Prenatal opioid use as a predictor of postpartum suicide attempt among reproductive-age women enrolled in Oregon Medicaid

Abstract

Abstract Background The rates of suicide and opioid use disorder (OUD) among pregnant and postpartum women continue to increase. This research characterized OUD and suicide attempt among Medicaid-enrolled perinatal women and examined prenatal OUD as a marker for postpartum suicide attempt. Methods Data from Oregon birth certificates, Medicaid eligibility and claims files, and hospital discharge records were linked and analyzed. The sample included Oregon Medicaid women aged 15–44 who became pregnant and gave live births between January 2008 and January 2016 (N = 61,481). Key measures included indicators of suicide attempt (by any means and opioid poisoning), OUD, major depressive disorders (MDD), and substance use disorders (SUD), in pregnancy and one-year postpartum. Probit regression was used to estimate an overall relationship between prenatal OUD and postpartum suicide attempt. A simultaneous equations model was used to explore a link between prenatal OUD and postpartum suicide attempt via postpartum OUD. Results Thirty-three women attempted suicide in pregnancy (53.7 attempts per 100,000). Postpartum suicide attempts were more frequent with 58 attempts (94.3 attempts per 100,000) and a majority (n = 46) involved OUD. Prenatal OUD was associated with a greater risk of suicide attempt by opioid poisoning, as well as with postpartum OUD, SUD, and MDD. Prenatal OUD was associated with an increased risk of attempting postpartum suicide by opioid poisoning through postpartum OUD. Conclusions The risk of suicide attempt by opioid poisoning is elevated for Medicaid-enrolled reproductive-age women during pregnancy and postpartum. Prenatal OUD may increase the risk of attempting postpartum suicides.