The Occurrence of parasuicide among pregnant women at Dr George Mukhari Hospital: a retrospective study

Abstract

BACKGROUND: Parasuicide is defined as an act with non-fatal outcome, in which an individual deliberately initiates a non-habitual behaviour that without intervention from others will cause self-harm, or when an individual deliberately ingests a substance in excess of the prescribed or generally recognized therapeutic dosage. Pregnant women experience higher rates of depression, anxiety, psychosomatic symptoms and lower level of social adjustments than nonpregnant women. Cases of parasuicide among pregnant women have been seen and treated at Dr George Mukhari Hospital over the years without any systematic assessment of the extent of the problem. OBJECTIVE: The aim of the study was to evaluate the impact of cases of parasuicide on the eventual maternal and foetal outcomes. 10 MATERIALS AND METHODS: The study was conducted retrospectively using the hospital files of those pregnant women who had been diagnosed at Dr George Mukhari Hospital. The medical records of all such cases were retrieved from the filling room for assessment. The review period covered 1st January 2004 to 31st December 2006. Analysis was predominantly descriptive in which rates of incidences as well as proportion of occurrence of variables were calculated. Evaluation was for demographics, social status, intents and methods of parasuicide. In addition, the outcome of treatment for the mothers and their babies were evaluated. All the patients had been treated with gastric lavage and ingestion of activated charcoal from their referring centres regardless of the material used. The patients were stabilized and then referred for psychological counselling. RESULTS: During the three-year review period, 54 cases of parasuicide were recorded, with files for 42 (77.7%) patients found and evaluated. The ages of the women ranged from 16 to 35 years (median=21 years). Majority of women (57.1%) were parous while 42.9% were nulliparous. Socio-economic status of the women revealed that most patients were unemployed (95%), most were living with parents (90%), pregnancy was planned by 62%, 10% reported history of 11 physical abuse and only one of the women (2%) had a problem of alcohol abuse. Materials used for parasuicide included ingestion of tablets (23; 54.8%), organophosphates (7; 16.7%), herbal potions (6; 14.3%), rat poison (2; 4.8%) and other things such as paraffin, detergent (Jik) and laxatives. Thirty five of the 42 patients (83.3%) had reasons documented for parasuicide, of which the majority had relationship difficulties with their partners (22; 62.8%), (8; 22.9%) had relationship problems with family members and (5; 14.3%) wanted to terminate the pregnancy. The gestation at admission for treatment for parasuicide ranged between 16 and 40 weeks and at delivery pregnancy ended as: abortion (6; 14.3%), preterm delivery (13; 36.1%) and term delivery (23; 63.9%). The rate of abortion (14.3%) was significantly higher in these patients (ρ-value = 0.0001) compared to non-parasuicide patients (1.2%). Most of them delivered vaginally (95%), only one patient needed ICU admission for 6 days and there was no case of maternal death. Out of the 36 women who delivered viable babies, there were 33 (91.7%) who had live births, three other women had IUFDs (8.3%) and no neonatal death was recorded. 12 CONCLUSION Although parasuicide in pregnancy occurs infrequently at DGMH, the most striking factor which could have led to attempts at parasuicide was the socioeconomic situation of the women. A scenario in which 95% of these pregnant women were unemployed, 90% were unmarried and for most of the women the reasons for parasuicide were related to relationship difficulties, provide an effective recipe for parasuicide.