Postpartum depression and suicide in Iran

Abstract

In Iran, postpartum depression is one of the common emotional symptoms which affects approximately 25% of the women who experienced childbirth. Iranian Forensic Medicine Organization (IFMO) and its branches across the country are the comprehensive sources of collecting data related to suicide deaths. In the data collecting form of suicide, there is not any item about the pregnancy of women at the time of suicide, having childbirth during the previous six weeks, and the time interval between delivery and suicide. It is suggested that, in addition to modifying the suicide registration forms by the IFMO, attention should be given to developing a mechanism that gives forensic physicians access to medical records information in the integrated health system as well as hospital information system.

Dear Editor,

Postpartum depression is one of the common emotional symptoms which affects approximately 10%–15% of the women who experienced childbirth, based on the results of a meta-analysis study. ¹ In general, the prevalence of postpartum depression in Iran has been reported as 25.3%, which is higher than other countries. ² The results of a study showed that depression and suicidal thoughts are correlated in prenatal and postpartum stages so that women think of suicide at the postpartum period more than the prenatal period. ³ Moreover, the positive screening for depression and anxiety in the postpartum evaluation shows a significant correlation with suicidal thoughts in the future. ⁴ In Iran, suicide data have the shortcomings due to quantity and quality, some of which are described elsewhere. ⁵ In 2015, the rate of death due to suicide was estimated to be 2.64% per 100,000 people among Iranian women, ⁶ which seems increasing; ⁷ and this issue indicates the importance of paying attention and dealing to suicide data collection quality among women more than ever. ⁷

According to the definition of World Health Organization, death during pregnancy until 42 days after delivery, ignoring its place and time, due to any reason related to pregnancy, intensified in pregnancy, or due to provided care in this period (except death due to an accident or unexpected event) is called “maternal death,” which includes direct and indirect deaths. ⁸ According to this definition, suicide in this time period is considered pregnant maternal death that is an important index to evaluate the health system of every country. In Iran, Forensic Medicine Organization and its branches across the country are the comprehensive sources of collecting data related to suicide deaths. ⁹ In the data collecting form of suicide, there is not any item about the pregnancy of women at the time of suicide, having childbirth during the previous 6 weeks, and the time interval between delivery and suicide.

According to the remarkable prevalence of postpartum depression in Iran, postpartum depression can be an important risk factor for attempted suicide or completed suicide. Based on the increasing importance of the effect of mental and psychosocial factors on different stages of individuals’ life, it seems that there is a gap in data collecting forms of suicide in women, and considering these items in reporting forms of suicide helps improve information insufficiency and recognize the massiveness and intensity of problem and manage preventive measures better.