vendredi 14 octobre 2016

ETUDE RECHERCHE Les facteurs de risque pour tentative de suicide pendant la grossesse et la période post-partum chez les femmes atteintes de maladies mentales graves

Titre original : Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses
Florence Gressier a, b, , , Virginie Guillard a, Odile Cazas a, Bruno Falissard c, Nine M-C. Glangeaud-Freudenthal d, Anne-Laure Sutter-Dallay e
a Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
b Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Bicêtre University Hospital, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
c Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Department of Biostatistics, Maison de Solenn, 97 Bld de Port-Royal, 75679 Paris Cedex 14, France
d INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France
e Research Center Inserm 1219, Bordeaux Population Health Bordeaux University, University Department of Adult Psychiatry, Charles-Perrens Hospital, 33000 Bordeaux, France 
Journal of Psychiatric Research Available online 13 October 2016
In Press, Accepted Manuscript

Le suicide est un problème majeur de santé publique dans le monde entier, et les troubles mentaux ont été identifiés comme un facteur de risque principal. Le suicide est aussi l'une des principales causes de mortalité maternelle périnatale, mais très peu d'études ont porté sur les tentatives de suicide (TS) dans la période périnatale. Ce travail vise à évaluer les facteurs de risque associés à la TS pendant la grossesse et dans la période post-partum chez les femmes souffrant de troubles de santé mentale.

Abstract
Suicide is a major public health concern worldwide, and mental disorders have been identified as a main risk factor. Suicide is also one of the leading causes of perinatal maternal mortality, but very few studies have focused on suicide attempts (SA) in the perinatal period. This work aims to assess risk factors associated with SA in pregnancy and in the post-partum period in women with mental health disorders.
Women (n = 1439) with psychiatric disorders jointly admitted with their infant to 16 psychiatric Mother-Baby Units over 10 years (2001–2010) were assessed retrospectively for the occurrence of SA in pregnancy or the postpartum period. Multinomial logistic regression was used to explore the independent impact of maternal sociodemographic characteristics, history of childhood maltreatment and abuse, current mental illness and pregnancy data on SA in pregnancy and/or postpartum.
One hundred and fifty-four women (11.68%) attempted suicide: 49 in pregnancy (3.71%) and 105 (7.97%) in the post-partum period. SA in pregnancy was related to alcohol use (OR = 2.37[1.02–5.53]; p = 0.04) and smoking during pregnancy (OR = 1.87[1.01–3.49]; p = 0.04) and also to a history of miscarriage (OR = 2.29[1.18–4.41]; p = 0.01). SA in the post-partum period was associated with major depressive episode (OR = 2.72[1.40–5.26]; p = 0.003) or recurrent depression (OR = 4.12[2.25–7.51], p < 0.001) and younger age (OR = 0.96[0.93–0.99], p = 0.03).
SAs in the course of pregnancy and the postpartum period have different risk factors. Special attention to risk of suicide is needed during pregnancy for women with severe mental illness and a history of miscarriage, alcohol or cigarette use, young age and depression in the perinatal period.
Corresponding author. Department of Psychiatry, Univ Paris Sud, Bicêtre University Hospital, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France .

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