Year of Publication

2016

College

Public Health

Degree Name

Dr. of Public Health (Dr.P.H.)

Committee Chair

Sabrina Brown, DrPH

Committee Member

Wayne Sanderson, PhD, MS

Committee Member

Erin Abner, PhD

Abstract

Background: Although maternal deaths due to direct causes (those caused by complications during pregnancy), such as bleeding or infection, have declined over the years, maternal deaths due to indirect causes (those caused by pre-existing physical and mental health conditions), such as suicides, have not seen a corresponding decline. Suicide has become one of the leading causes of death in pregnant and post-partum women. Suicides are the fourth leading cause of death among women between the ages of 15-54 years in the United States (U.S.). The total lifetime medical and work loss costs of suicides among women of reproductive age (15-54 years), were $108,130,000 and $38,986,498,000 respectively in 2010. Residence status, specifically, residence in rural areas is reported as a significant risk factor for suicides. There is, however, a paucity of research examining how suicide risk factors differ among women from rural or urban counties in the U.S.

Aim: To examine whether rural-urban county status modifies measures of association between suicide risk factors and pregnancy status among pregnant, post-partum and non-pregnant female suicide decedents aged 15-54 years for the years 2003 to 2012.

Methods: This study used data from the National Violent Death Reporting System, Restricted Access Dataset. Multivariable polytomous logistic regression analyses were used to examine if residence county status modified the association between suicide risk factors and pregnancy status. These included, stratification by county and two-way interactions between model predictors and county type.

Results: Chi-squared analysis indicated that rural suicide decedents were much older, married, less likely to have had a mental health diagnosis and more likely to use a firearm. Multivariable polytomous logistic regression analyses confirmed that there are some variations in suicide risk factors among pregnant, post-partum and non-pregnant decedents from rural and urban counties.

Conclusion: This data suggests that there is the need for differences in strategies for suicide prevention in rural and urban counties in the U.S.

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