuynh, A., Villarreal, E. L., & Neal, D. (2023) · Cureus · doi:10.7759/cureus.49678 · Cited by 1
“…with postpartum psychiatric disorders had a higher mortality rate ratio than those without psychiatric history, with 40.6% of fatalities in this high-risk population attributed to unnatural causes such as suicides, accidents, and homicides, highlighting a significant increase in suicide risk [3].”
BackgroundInfluentialSuicide among Reproductive-Age Women in Northwest Ethiopia: A Community-Based Cross-Sectional Study
Tinsae, T., Fanta, B., & Alemu, W. G. (2024) · Depression and Anxiety · doi:10.1155/2024/1735716 · Cited by 1
“Major risk factors for SI and SA included depression, exposure to potentially fatal situations, marital violence and mistreatment of children, low socioeconomic position, and a lack of social support [19, 20, 23, 24].”
Call For Action: The Obstetrician's Role In Peripartum Mental Health
Chauhan, A. R., & Chauhan, A. R. (2024) · The Journal of Obstetrics and Gynecology of India · doi:10.1007/s13224-024-02076-3 · Cited by 1
Current opinion in anesthesiology: post-traumatic stress disorder following birth
Tremper, L. S., & Neumann, K. E. (2025) · Current Opinion in Anaesthesiology · doi:10.1097/aco.0000000000001470 · Cited by 1
Grundström, H., Malmquist, A., Thorsell, M., & Nieminen, K. (2025) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2025.2553197 · Cited by 1
“…vulnerability during the transition to parenthood and the importance of targeted support for this group. the overall prevalence of PPD in this study was higher than reported in a previous Danish study (Johannsen et al. 2016) but in line with previous international studies (choi and sikkema 2016).”
Prevalence of and Risk Factors for Postpartum Anxiety in a U.S. Cohort With Commercial Insurance
Smith, M., Koons, N. J., Callihan, P., Guo, N., Simard, J. F., Gardner, R. M., Carvalho, B., Bateman, B. T., Leonard, S. A., & Sultan, P. (2026) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000006220 · Cited by 1
Psychiatric Problems in Pregnancy and Post Partum
MacLean, J. V., & Pearlstein, T. B. (2018) · Wiley eBooks · doi:10.1002/9781119211457.ch14 · Cited by 2
Isobel, S., Green, A., & Lim‐Gibson, S. (2025) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.14269 · Cited by 1
Stolen motherhood-case study of postpartum depression
Gerhant, A., Olajossy, M., Kalińska, A., & Miernicka, A. (2016) · Current Problems of Psychiatry · doi:10.1515/cpp-2016-0016 · Cited by 1
“Ryzyko samobójstwa w tym okresie jest niemal 290 razy większy niż u zdrowych kobiet [27].”
BackgroundFreedman, R., Lewis, D. A., Michels, R., Pine, D. S., Rush, A. J., Schultz, S. K., Tamminga, C. A., & Pier, K. S. (2016) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2016.16101120 · Cited by 1
Patterson, R., & Meltzer-Brody, S. E. (2024) · Neuropsychopharmacology · doi:10.1038/s41386-024-01818-1 · Cited by 1
“Maternal suicide from PPD has been well documented in the literature as being one of the greatest causes of maternal death [2, 3].”
Self-citationLin, H., Hu, C.-L. J., Hu, S., Ying, Y., Shang, L., Qiu, X., Luo, Q., & Xu, H. (2025) · Research Square · doi:10.21203/rs.3.rs-7079798/v1 · Cited by 1
Stone, B., Amiri, A., Zhao, S., Hamidi, S., Johnson, P., & Bruns, D. (2025) · Healthcare · doi:10.3390/healthcare13192407
“Hagatulah et al. [14] found an association between postpartum depression (PPD) and an increased risk of death of both natural and unnatural causes compared to women who did not have PPD. Postpartum women with severe psychiatric disorders had an increased risk of maternal mortality [15,16].”
Vikström, J. (2016) · Linköping University medical dissertations · doi:10.3384/diss.diva-132764
Die Einschätzung des Suizidrisikos
Jandl, M., Steyer, J., Hodgkinson, S., & Kaschka, W. P. (2017) · Nervenheilkunde · doi:10.1055/s-0038-1627007
“In einer dänischen Kohortenstudie, die 1 545 857 Frauen einschloss, zeigte diese Gruppe im ersten Jahr nach Diagnosestellung ein deutlich erhöhtes relatives Risiko für Suizide im Vergleich zur Kontrollgruppe (86).”
BackgroundClinical Conundrum: A Complex Case of Postpartum Depression
Chandra, P. S., Ganjekar, S., & Parameshwaran, S. (2018) · Springer eBooks · doi:10.1007/978-3-319-70311-4_5
Perinatal Patients with Manic Symptoms
Bottom, R. L. (2021) · Springer eBooks · doi:10.1007/978-3-030-71497-0_12
Metadata
- Authors
- Johannsen, B. M. W., Larsen, J. T., Laursen, T. M., Bergink, V., Meltzer-Brody, S., & Munk-Olsen, T.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- From the National Center for Register-Based Research and the Center for Integrated Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark; the Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands; and the Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill.
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2016-06-01
- Volume
- 173
- Issue
- 6
- Pages
- 635-642
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC5325688
- OpenAlex
- W2292507621
- Cited by
- 110
- References
- 32
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 15 · 2023: 9 · 2022: 11 · 2021: 10 · 2020: 8 · 2019: 11 · 2018: 10 · 2017: 9 · 2016: 8
- FWCI
- 12.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- PubMed Central (acceptedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Funders
- Lundbeckfonden (R155-2014-1724, R155-2012-11280)
- National Institute of Mental Health (R01MH104468)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- postpartum mental disorders, all-cause mortality, suicide risk, postpartum depression, childless women, mothers, mortality rate ratio, unnatural causes of death, postpartum period
- MeSH terms
- Adolescent, Adult, Mental Disorders, Cause of Death, Denmark, Female, Humans, Puerperal Disorders, Registries, Suicide, Survival Analysis, Case-Control Studies, Postpartum Period, Young Adult
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