All Hands on Deck: Addressing Perinatal Suicide in Colorado with a Cross-Sector Public Health Approach

Body of Abstract: This conference session will focus on statewide, state-led strategies that support suicide prevention activities for perinatal people across the state of Colorado. For the purpose of this presentation, the Colorado Office of Suicide Prevention (OSP) defines the perinatal period as the period during pregnancy though one year postpartum.

The Colorado OSP will present statewide efforts to address perinatal suicide, successes to date, and identified opportunities to better improve prevention activities related to perinatal suicide. The presenters will provide a high-level overview of suicide fatality data among perinatal Coloradans, shared risk and protective factors identified for perinatal suicide and other preventable fatalities, and successes and challenges to implementing a comprehensive, cross-sectoral public health approach to perinatal suicide prevention. Presenters will facilitate a discussion to engage other session attendees to learn more about what other states and partners are implementing to support perinatal populations. Rather than offer prescriptive solutions, this session creates a vital space for suicide prevention partners to come together to discuss opportunities and challenges to preventing perinatal suicide.

Addressing strategies to support perinatal Coloradans is both timely and relevant. Based on data from the Colorado Maternal Mortality Prevention Program, suicide was the leading cause of pregnancy-associated deaths in Colorado between 2016-2020. This mirrors national trends, where suicide is a leading cause of preventable pregnancy-associated deaths. Colorado’s statutorily established Maternal Mortality Review Committee (MMRC) determined that approximately 90% of these deaths were preventable. The MMRC defines a preventable death as a fatality where there was “at least some chance of the death being averted by one or more reasonable changes at the patient, provider, facility, systems, or community levels.” Contributing factors related to preventable deaths include delays in care, discrimination, lack of care coordination, intimate partner violence, substance use, mental health, social isolation, and failure to screen. Between 2016-2020, Colorado’s MMRC determined that a decentent’s mental health contributed to 40% of pregnancy-associated death as well as the decedent’s substance use, which also contributed to 40% of pregnancy-associated deaths. Disparities in perinatal fatalities have been identified. Racial disparities in perinatal mortality and morbidity are due to interpersonal, institutional, and systemic racism, resulting in disproportionate rates of perinatal death among non-white populations. Specifically, the pregnancy-related mortality ratio (PRMR) for American Indian/Alaska Native mothers was 3 times higher than the overall PRMR in Colorado and the for those who are Black was 2 times higher than the overall PRMR in Colorado. The PRMR has also shown to be higher in rural and frontier counties in Colorado as compared to urban counties. Access to transportation, child care, and health care, especially obstetric providers have been identified as potential causes for the increased PRMR in rural and frontier Colorado.

These findings and identified disparities informed the OSP’s cross-sectoral, comprehensive, public health approach to perinatal suicide prevention. Given this context, it is clear that OSP’s response to perinatal suicide must address inequalities in order to be effective. OSP also identified the need for collaboration among different professional sectors as a necessary element to a comprehensive approach. To that end, the Colorado Office of Suicide Prevention collaborates with cross-sector partners in the following ways: Facilitating the Maternal Mortality Task Force within Colorado’s Suicide Prevention Coalition, to provide equity-focused and lived experience-centered recommendations to improve perinatal mortality across different settings throughout Colorado; participation in the state’s Maternal Mortality Review Committee, to provide a suicide prevention angle to maternal mortality review; hosting Zero Suicide Learning Collaboratives, to educate health systems and provide opportunities for dialogue and peer learning; aligning strategies and next steps with the state’s Overdose Prevention Unit regarding shared risk and protective factors; collaborating with the Colorado Perinatal Care Quality Collaborative, to align with their innovative perinatal mental health patient safety bundles, and legislation addressing healthcare improvements in the area; and partnering with the Colorado Department of Health Care Policy and Financing, to encourage health systems to participate in Colorado’s Hospital Quality Incentive Payment Plan by implementing suicide prevention and maternal health promotion activities at the health organization level.

In this intermediate-level presentation, OSP’s Conlin Bass, Health Systems Suicide Prevention Manager, and Kaleigh Kessel, Suicide and Overdose Prevention Coordinator, will present on the OSP’s work to bring together diverse stakeholders and implement comprehensive strategies to prevent perinatal suicide. Specifically, the presenters will provide an overview of the collaborative spaces the team engages in related to perinatal suicide, progress made through these collaborations, barriers to implementing perinatal suicide prevention activities, and opportunities for future collaboration. As OSP is committed to learning both from local partners and from other partners across the country, this conference session will promote idea sharing, strategies, and collaborative problem-solving.

Learning Objectives:

• Describe suicide-related disparities impacting perinatal Coloradans
• Discuss innovative strategies to prevent perinatal suicide and related negative health outcomes
• Discuss challenges regarding implementation of comprehensive suicide prevention efforts to address perinatal suicide