A qualitative review of preventable pregnancy-associated mental health deaths in Georgia, 2018-2019
Abstract
Background: Mental-health related deaths, including suicide or unintentional overdose, are the leading cause of pregnancy-related deaths in the US and the second leading cause in Georgia. This qualitative study characterizes the lives of individuals who died from a preventable pregnancy-associated mental health death in Georgia, 2018-2019, and explores individuals’ engagement with the healthcare system and substance use and mental health treatment.
Methods: Data were obtained from Georgia’s Maternal Mortality Review Committee (MMRC) and included a qualitative case summary of clinical and non-clinical details of an individual’s life and death as well as descriptions of contributing factors to the death and recommendations to prevent future deaths. Standard content analysis was applied to the qualitative data to generate salient themes.
Results: Among 42 preventable pregnancy-associated mental health deaths in Georgia in 2018-2019, most were among non-Hispanic white individuals (67%), aged 25-36 (67%), with a high school diploma or less (59%), who resided in an urban area (67%), and who were insured through Medicaid during prenatal care or at the time of delivery (81%). One-quarter (26%) of individuals died by suicide, and one-third (33%) died by unintentional overdose. Case narratives described that most individuals experienced multiple mental health conditions throughout their lifetime. While most received some prenatal care, they did not receive routine postpartum care. Frequent visits to the emergency department were also common. Mental health and substance use were described by the Georgia MMRC as contributors to the death of these individuals. Recommendations to prevent future deaths focused on improving access to care, specifically screening and treatment.
Conclusions: Mental health conditions are a leading cause of preventable pregnancy-associated deaths in Georgia. Strategies for preventing future maternal mental health-related deaths should emphasize comprehensive screening and treatment and improved care coordination and case management for individuals with mental health and substance use conditions.
Keywords
maternal mortality, maternal mortality review committee, mental health, substance use
A qualitative review of preventable pregnancy-associated mental health deaths in Georgia, 2018-2019
Background: Mental-health related deaths, including suicide or unintentional overdose, are the leading cause of pregnancy-related deaths in the US and the second leading cause in Georgia. This qualitative study characterizes the lives of individuals who died from a preventable pregnancy-associated mental health death in Georgia, 2018-2019, and explores individuals’ engagement with the healthcare system and substance use and mental health treatment.
Methods: Data were obtained from Georgia’s Maternal Mortality Review Committee (MMRC) and included a qualitative case summary of clinical and non-clinical details of an individual’s life and death as well as descriptions of contributing factors to the death and recommendations to prevent future deaths. Standard content analysis was applied to the qualitative data to generate salient themes.
Results: Among 42 preventable pregnancy-associated mental health deaths in Georgia in 2018-2019, most were among non-Hispanic white individuals (67%), aged 25-36 (67%), with a high school diploma or less (59%), who resided in an urban area (67%), and who were insured through Medicaid during prenatal care or at the time of delivery (81%). One-quarter (26%) of individuals died by suicide, and one-third (33%) died by unintentional overdose. Case narratives described that most individuals experienced multiple mental health conditions throughout their lifetime. While most received some prenatal care, they did not receive routine postpartum care. Frequent visits to the emergency department were also common. Mental health and substance use were described by the Georgia MMRC as contributors to the death of these individuals. Recommendations to prevent future deaths focused on improving access to care, specifically screening and treatment.
Conclusions: Mental health conditions are a leading cause of preventable pregnancy-associated deaths in Georgia. Strategies for preventing future maternal mental health-related deaths should emphasize comprehensive screening and treatment and improved care coordination and case management for individuals with mental health and substance use conditions.
