Suicide is the leading cause of maternal death in the UK, and accounted for 68 of approximately 400 such deaths between 1997 and 1999, a British expert said last night.
These maternal deaths, defined as deaths of women from the early stages of pregnancy up to a year after delivery, have been examined in a new report entitled Why Women Die 1997-1999.
The report, by a committee which reports on maternal deaths every three years, states that psychiatric disorders leading to suicide are known to have caused or contributed to over 10 per cent of maternal deaths in the UK between 1997 and 1999. But since the report was completed the percentage has been found to be higher, according to a member of the committee who spoke to The Irish Times last night.
One chapter deals with maternal deaths from psychiatric causes and the cases of 42 women identified as having psychiatric disorders causing or contributing to their deaths are examined. Of these, 28 died by suicide, making suicide the second leading cause of maternal death after thromboembolism and cardiac disease, the report said.
But Dr Margaret Oates said last night that it had emerged after the study was completed that a further 40 maternal deaths had been caused by suicide between 1997 and 1999, bringing the number of maternal deaths by suicide during the period to 68.
"This now makes suicide the leading cause of maternal deaths by a long way. Suicide now accounts for 27 per cent of all maternal deaths," she said.
She added that two-thirds of the suicides occurred following delivery.
Most of the 28 victims of suicide whose cases are examined in the report suffered from a depressive psychosis or severe depression while a number also abused alcohol or drugs. But "in four cases of suicide, there was no evidence to suggest serious mental illness in the days before the suicide, although the mode of death in three cases strongly suggests that the woman was mentally ill," the report said.
"Not one case of suicide following an abortion was reported to the committee of inquiry," Dr Oates, a senior lecturer in psychiatry at Nottingham University, said. Dr Oates, who specialises in the psychiatry of obstetrics, stressed that the suicide figures should be seen in the context of more than two million pregnancies during the years covered by the report. She said suicide was not becoming more common among pregnant women or those who give birth but that they are more likely to be reported nowadays.
"Although the number of cases reported to this inquiry suggests that death from mental illness is the second leading cause of maternal mortality, a recent study has shown that a large number of deaths were not reported and if these were included then deaths from psychiatric causes would be the leading cause of maternal mortality," she said.
"From the cases reported to this inquiry, the risk of suicide is one per 100,000 maternities, but if all the cases recently identified had been included the risk would be two per 100,000 maternities."
The Minister for Health, Mr Martin, yesterday ordered a copy of the report.
The report, which was carried out on behalf of the Scottish Executive Health Department, the Department of Health, Social Services and Public Safety, Northern Ireland, and the National Institute for Clinical Excellence, says that mental illness associated with childbirth is common - "both new episodes specifically related to childbirth and recurrences of pre-existing conditions". However, it goes on: "Despite the frequency of psychiatric disorder, suicide is a rare event during pregnancy and the postpartum period."
Dr Oates pointed out that "in the absence of adequate information from psychiatric sources and in the absence of any control group, it was not possible to know whether the factors identified in these case studies can be generalised".