Correspondence

Suicide after Ectopic Pregnancy

N Engl J Med 1994; 330:714March 10, 1994

Article

To the Editor:

Pregnancy and the first postnatal year are considered a period with a low risk of suicidal behavior1,2. The risk of suicide among women at this stage of life was one sixth that in a matched population of nonpregnant women. Possible reasons are maternal emotions and close contact with family members and health professionals who provide support, early detection, and treatment of patients in whom psychiatric disorders do develop.

With respect to this low-risk population, attention has been drawn to a grief reaction after early pregnancy loss,3 which can be intense in cases of first-trimester spontaneous abortion4. There are typical characteristics of depression, including despair, guilt, loss of control, and death anxiety5. This reaction is similar in nature and intensity to the grief reaction following the loss of a child or close relative.

We studied the long-term reproductive performance of women after surgical treatment for ectopic pregnancy and found another group at high risk for suicide related to pregnancy. In a 10-year retrospective study we identified 160 patients treated surgically with salpingectomy for ectopic pregnancy. Using hospital files and a questionnaire, we reviewed all hospitalizations or treatments after the operations. We found that six women, all primigravidas, had attempted suicide (one succeeded) within the first year after operation. None had a history of any psychiatric disorder. The calculated rates of attempted suicide and mortality due to suicide in these patients were 3.75 percent and 0.625 percent, respectively. In comparison, the reported rates of attempted suicide and mortality due to suicide in a matched nonpregnant population during the same period were 0.04 to 0.06 percent and 0.002 percent, respectively (Stein N, Department of Information and Computer Services, Ministry of Health, State of Israel: personal communication).

These data indicate that the combination that leads to a breaking point is an insult to self-image due to failure of pregnancy, together with the trauma of surgery and the threat to future reproduction.

Women who have had ectopic pregnancies should be considered at high risk for suicide after operation and should receive psychological and moral support. Further investigation is required to substantiate the correlation between ectopic pregnancy and psychotic or depressive reactions.

Jacob Farhi, M.D.
Zion Ben-Rafael, M.D.
Dov Dicker, M.D.
Golda Meir Medical Center, Petah-Tiqva, Israel

5 References

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   Kendell RE. Suicide in pregnancy and the puerperium. BMJ 1991;302:126-127
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   Appleby L. Suicide during pregnancy and in the first postnatal year. BMJ 1991;302:137-140
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   Lindberg CE. The grief response to mid-trimester fetal loss. J Perinatol 1992;12:158-163
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   Rosenfeld JA. Bereavement and grieving after a spontaneous abortion. Am Fam Physician 1991;43:1679-1684
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   Neugebauer R, Kline J, O'Connor P, et al. Determinants of depressive symptoms in the early weeks after miscarriage. Am J Public Health 1992;82:1332-1339
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Citing Articles (1)

Citing Articles

1. 1

   Pythia T Nieuwkerk, Petra J Hajenius, Willem M Ankum, Fulco Van der Veen, Wouter Wijker, Patrick M.M Bossuyt. (1998) Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patients’ health-related quality of life. Fertility and Sterility 70:3, 511-517
   CrossRef