Suicidal ideation in pregnancy: an epidemiologic review

Vitamin C and suicidal ideation: A cross-sectional and Mendelian randomization study

BACKGROUND

Studies have shown that a history of suicide attempts is associated with low levels of antioxidant vitamins. However, the specific relationship between vitamin C and suicidal ideation remains poorly understood. The purpose of this study is to investigate the effect of vitamin C on the development of suicidal ideation and to explore further the causal relationship using Mendelian randomization (MR).

METHODS

Using the 2005-2018 National Health and Nutrition Examination Survey (NHANES) dataset, a comprehensive, cross-sectional, stratified survey of 28,623 participants aged 20 years and older was conducted. Suicidal ideation was assessed using item 9 of the Patient Health Questionnaire-9 (PHQ-9) item. The relationship between vitamin C and suicidal ideation was revealed by weighted multiple linear regression, smooth curve fitting, hierarchical analysis, and interaction test. To determine causality, MR was performed on vitamin C and suicidal ideation.

RESULTS

In cross-sectional studies, all models showed a negative association between vitamin C and suicidal ideation, with a 37 % reduction in the risk of suicidal ideation for each unit increase in vitamin C in the highest quartile in the fully adjusted model. The results of the subgroup analysis showed that the association between vitamin C and suicidal ideation was stable across gender, age, education, smoking status, and marital status. In the MR study, our bivariate model showed no significant causal relationship between vitamin C and the development of suicidal ideation.

CONCLUSIONS

Dietary vitamin C intake was negatively associated with the development of suicidal ideation. However, genetic evidence does not support causation of these associations.

Thoughts on Self-Harm in Polish Pregnant and Postpartum Women During the Pandemic Period

Background: The risk of depression during pregnancy and postpartum is high and has intensified during the COVID-19 pandemic. The aim of this study was to estimate the risk of depressive disorders and self-harm thoughts in the third trimester of pregnancy and the first week postpartum in the pandemic period. Methods: This study involved a total of 317 pregnant and postpartum women. The risk and severity of depressive disorders and the prevalence of self-harm thoughts in women during the perinatal period were assessed using EPDS. Results: Pregnant women were significantly more likely to have higher EPDS scores compared to postpartum women. Mild depressive symptoms were reported by 22.08% of pregnant women and 17.18% of postpartum women, and severe symptoms were observed in 25.97% of pregnant women and 16.56% of postpartum women. Thoughts of self-harm were reported by 11.69% of pregnant women and 17.79% of postpartum women. Self-harm thoughts were significantly more common among pregnant women: multiparous women, pregnant women who received psychiatric treatment before pregnancy, those diagnosed with depressive disorders, those who suffered from prolonged periods of anxiety and sadness, and those lacking a supportive person. Among postpartum women, there were statistically significant differences in the prevalence of self-harm thoughts for place of residence, education, type of occupation, number of pregnancies, course of pregnancy, and presence of a supportive person. Conclusions: The increased prevalence of depressive symptoms and self-harm thoughts related to the COVID-19 pandemic highlights the urgent need for screening among pregnant women and the implementation of clinical interventions.

Perinatal women's views and experiences of discussing suicide in maternity care settings: A qualitative study

BACKGROUND

Suicide is a leading global cause of maternal death in the first year after birth. Limited research has explored which factors may support or prevent women from disclosing suicidality. This is important for informing appropriate approaches to identifying perinatal women who may require support.

AIMS

(i) explore perinatal women's views and experiences regarding the barriers, facilitators, and implications of identifying and disclosing suicidality in maternity care settings; and (ii) explore their perspectives on appropriate approaches for healthcare practitioners (HCPs) to take when asking about suicide during pregnancy or after birth.

METHODS

Twenty-one semi-structured interviews with perinatal women in the UK. Of these women, 17 had experienced self-reported perinatal mental health (PMH) problems and/or suicidality. Inductive thematic analysis was used to explore the data and identify themes.

RESULTS

Four themes, comprising 11 subthemes were identified. Barriers that affected women's willingness and capacity to disclose suicidality included: stigma, social expectations of motherhood, not recognising symptoms, not being asked about PMH and/or rushed appointments, lack of care continuity, and HCPs interpersonal skills. Important facilitators were the provision of PMH information and peer support. Women also suggested providing more choice in how PMH and suicide-related questions are administered (e.g., via a form and in-person) and for HCPs to frame these discussions sensitively.

CONCLUSIONS

Significant barriers impact perinatal women's disclosure of suicidality. Appropriate approaches for identifying suicidality in maternity contexts need to be developed that take account of these barriers and support women to feel safe, comfortable, and able to answer suicide-related questions honestly.

Societal implications of the Dobbs v Jackson Women's Health Organization decision

On June 24, 2022, the US Supreme Court's decision in Dobbs v Jackson Women's Health Organization marked the removal of the constitutional right to abortion in the USA, introducing a complex ethical and legal landscape for patients and providers. This shift has had immediate health and equity repercussions, but it is also crucial to examine the broader impacts on states, health-care systems, and society as a whole. Restrictions on abortion access extend beyond immediate reproductive care concerns, necessitating a comprehensive understanding of the ruling's consequences across micro and macro levels. To mitigate potential harm, it is imperative to establish a research agenda that informs policy making and ensures effective long-term monitoring and reporting, addressing both immediate and future impacts.

Association of Psychiatric Emergency Visits and Warm Ambient Temperature during Pregnancy: A Time-Stratified Case-Crossover Study

BACKGROUND

Acute exposure to high ambient temperature and heat waves during the warm season has been linked with psychiatric disorders. Emerging research has shown that pregnant people, due to physiological and psychological changes, may be more sensitive to extreme heat, and acute exposure has been linked to increased risk of pregnancy complications; however, few studies have examined psychiatric complications.

OBJECTIVE

Our objective was to examine the association between acute exposure to warm ambient temperatures and emergency department (ED) visits for mental disorders during pregnancy.

METHODS

A time-stratified case-crossover design with conditional logistic regression was performed on ∼ 206,000 psychiatric ED visits for pregnant patients in North Carolina, from May to September 2016 to 2019. Daily average ambient temperature was the main exposure and was linked to daily visits by maternal zip code of residence for prenatal mood and anxiety disorders (PMAD), severe mental illness (SMI), mental disorder of pregnancy (MDP), suicidal thoughts (SUIC), and any psychiatric disorder (Any). Effect modification by trimester, residential segregation, economic segregation, urbanicity, and availability of greenspace was also investigated.

RESULTS

Each 5 ° C increase in same-day exposure to warm ambient temperature on case days was associated with an increase in incidence rate ratio (IRR) for any psychiatric disorder [IRR = 1.07; 95% confidence interval (CI): 1.01, 1.14] including anxiety (IRR = 1.14; 95% CI: 1.00, 1.30), bipolar disorder (IRR = 1.28; 95% CI: 0.98, 1.67), and suicidal thoughts (IRR = 1.28; 95% CI: 1.00, 1.65) compared to control days. In general, the associations were strongest for warm season temperatures on the same day of exposure or for temperatures averaged over the 3 or 6 d preceding the ED visit. The greatest risk of an incident ED admission for PMAD (RR = 1.20; 95% CI: 1.04, 1.39), particularly for anxiety (RR = 1.30; 95% CI: 1.07, 1.59), and any psychiatric disorder (RR = 1.17; 95% CI: 1.07, 1.28) occurred following cumulative exposure to hot temperatures the week before admission. Higher psychiatric burden from temperature was observed in urban areas and on extreme heat days.

CONCLUSIONS

For this pregnant population in the southeastern United States, short-term exposure to high ambient temperatures during the warm season was associated with a greater risk of ED visits for an array of psychiatric disorders. Findings show that climate-related increases in ambient temperature may contribute to psychiatric morbidity in pregnant people. https://doi.org/10.1289/EHP13293.

Insomnia, poor sleep quality and perinatal suicidal risk: A systematic review and meta-analysis

Suicidal risk in mothers is a public health priority. Risk factors include biological, psychological and psychosocial factors. Among the biological factors, the role of sleep disturbances as potential contributors to increased suicidal risk during the peripartum period is becoming apparent. To explore this further, we conducted a systematic review following the PRISMA criteria. Currently, 10 studies have examined the role of insomnia and poor sleep quality in suicidal risk during the peripartum period and have involved 807,760 women. The data showed that disturbed sleep and poor sleep quality increase the risk of suicidal ideation in both pregnant women with and without perinatal depression. The results of the meta-analysis indicated that insomnia and poor sleep quality increase the odds of suicidal risk in pregnant women by more than threefold (OR = 3.47; 95% CI: 2.63-4.57). Specifically, the odds ratio (OR) for poor sleep quality was 3.72 (95% CI: 2.58-5.34; p < 0.001), and for insomnia symptoms, after taking into account perinatal depression, was 4.76 (95% CI: 1.83-12.34; p < 0.001). These findings emphasise the importance of assessing and addressing sleep disturbances during the peripartum period to mitigate their adverse effects on peripartum psychopathology and suicidal risk.

Utilization of Mental Health Services Within 1 Year of Delivery among Different Language Groups

OBJECTIVES

Cultural differences can affect postpartum mental health disorders and the utilization of mental health services. We compared women speaking English, Spanish, Russian, and Urdu/Bengali/Punjabi from postpartum through 1 year after delivery.

METHODS

This was a retrospective study of 3478 pregnant women from a public hospital in New York City. The primary outcome was a composite outcome of the presence of any of the following: diagnosis of depressive disorder, diagnosis of anxiety disorder, visit to a behavioral health service provider, and/or psychiatric admission. The secondary outcome was healthcare provider referral to a behavioral health service provider.

RESULTS

Languages spoken were English (n = 1881), Spanish (n = 694), Russian (n = 600), and Urdu/Bengali/Punjabi (n = 303). The language groups differed significantly (P = 0.02) for the composite outcome, with English having the greatest percentage (3.5%) and Russian the lowest percentage (1.2%). The language groups significantly differed for referral to behavioral health (P = 0.04), with Spanish having the greatest percentage (1.6%) and Russian the lowest percentage (0.2%). Anxiety disorder history (odds ratio [OR] 10.43, 95% confidence interval [CI] 4.75-22.91, P < 0.001) and psychiatric disorder history (OR 5.26, 95% CI 2.13-8.49, P < 0.001) were each significantly associated with increased odds for the composite outcome. Anxiety disorder history (OR 6.42, 95% CI 1.92-21.45, P = 0.003) and elevated depressive symptoms (OR 4.92, 95% CI 2.04-11.83, P < 0.001) each were significantly associated with increased odds for referral to behavioral health.

CONCLUSIONS

Russian language was associated with lower utilization of mental health services postpartum. These findings can help clinicians determine among postpartum women who will be affected with mental health concerns and who will seek treatment for mental health concerns.

Suicidal ideation and associated factors among pregnant women attending antenatal care at public hospitals of Harari regional state, eastern Ethiopia: A cross-sectional study

BACKGROUND

Suicide is a global issue. It is the third responsible for death among the reproductive age group. Pregnancy is a complicated event and crucial in the life of a woman with considerable physiological, hormonal changes, social, and mental changes. However, third-world countries like Ethiopia have not been investigated well. Therefore, the study planned to assess the magnitude and factors associated with suicidal ideation. Furthermore, it will identify the role of hyperemesis gravidarum on suicidal ideation.

METHOD

A Cross-sectional study was employed for 543 pregnant participants attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal General Hospital, Harari regional state, eastern Ethiopia from June 1 to August 1, 2022. The recruited participants were selected by systematic random sampling method. Suicide was assessed using Composite International Diagnostic by interview methods data collection. Epi data and STATA version 14.1 were used for data entry and analysis respectively. Candidate variables were entered into a multivariate logistic regression then those variables that have p-value < 0.05 were considered as significantly associated.

RESULTS

The magnitude of suicidal ideation in this study was found to be 11.15% at (95% CI: 8.75-14.11). Regarding the associated factor, unwanted pregnancy (AOR = 3.39: at 95% CI = 1.58-7.27), Hyperemesis gravidarum (AOR = 3.65: at 95% CI = 1.81-7.34), having depressive symptoms (AOR = 2.79: at 95% CI = 1.49-5.23), having anxiety symptoms (AOR = 3.37; at 95% CI = 1.69-6.68), experiencing intimate partner violence (AOR = 2.88: at 95% CI = 1.11-7.46), and having stress (AOR = 3.46; at 95% CI = 1.75-6.86) were significantly associated variable with suicidal ideation among pregnant women.

CONCLUSION AND RECOMMENDATION

This study revealed that suicidal ideation is common among pregnant women. Regarding the associated factors unwanted pregnancy, hyperemesis gravidarum, having depressive and anxiety symptoms, experiencing intimate partner violence, and stress were significantly associated with suicidal ideation. Thus, giving awareness and early screening and interferences for antenatal suicide should be warranted.

Self-harm thoughts among postpartum women - associated factors

BACKGROUND

Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented.

AIM

We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs.

METHOD

1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables.

RESULTS

Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs.

CONCLUSION

The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.

Trajectories of perinatal suicidal ideation from early pregnancy to six weeks postpartum and their influencing factors: A prospective longitudinal study

Few studies focused on the trajectory of perinatal suicidal ideation from early pregnancy and covered whole routine perinatal periods. This study aimed to investigate the prevalence of suicidal ideation from early pregnancy to six weeks postpartum, and further explore the trajectories of perinatal suicidal ideation and their risk factors. A prospective longitudinal study was conducted in a comprehensive tertiary hospital in Hunan province, China among 1089 participants. Perinatal suicidal ideation and depression were assessed by item 9 of Patient Health Questionnaire 9 and the remaining eight items. Sociodemographic and psychological factors were collected by self-reported comprehensive questionnaires. Latent Growth Curve and Growth Mixture Modeling were used to identify the trajectories of suicidal ideation and logistic regression was used to explore risk factors of trajectories. A total of 629 participants were included. The prevalence of suicidal ideation was 16.4% from early pregnancy to six weeks postpartum, with 12.1% in pregnancy and 7.8% in postpartum. Two trajectories were identified: "persistent low levels of suicidal ideation" (92.9%) and "persistent high levels of suicidal ideation" (7.1%). 40.63% of women who screened positive for suicidal ideation during early pregnancy were in the "persistent high level of suicidal ideation" trajectory. A low level of neuroticism and anxiety symptoms during early pregnancy was associated with "persistent high levels of suicidal ideation". In conclusion, suicidal ideation of women during the perinatal period was dynamic, Suicidal ideation screening and identification in early pregnancy should be addressed for perinatal women to facilitate timely early interventions.

Screening for postpartum depression and risk of suicidality with obstetrical patients: a cross-sectional survey

BACKGROUND

Pregnancy is a vulnerable time where the physical and social stress of the COVID-19 pandemic affects psychological health, including postpartum depression (PPD). This study is designed to estimate the prevalence and correlates of PPD and risk of suicidality among individuals who gave birth during the COVID-19 pandemic.

METHODS

We surveyed individuals who gave birth at The Ottawa Hospital and were ≥ 20 days postpartum, between March 17 and June 16, 2020. A PPD screen consisted of a score ≥ 13 using the Edinburgh Postnatal Depression Scale. A score of 1, 2, or 3 on item 10 ("The thought of harming myself has occurred to me") indicates risk of suicidality. If a participant scores greater than ≥ 13 or ≥ 1 on item 10 they were flagged for PPD, the Principal Investigator (DEC) was notified within 24 h of survey completion for a chart review and to assure follow-up. Modified Poisson multivariable regression models were used to identify factors associated with PPD and risk of suicidality using adjusted risk ratios (aRR) and 95% confidence intervals (CI).

RESULTS

Of the 216 respondents, 64 (30%) screened positive for PPD and 17 (8%) screened positive for risk of suicidality. The maternal median age of the total sample was 33 years (IQR: 30-36) and the infant median age at the time of the survey was 76 days (IQR: 66-90). Most participants reported some form of positive coping strategies during the pandemic (97%) (e.g. connecting with friends and family, exercising, getting professional help) and 139 (64%) reported negative coping patterns (e.g. over/under eating, sleep problems). In total, 47 (22%) had pre-pregnancy anxiety and/or depression. Negative coping (aRR:2.90, 95% CI: 1.56-5.37) and pre-existing anxiety/depression (aRR:2.03, 95% CI:1.32-3.11) were associated with PPD. Pre-existing anxiety/depression (aRR:3.16, 95% CI:1.28-7.81) was associated with risk of suicidality.

CONCLUSIONS

Almost a third of participants in this study screened positive for PPD and 8% for risk of suicidality. Mental health screening and techniques to foster positive coping skills/strategies are important areas to optimize postpartum mental health.

Incidence and risk factors for postpartum mood and anxiety disorders among women veterans

BACKGROUND

Our aim was to determine rates of postpartum mood and anxiety disorders (PMADs) among U.S. women Veterans and the overlap among PMADs. We further sought to identify PMAD risk factors, including those unique to military service.

METHODS

A national sample of women Veterans completed a computer-assisted telephone interview (N = 1414). Eligible participants were aged 20-45 and had separated from service within the last 10 years. Self-report measures included demographics, general health, reproductive health, military exposures, sexual assault, childhood trauma, and posttraumatic stress disorder (PTSD). The PMADs of interest were postpartum depression (PPD), postpartum anxiety (PPA) and postpartum PTSD (PPPTSD). This analysis included 1039 women Veterans who had ever been pregnant and who answered questions about PPMDs related to their most recent pregnancy.

RESULTS

A third (340/1039, 32.7%) of participants were diagnosed with at least one PMAD and one-fifth (215/1039, 20.7%) with two or more. Risk factors common for developing a PMAD included: a mental health diagnosis prior to pregnancy, a self-report of ever having had a traumatic birth experience, and most recent pregnancy occurring during military service. Additional risk factors were found for PPD and PPPTSD.

CONCLUSION

Women Veterans may be at an increased risk for developing PMADs due to high rates of lifetime sexual assault, mental health disorders, and military-specific factors including giving birth during military service and military combat deployment exposures.

Prenatal Stress Exposure Amplifies Effect of Maternal Suicidal Ideation on Early Childhood Behavioral Trajectories

The in utero environment influences fetal development and may predispose to disease later in life. This study examines whether maternal suicidal ideation during pregnancy is associated with children's behavioral trajectories across early childhood, and whether prenatal maternal traumatic stress accelerates the trajectories. The study included mother-child dyads (N = 331, 51.1% boys) from the longitudinal Stress In Pregnancy study; 31.1% (n = 103) mothers were Exposed to Superstorm Sandy. During their second trimester, 12.4% (n = 41) women reported suicidal ideation during pregnancy. Mothers completed the Behavior Assessment Scale for Children-2 annually from ages 2- to 6-years-old to assess multiple behavioral domains. Hierarchical linear modeling estimated within-person longitudinal trajectories of clinical behaviors, and between-person effects of maternal suicidal ideation and disaster-related stress in utero on changes in child behavior. For children exposed to both risks, Atypical behaviors (i.e., unusual behaviors, social disconnection) increased linearly across early childhood. Exposure to Superstorm Sandy and maternal suicidal ideation were independently associated with non-linear increases in Anxiety severity and maternal suicidal ideation during pregnancy was associated with a linear increase in Attention problems across early childhood. Maternal suicidal ideation during pregnancy is associated with increased risk for a range of behavioral and emotional difficulties in early childhood and the trajectory of atypical behaviors was amplified by disaster-related traumatic stress. Findings highlight the need for health professionals to screen for suicidal ideation among their pregnant patients. Pregnant women who experience severe stress may require additional monitoring and support to reduce risk for poorer early childhood outcomes.

Factor Structure and Measurement and Structural Invariance of the Edinburgh Postnatal Depression Scale during the Perinatal Period among Japanese Women: What Is the Best Model?

The Edinburgh Postnatal Depression Scale (EPDS) is a widely used screening tool for perinatal depression. Its factor structure is still a debatable topic. Our study aimed to examine the factor structure and measurement invariances of the Japanese version of the EPDS from late pregnancy to early postpartum. A total of 633 women were followed with the EPDS at three times over the perinatal period: late pregnancy (n = 633), 5 days after childbirth (n = 445), and 1 month after childbirth (n = 392). We randomly divided the participants into two groups: one for exploratory factor analyses (EFAs) and another for confirmatory factor analyses (CFAs). The result of the EFAs indicated different factor models at each time point. Hence, CFAs were performed using the second sample set to compare different models including the ones previously reported. A 3-factor model consisting of depression (items 7, 9), anxiety (items 4, 5), and anhedonia (items 1, 2) (Kubota et al., 2018) was consistently stable during the whole perinatal period. Kubota's 3-factor model showed invariance across the perinatal period.

Newborn Outcomes Among Veterans Utilizing VHA Maternity Benefits, 2016-2020

INTRODUCTION

Public Law 111-163 Section 206 of the Caregivers and Veteran Omnibus Health Services Act amended the Veterans Health Administration's (VHA) medical benefits package to include 7 days of medical care for newborns delivered by Veterans. We examined the newborn outcomes among a cohort of women Veterans receiving VHA maternity benefits and care coordination.

MATERIALS AND METHODS

We conducted a secondary analysis of phone interview data from Veterans enrolled in the COMFORT (Center for Maternal and Infant Outcomes Research in Translation) study 2016-2020. Multivariable regression estimated associations with newborn outcomes (preterm birth; low birthweight).

RESULTS

During the study period, 829 infants were born to 811 Veterans. Mothers reported "excellent health" for 94% of infants. The prevalence of preterm birth was slightly higher in our cohort (11% vs. 10%), as were low birthweight (9%) deliveries, compared to the general population (8.28%). Additionally, 42% of infants in our cohort required follow-up care for non-routine health conditions; 11% were uninsured at 2 months of age. Adverse newborn outcomes were more common for mothers who were older in age, self-identified as non-white in race and/or of Hispanic ethnicity, had a diagnosis of posttraumatic stress disorder, or had gestational comorbidities.

CONCLUSIONS

The current VHA maternity coverage appears to be an effective policy for ensuring the well-being and health care coverage for the majority of Veterans and their newborns in the first days of life, thereby reducing the risk of inadequate prenatal and neonatal care. Future research should examine costs associated with extending coverage to 14 days or longer, comparing those to the projected excess costs of neonatal health problems. VHA policy should continue to support expanding care and resources through the Maternity Care Coordinator model.

Self-harm in pregnancy and the postnatal year: prevalence and risk factors

BACKGROUND

Self-harm in pregnancy or the year after birth ('perinatal self-harm') is clinically important, yet prevalence rates, temporal trends and risk factors are unclear.

METHODS

A cohort study of 679 881 mothers (1 172 191 pregnancies) was conducted using Danish population register data-linkage. Hospital treatment for self-harm during pregnancy and the postnatal period (12 months after live delivery) were primary outcomes. Prevalence rates 1997-2015, in women with and without psychiatric history, were calculated. Cox regression was used to identify risk factors.

RESULTS

Prevalence rates of self-harm were, in pregnancy, 32.2 (95% CI 28.9-35.4)/100 000 deliveries and, postnatally, 63.3 (95% CI 58.8-67.9)/100 000 deliveries. Prevalence rates of perinatal self-harm in women without a psychiatric history remained stable but declined among women with a psychiatric history. Risk factors for perinatal self-harm: younger age, non-Danish birth, prior self-harm, psychiatric history and parental psychiatric history. Additional risk factors for postnatal self-harm: multiparity and preterm birth. Of psychiatric conditions, personality disorder was most strongly associated with pregnancy self-harm (aHR 3.15, 95% CI 1.68-5.89); psychosis was most strongly associated with postnatal self-harm (aHR 6.36, 95% CI 4.30-9.41). For psychiatric disorders, aHRs were higher postnatally, particularly for psychotic and mood disorders.

CONCLUSIONS

Perinatal self-harm is more common in women with pre-existing psychiatric history and declined between 1997 and 2015, although not among women without pre-existing history. Our results suggest it may be a consequence of adversity and psychopathology, so preventative intervention research should consider both social and psychological determinants among women with and without psychiatric history.

Adverse Perinatal Outcomes and Postpartum Suicidal Behavior in California, 2013-2018

Background: The objectives of this study were to describe trends in the prevalence of postpartum suicidal behaviors in California, 2013-2018, and to estimate associations between adverse perinatal outcomes and suicidal behaviors. Materials and Methods: We used data from a population-based cohort derived from all birth and fetal death certificates. Records were individually linked to maternal hospital discharge records for the years before and after delivery. We estimated the prevalence of postpartum suicidal ideation and attempt by year. Then, we estimated crude and adjusted associations between adverse perinatal outcomes and these suicidal behaviors. The sample included 2,563,288 records. Results: The prevalence of postpartum suicidal ideation and attempt increased from 2013 to 2018. People with postpartum suicidal behavior were younger, had less education, and were more likely to live in rural areas. A greater proportion of those with postpartum suicidal behavior were Black and publicly insured. Severe maternal morbidity, neonatal intensive care unit admission, and fetal death were associated with greater risk of ideation and attempt. Major structural malformation was not associated with either outcome. Conclusions: The burden of postpartum suicidal behavior has increased over time and is unequally distributed across population subgroups. Adverse perinatal outcomes may help identify individuals that could benefit from additional care during the postpartum period.

Sleep quality, antepartum depression and self-harm thoughts in pregnant Chinese women

BACKGROUND

Previous literature has shown a significant association between sleep and depression, whereas limited studies have examined the association of sleep quality with self-harm ideation in pregnant Chinese women.

METHODS

A total of 898 pregnant women (first to third trimester) from the Young Investigation Study were enrolled in this study. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess sleep quality. Antepartum depression and self-harm ideation were evaluated using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs).

RESULTS

In this sample, the prevalence of poor sleep quality and antepartum depression was 44.3 % and 24.4 %, respectively. Furthermore, 12.8 % of women were considered as having self-harm ideation. Individuals in different trimesters reported similar prevalence of self-harm thoughts. Women were more likely to report self-harm thoughts if they were categorized as poor sleep quality or antepartum depression. And women with moderate or severe depression had higher risk of self-harm ideation and poor sleep, compared with those with mild depression. Although sleep quality indirectly influenced self-harm thoughts through the mediation effect of depressive symptoms, poor sleep quality was still associated with a 2.62-fold increased odds of self-harm ideation among women in the second trimester (OR = 2.62; 95 % CI: 1.11-6.21), after adjustment for depression.

LIMITATIONS

Causality cannot be inferred. Results should be generalized carefully. Depression was evaluated by a screening tool rather than clinical interviews.

CONCLUSIONS

The prevalence of poor sleep quality, depressive symptoms and self-harm ideation in pregnant Chinese women were noteworthy and high. Besides, a direct effect was also found between sleep quality and self-harm thoughts among women in the second trimester. Our findings suggest the need to identify and intervene when sleep disturbances are observed in women during pregnancy.

Measures of suicidality in perinatal women: A systematic review

BACKGROUND

Suicide is a leading cause of death for perinatal women. Identifying women at risk of suicide is critical. Research on the validity and/or reliability of measures assessing suicidality in perinatal women is limited. This review sought to: (1) identify; and (2) evaluate the psychometric properties of suicidality measures validated in perinatal populations.

METHODS

Nine electronic databases were systematically searched from inception to January 2022. Additional articles were identified through citation tracking. Study quality was assessed using an adapted tool, and the psychometric properties of measures were reviewed and presented using a narrative synthesis.

RESULTS

A total of 208 studies were included. Thirty-five studies reported psychometric data on ten suicidality measures. Fifteen studies reported both validity and reliability data, 12 reported more than one type of validity, seven validated more than one measure and four only reported reliability. Nearly all measures primarily screened for depression, with an item or subscale assessing suicidal ideation and/or behaviours. Three measures were specifically developed for perinatal women, but only two were validated in more than one study. The Postpartum Depression Screening Scale (PDSS), suicidal thoughts subscale, was validated most frequently.

LIMITATIONS

Methodological differences and variability between the measures (e.g., suicidality construct assessed, number of items and administration) precluded direct comparisons.

CONCLUSION

Further validation of suicidality measures is needed in perinatal women. Screening for perinatal suicidality often occurs in the context of depression. The development of a standalone measure specifically assessing suicidality in perinatal women may be warranted, particularly for use in maternity care settings.

Risk Factors Associated With Peripartum Suicide Attempts in Japan

IMPORTANCE

Peripartum suicide attempt is a major psychiatric complication associated with pregnancy, but the risk factors remain largely uncertain.

OBJECTIVE

To identify the demographic characteristics and predisposing risks for peripartum suicide attempts and postpartum depression.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used retrospective data on pregnant women who delivered children between April 1, 2016, and March 31, 2021, at 712 hospitals in Japan. The nationwide Diagnosis Procedure Combination database was used.

EXPOSURES

Psychiatric and nonpsychiatric medical history, age, alcohol and tobacco use, and obstetric complications and procedures.

MAIN OUTCOMES AND MEASURES

Data on admissions for prepartum suicide attempt and delivery during the same hospital stay and readmissions for depression or suicide attempt within 1 year post partum were collected. Comparisons of prevalence of each study variable were performed, and multivariable logistic regression analyses were used to determine risk factors.

RESULTS

From a total of 39 908 649 hospitalization episodes, 804 617 cumulative pregnant women (median [IQR] age at childbirth, 33 [29-36] years) who delivered at the enrolled hospitals were identified, including 1202 who were admitted for suicide attempt and delivery during the same hospital stay and 111 readmitted for suicide attempt within 1 year post partum. Risk factors associated with prepartum suicide attempts included younger age (adjusted odds ratio [aOR], 0.99; 95% CI, 0.98-1.00) and histories of personality disorder (aOR, 10.81; 95% CI, 5.70-20.49), depression (aOR, 3.97; 95% CI, 2.35-6.70), schizophrenia (aOR, 2.89; 95% CI, 1.52-5.50), and adjustment disorder (aOR, 2.66; 95% CI, 1.07-6.58). Risk factors associated with postpartum suicide attempts included younger age (aOR, 0.96; 95% CI, 0.93-1.00), heavy tobacco use (aOR, 23.09; 95% CI, 5.46-97.62), and histories of alcohol use disorder (aOR, 163.54; 95% CI, 28.30-944.95), personality disorder (aOR, 10.28; 95% CI, 3.29-32.10), anxiety disorders (aOR, 8.13; 95% CI, 2.88-22.98), depression (aOR, 7.27; 95% CI, 2.95-17.91), schizophrenia (aOR, 5.77; 95% CI, 2.17-15.38), bipolar disorder (aOR, 3.98; 95% CI, 1.36-11.67), and insomnia (aOR, 3.17; 95% CI, 1.30-7.78). On sensitivity analysis, risk factors associated with postpartum depression after excluding those with prenatal depression included histories of personality disorder, adjustment disorder, bipolar disorder, insomnia, and anxiety disorders.

CONCLUSIONS AND RELEVANCE

The findings of this cohort study suggest that histories of smoking and prenatal psychiatric disorders are potential risk factors for peripartum suicide attempts and may require additional treatment and prevention interventions.

Perinatal suicidal behavior in sub-Saharan Africa: A study protocol for a systematic review with meta-analysis

BACKGROUND

Perinatal mental illnesses are predominant during gestation and continue for a year after delivery. According to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), suicide is classified as a direct cause of death among the maternal population. The occurrence of suicidal behavior among perinatal women was considered the main contributor to the burden of the disorder. Hence, the current study will develop a protocol for a systematic review as well as a meta-analysis on estimating the prevalence and determinants of perinatal suicidal behavior in Sub-Saharan African countries.

METHODS

PubMed/MEDLINE, Scopus, EMBASE, PsycINFO, and the Web of Science electronic databases will be searched for studies reporting primary data. The second search strategy will be done with Google Scholar, using a combination of the medical subject headings and keywords as the search terms. The studies will be classified into included, excluded, and undecided categories. The studies will be judged based on the eligibility criteria. Heterogeneity will be checked by using the I2 test (Cochran Q test) at a p-value of 0.05 and assuming that the I2 value is > 50%. Publication bias will be checked using a funnel plot, Beg's rank, and Eggers linear statistical tests. A subgroup analysis and sensitivity test will be carried out. The risk of bias will be assessed using the Joanna Briggs Institute (JBI), and the quantitative analysis will determine whether or not to proceed based on the results.

DISCUSSION

This protocol's comprehensive review is expected to generate sufficient evidence on the prevalence of suicidal behavior and its determinants among women during the perinatal period in Sub-Saharan African countries over the last two decades. Hence, this protocol will be imperative to collect and combine empirical data on suicidal behavior during the perinatal period, and doing so will help to provide essential implications or better evidence to plan different kinds of interventions considering determinants expected to impact the burden of suicidal behavior during the perinatal period.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42022331544).

Characteristics of suicidal attacks in pregnancy; a multicenter study

BACKGROUND

Maternal death, fetal death and suicidal attack (SA), each one of these topics are an important public health problem. A suicide attack attempt during pregnancy includes all these important issues together and requires additional attention. Some factors may show regional differences such as suicidal method, distribution of attempts according to the gestational week and the most common preferred drugs. The predetermination of these variables may allow taking preventive measures and advantages can be gains on maternal-fetal health.

METHODS

The data of pregnant women who were admitted to 3 different university hospital emergency departments in same city between 2015 and 2020 after a SA was investigated. SAs features and distribution of attacks based on variables such as age, gravidity and gestational week etc. was recorded. In addition, obstetric/non-obstetric injuries and pregnancy outcomes was also analyzed.

RESULTS

The mean age of 78 cases was 26.9 ± 6.4 (17-44) years. SAs were detected most frequently in the 1st trimester (42.3%) and at least in the 3rd trimester (20.5%). The most preferred SA method (89.7%) was high-dose drug intake. The most commonly preferred drugs were paracetamol, iron/folic acid replacement therapy drugs and antidepressants.

CONCLUSIONS

Pregnant women are at risk of SA, especially in the first trimester. Contrary to popular belief, 75% of pregnant women who have SA do not have a known psychiatric disease diagnosis before. Therefore, psychiatric evaluation should be a part of routine pregnancy follow-up examination, especially in the first trimester. In this way, pregnant women which have increased risk factors for SA such as alcohol addiction, unwanted pregnancy, and depressive mood can be detected early. In this special patient group, the most commonly SA method is high-dose drug intake. Knowing the high dose treatments for frequently used drugs such as paracetamol by emergency physicians and obstetricians, educating medical staff about treatments can save additional time for mother and fetus and can be a life saver approach.

Disability and suicidal behaviors among women of reproductive age

Limited research exists on suicidal behaviors among women with disabilities. This study examined disability, suicidal behaviors, and associated health determinants among non-pregnant women of reproductive age. Data from the 2015-2019 National Survey on Drug Use and Health (n = 76,750) were used to estimate associations between disability and suicidal behaviors and evaluate the effects of health determinants on suicidal behaviors among non-pregnant women of reproductive age with disabilities. Approximately 22% of non-pregnant women of reproductive age with disabilities reported suicidal behaviors compared to only 4.3% of women without disabilities. Women with disabilities had greater adjusted odds of past-year suicidal behaviors (AOR 1.73; 95% CI 1.60-1.87) than those without disabilities. Psychological distress (OR 3.66; 95% CI 2.98-4.49), major depressive episode (OR 3.22; 95% CI 2.82-3.67), unmet perceived mental health need (OR 2.29; 95% CI 1.98-2.65), age 18-25 years (OR 1.65; 95% CI 1.43-1.92), and illicit drug use (OR 1.40; 95% CI 1.20-1.64) were significantly associated with higher odds of suicidal behaviors, and specifically suicidal ideation, among women with disabilities. Non-pregnant women of reproductive age with disabilities are at increased risk for exhibiting suicidal behaviors. Better understanding of suicidal behaviors among women with disabilities can assist public health officials and medical professionals in developing meaningful prevention, detection, and intervention programs.

Self-harm among post-natal mothers in Northwest Ethiopia: Implication for policy and practice

Introduction

Self-harm is a global public health concern affecting thousands of women. However, it is an under-reported and neglected aspect of maternal health, particularly in developing countries. In Ethiopia, there is a paucity of evidence regarding self-harm, and it is rarely given attention. Therefore, this study aimed to assess the proportion of self-harm and associated factors among postnatal mothers in Gondar city, Northwest Ethiopia.

Method

A community-based cross-sectional study was conducted from 1 July, 2021, to 30 August, 2021, in Gondar city. A cluster sampling technique was conducted to select 858 women who gave birth in the last 12 months. The data were collected using a structured questionnaire through face-to-face interviews. The data were entered into EpiData version 4.6 and exported to SPSS 25 for analysis. The multivariable logistic regression analysis was fitted to identify factors associated with the outcome variable. The level of significant association was determined at a p-value of ≤ 0.05.

Result

The proportion of postnatal self-harm was found to be 8.5% (95% CI: 6.7,10.5). Having lower family income (AOR: 2.41, 95% CI: 1.05,5.56), having unplanned pregnancy (AOR: 2.70, 95% CI: 1.53,4.79), experiencing adverse birth outcomes (AOR: 3.11, 95% CI: 1.10,8.83), birth not attended by health provider (AOR: 4.15, 95% CI: 1.76,9.79), experiencing intimate partner violence (AOR: 1.93, 95% CI: 1.12,3.32), and poor decision-making power (AOR: 1.70, 95% CI: 1.02, 2.84) were the variables significantly associated with self-harm.

Conclusion

This study revealed that the proportion of self-harm among postnatal mothers was prevalent. Factors like monthly income of a family, planned pregnancy, birth outcome, birth assistant, intimate partner violence, and decision-making power show an association with maternal self-harm. Antenatal and postnatal self-harm screening as part of the continuum of maternal healthcare is important. Self-harm is also a danger for women who have experienced intimate partner violence or have low socioeconomic economic status, all of which require exceptional mental health assessment.

HIV and suicide risk across adolescence and young adulthood: an examination of socio-demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

INTRODUCTION

As children become adolescents and young adults (AYA), their risk for attempting suicide increases dramatically, with chronic health conditions an important risk factor. This study examined correlates of suicidality across development in AYA living with perinatally acquired HIV (AYALPHIV) and those perinatally HIV-exposed but uninfected (AYAPHEU).

METHODS

Data come from an ongoing longitudinal New York City-based study (N = 339) with AYALPHIV and AYAPHEU interviewed every 12-18 months from 2003 to 2019 (mean enrolment age = 12 years; current mean age = 27 years). The Diagnostic Interview Schedule for Children (adolescent or young adult version) assessed psychiatric disorders and first-reported suicide attempt. Generalized estimating equations were used to examine associations between first-reported suicide attempt and socio-demographic, contextual and psychosocial correlates measured concurrently across six timepoints.

RESULTS

At enrolment, 51% of participants were female, 72% heterosexual, 60% Black and 50% Latinx. Attempted suicide was significantly higher among AYALPHIV (27%, CI 21-33%) compared to AYAPHEU (16%, CI 10-22%), with an OR of 1.74 (CI 1.04-2.92) in a model adjusting for age. For AYALPHIV, anxiety (OR 2.66, CI 1.46-4.85), mood (OR 3.62, CI 1.49-8.81) and behaviour disorders (OR 5.05, CI 2.15-11.87) and past-year arrest (OR 3.05, CI 1.26-7.4), negative life events (OR 1.27, CI 1.11-1.46), city stress (OR 2.28, CI 1.46-3.57), pregnancy (OR 2.28, CI 1.08-4.81) and HIV stigma (OR 2.46, CI 1.27-4.75) were associated with increased odds of attempted suicide, while identifying as heterosexual (OR 0.27, CI 0.14-0.52), higher personal (OR 0.45, CI 0.26-0.80) and family self-concept (OR 0.36, CI 0.22-0.57) were protective. Interactions by HIV status and age were found: substance use was more strongly associated with attempted suicide among AYAPHEU than AYALPHIV, while negative life events and higher religiosity were more strongly associated with increased odds of attempted suicide among AYA ≥ 19 versus ≤ 18 years.

CONCLUSIONS

AYALPHIV compared to AYAPHEU faced unique risks for attempted suicide as they age into adulthood, with the highest risk among AYALPHIV experiencing HIV stigma or pregnancy and the highest risk among AYAPHEU with substance use. Assessing for suicide risk and correlates with attention to ageing can inform preventive interventions tailored to meet AYALPHIV and AYAPHEU needs.

Obstetrician/Gynecologists' Knowledge, Attitudes, and Practice Regarding Suicide Screening Among Women

Background: Suicide is a public health issue, and there are differences between men and women in terms of suicide ideation, behavior, and completion. Obstetrician/gynecologists (OB/GYNs) are uniquely positioned to assess women's suicide risk. Methods: A 53-question survey was distributed to the Pregnancy-Related Care Research Network, assessing practice, attitudes, and knowledge regarding suicide risk assessment and management, and personal experience with suicide. Wilcoxon signed-rank tests with paired samples were used to compare the frequency of screening and interventions for different groups of women, and practices of those with and without suicide experience. Significance was set at p < 0.05. Results: Response rate was 31.9%. Respondents were largely White females. OB/GYNs reported more frequently screening for suicide ideation/intent/behavior among pregnant and postpartum patients than nonpregnant/nonpostpartum patients of childbearing age. The most common assessment tool was the Edinburgh Postnatal Depression Scale; half ask about past suicide ideation/behavior or current thoughts/plans. The most common intervention for at-risk patients was a mental health referral; all interventions were reported more frequently for pregnant patients. Common barriers to screening were inadequate mental health services, time constraints, and inadequate training. Most agreed suicide screening is within their purview, and were knowledgeable about the topic, although gaps were identified. Few reported adequate training in suicide risk assessment, and believed continuing education would be beneficial. A majority endorsed experience with suicide and some practice differences emerged. Conclusions: OB/GYNs view suicide risk assessment in their scope. Some knowledge gaps were identified, and respondents believe additional training would be beneficial.

Review of suicidal ideation during pregnancy: risk factors, prevalence, assessment instruments and consequences

Background

Pregnancy is a period when women are particularly vulnerable to suicidal ideation and a great opportunity for suicide risk prevention.

Aims

This study aimed to establish a comprehensive understanding of suicidal ideation prevalence, risk factors, screening tools, consequences and management during pregnancy.

Method

A literature search was performed in MEDLINE and PsycInfo databases from 2016 to 2021. A narrative synthesis of the literature and a critical overview of the current issues/questions to be addressed within the topic of suicidal ideation during pregnancy was performed.

Results

The prevalence of suicidal ideation during pregnancy was between 2.73 and 18% internationally. The risk factors identified were major depressive disorder, anxiety disorder, difficulties with sleep, previous suicide attempts, high rumination, low incomes, being black, being young, low educational level, partner violence, having poor support, food insecurity, history of child abuse, high obstetric risk, multiparity, previous induced abortion and exposure to tobacco or human immunodeficiency virus diagnosis. The screening tools used for suicidal ideation during pregnancy were item 10 of the Edinburgh Postpartum Depression Scale and item 9 of the Patient Health Questionnaire. Results showed that suicidal ideation during pregnancy is associated with poor cognitive development in children and low birth weight. No case management studies on suicidal ideation were found.

Limitations

The main limitation of the available studies was the lack of articles with a high degree of methodological rigour on this subject.

Conclusions

This narrative review is a state-of-the-art paper about suicidal ideation during pregnancy. Further research is needed, and researchers should carry out systematic reviews and meta-analyses, leading to Clinical Practice Guidelines in this area. This effort would improve our evidence-based practice in Perinatal Psychology and prevent associated suicidal behaviour.

Suicide Among Women and the Role of Women's Health Care Providers

Importance

Suicide is a leading cause of death in the United States, with increasing rates among women. Women are more likely to experience suicidal ideation and engage in suicide behavior than men, and risk is elevated at key points where they may engage in care with a women's health care provider.

Objective

This review describes the prevalence of and risk factors for suicide among women and highlights the role of obstetrician-gynecologists in suicide prevention.

Evidence Acquisition

A PubMed, MEDLINE, and PsycINFO search was completed for English-language publications about suicide among women, including subtopics (eg, perinatal suicide, suicide during perimenopause).

Results

There are overlapping risk factors that contribute to suicide among women, including intimate partner violence and substance use. Specific groups of women may present with unique risk factors, such as women veterans, women in rural areas, and women with preexisting mental health diagnoses, particularly serious mental illnesses. Some women at risk for suicide are not seen in clinical settings, and thus community interventions may be beneficial. There are roles for obstetrician-gynecologists within and outside of the clinic to prevent suicide.

Conclusions and Relevance

Obstetrician-gynecologists can save lives by being aware of the prevalence of suicide ideation and behavior among women, understanding risk factors for suicide over the lifespan, regularly screening for these factors, asking directly about suicide ideation and intent, and being aware of clinical and community resources. Outside of the clinic, they can advocate for increased health care access and community-based interventions. These efforts can contribute to the reduction of preventable death and maternal mortality.

Blood Pressure, Depression, and Suicidal Ideation Among Pregnant Women with HIV

Although prior research has examined associations between blood pressure (BP), depression, and suicidal ideation, few studies have examined this in high-risk populations such as pregnant women with HIV (WHIV). The current study examined the association of BP with depression and suicidal ideation among pregnant WHIV (n = 217) in rural South Africa. BP data (measured ≤ 1 month before the study visit) was extracted from medical records. Depressive symptomatology and suicidal ideation were assessed using the Edinburgh Postnatal Depression Scale. Diastolic BP was positively associated with both suicidal ideation and depressive symptomatology, even after controlling for demographic variables, gestational age, and intimate partner violence. These findings suggest that WHIV with elevated BP may be at greater risk for antenatal depression and suicidal ideation. Future research should utilize longitudinal designs to examine potential mechanisms and the directionality of the relationship, as well as other contributing factors.

The prevalence of suicide ideation and predictive factors among pregnant women in the third trimester

BACKGROUND

Pregnancy is a period for women undergo major physical and psychological changes. Suicide is a cause of maternal death and suicidal ideation is a key factor in suicidal behavior. The purpose of this study was to investigate the prevalence of suicidal ideation in the third trimester and associated predictors including psychological factors such as attachment.

METHODS

A cross-sectional study included 432 pregnant women in the third trimester of pregnancy was conducted in a tertiary hospital. The Edinburgh Postpartum Depression Scale (EPDS) was used to assess prenatal depression and suicidal ideation. The Zung Self-Rating Anxiety Scale (SAS) and Experience of Close Relationship (ECR) scale were used to assess anxiety and attachment respectively.

RESULTS

The results showed that the EPDS scale screened 6.71% of pregnant women with suicidal ideation. Compared with those without suicidal ideation, pregnant women with suicidal ideation had a higher prevalence of insecure attachment, higher scores on the two dimensions of attachment (attachment avoidance and attachment anxiety), and higher prevalence of prenatal depression and anxiety. Binary logistic regression showed that marital satisfaction was a protective factor for suicidal ideation, while prenatal depression, prenatal anxiety and attachment anxiety were risk factors for suicidal ideation.

CONCLUSIONS

The suicidal ideation among pregnant women was high, which should be given more attention. In the process of preventing and intervening suicidal ideation, in addition to the emotional state of pregnant women, their psychological factors such as attachment anxiety should also be considered.

Maternal Suicide Ideation and Behaviour During Pregnancy and the First Postpartum Year: A Systematic Review of Psychological and Psychosocial Risk Factors

Suicide is a leading cause of maternal death during pregnancy and up to a year after birth (perinatal period). Many psychological and psychosocial risk factors for maternal suicidal ideation and behaviour have been investigated. Despite this, there have been no attempts to systematically search the literature on these risk factors. Additionally, few studies have described how the risk factors for suicidal ideation, attempted suicides and suicide deaths differ, which is essential for the development of tools to detect and target suicidal ideation and behaviour. Seven databases were searched up to June 2021 for studies that investigated the association between suicidal ideation and/or suicidal behaviour and psychological/psychosocial risk factors in pregnant and postpartum women. The search identified 17,338 records, of which 59 were included. These 59 studies sampled a total of 49,929 participants and investigated 32 different risk factors. Associations between abuse, experienced recently or during childhood, and maternal suicide ideation, attempted suicide and death were consistently reported. Social support was found to be less associated with suicide ideation but more so with suicide attempts. Identifying women who have experienced domestic violence or childhood abuse and ensuring all women have adequate emotional and practical support during the perinatal period may help to reduce the likelihood of suicidal behaviour.

Prevalence and associated factors of suicidal behavior among pregnant mothers in southern Ethiopia: a cross-sectional study

Background

Suicidal behavior among pregnant mothers is one of the most common psychiatric emergencies that require a major public health concern by researchers and mental health task forces. Pregnant mothers experience suicidal attempt, which is a fatal problem to end life. Therefore, there was a need to assess the prevalence and associated factors of suicidal behavior among pregnant mothers to integrate mental health care, particularly suicide, with maternal management.

Methods

A cross-sectional study was conducted among 504 pregnant mothers in the Gedeo zone, southern Ethiopia. Suicidal behavior was assessed using revised suicidal behavior questionnaire (SBQ-R) with a total score of 3-18; those scoring ≥7 were considered as having Suicidal behavior. Data were entered into Epi-data 3.1 and analyzed using SPSS version 20. Bivariate and multivariate binary logistic regression analysis was performed to identify associated factors of suicidal behavior. Variables with a P-value less than 0.05 with 95% CI were considered statistically significant.

Results

In this study, the overall prevalence of suicidal behavior among pregnant mothers was 47(9.3%) with 95% CI (7.1- 11.9). Regarding the factors; being unmarried [AOR = 5.69, 95% CI, (1.19, 27.23)], gestation age greater than 27 weeks, [AOR = 4.92, 95% CI (1.67, 14.53)], history of having chronic medical illness [AOR = 4.47, 95% CI (1.35, 14.85)], depression [AOR = 4.20, 95% CI (1.90, 9.28], and intimate partner violence [AOR = 7.60, 95% CI (3.27, 17.67)] were significantly associated with suicidal behavior at P value less than 0.05 and corresponding 95% CI.

Conclusion

Pregnant mothers in the community had a high prevalence of suicidal behavior compared to studies conducted among general populations. It is better to include and implement the assessment of suicidal risk factors as a primary treatment package for pregnant mothers, training of health extension workers and other primary health workers on how to assess the risk of suicide among pregnant mothers is warranted.

Suicidal ideation and behavior among perinatal women and their association with sleep disturbances, medical conditions, and known risk factors

OBJECTIVE

Suicide is considered one of the leading causes of maternal mortality, especially among women with postpartum depression. In the current systematic review, we conducted a qualitative data synthesis of recent studies exploring novel risk factors including sleep disturbances and medical conditions, alongside known and significant risk factors for perinatal suicidality.

EVIDENCE ACQUISITION

We conducted a systematic search of the literature according to PRISMA guidelines on PubMed, PsycNET, and Scopus databases. Search terms were "pregnancy" "OR" "postpartum" "OR" "peripartum" "OR" "perinatal" "OR" "postnatal" combined with the Boolean "AND" operator with "suicide" "OR" "suicidality" "OR" "suicidal ideation" "OR" "suicidal behavior."

EVIDENCE SYNTHESIS

The initial search yielded 1,458 records, of which 51 research reports that met inclusion criteria were analyzed. These 51 studies sampled a total of 45,942 participants. Clinically, sleep disturbance, psychopathology, and social support have been identified as dominant risk factors for suicidal behavior among pregnant and postpartum women, as well as medical conditions and aversive life events.

CONCLUSION

Monitoring sleep disturbance, depression, and perceived social support is critical given that they are significant risk factors for suicide among perinatal women. Early identification of perinatal women who may be at risk of suicide, although not depressed, is crucial.

LIMITATIONS

The use of tools designed to identify depression to identify suicidal risk, fail to identify women who are at risk but who do not suffer from depression. Other methodological limitations are the lack of longitudinal studies and the complexity of examining suicidal behavior in sample studies.

Depression moderates the association between pregnancy and suicidal ideation among pregnant and non-pregnant reproductive age women in Brazil

BACKGROUND

Maternal mental health problems are a serious public health concern. Previous data reported that pregnancy might have a protective effect against suicide. In contrast, more recent studies suggested that the prevalence of suicidal ideation (SI) is higher among pregnant women compared to the general population. Using a nationally representative population-based sample of Brazilian reproductive-aged women, this study aims to assess whether SI is more prevalent among pregnant women in comparison with nonpregnant woman.

METHODS

We used data from the Brazilian National Health Survey (PNS) of 2019, a cross-sectional study that comprised a representative sample of residents in private households in Brazil. For the analysis of this study, we selected women aged between 15 and 49 years old who have answered the questionnaire of the Selected Resident of the PNS, which comprised a sample of 27,249 women. Logistic regression models were performed to obtain crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI) for the association between pregnancy status and SI.

RESULTS

The prevalence of SI during pregnancy was 6.8% (95% CI: 6.2-7.4). The association between pregnancy status and SI was modified according to the recent clinical diagnosis of depression (interaction term: OR = 41.72, 95% CI: 5.64-308.45, p < 0.001). Our findings indicated that among nondepressed women, pregnancy status seems to decrease the probability of SI. Additionally, SI is associated with a vulnerable profile that includes being an adolescent, having an unpartnered/not married status, lower family income, lower education, and a recent clinical diagnosis of depression.

CONCLUSION

SI is a common problem for reproductive-age women. In the presence of a recent depression clinical diagnosis, pregnancy increases the risk of SI. Management of SI among pregnant women should correctly identify sociodemographic risk factors and the presence of a recent clinical diagnosis of depression.

Prevalence of suicidal ideation in pregnancy and the postpartum: A systematic review and meta-analysis

BACKGROUND

Suicidal ideation, a significant risk factor of suicide, is considered a potential trigger for intervention prior to self-harm or suicide; however, the prevalence of maternal suicidal ideation varied widely between studies. This review aims to synthesis the available evidence to estimate the prevalence of maternal suicidal ideation before and after pregnancy.

METHODS

We searched six English databases (PubMed, Web of Science, Embase, the Cochrane Library, PsycINFO, CINAHL) and three Chinese databases (China National Knowledge Infrastructure, Wang Fang, Chinese Biomedical Literature Databases) from database inceptions before August 31, 2020; and checked the reference list for relevant studies. Data in the included studies were used to calculate the prevalence of maternal suicidal ideation. Subgroup analysis and meta-regression were performed to detect the potential sources of heterogeneity.

RESULTS

6094 potentially studies were identified. 71 studies, including 23 cohort studies, 47 cross-sectional studies, and 1 RCT study, were included for final analysis. The total participants were 92146, with sample size ranged from 23 to 22118. The included studies were from 23 different countries distributing on six continents, most of the studies were conducted in Asia (n = 18), North America (n = 16), and South America (n = 15). The pooled prevalence of maternal suicidal ideation reported by eligible studies was 8% (95% CI 7-10%), with 10% in antenatal and 7% in postpartum. Prevalence significantly varied based on measuring tools, study design, study countries, and publication year, while prevalence was not conditional on the time-point assessment, sample size, and maternal age.

LIMITATION

Obvious heterogeneity and no standardization tools for measuring suicidal ideation may limit the results' interpretation.

CONCLUSION

Our systematic review reported the prevalence of suicidal ideation in pregnancy and postpartum was 8%. Future studies should establish standardization tools for measuring suicidal ideation and identify strategies of prevention and treatment.

Suicidal ideation: Prevalence and risk factors during pregnancy

INTRODUCTION

Although suicide is the main cause of maternal death during pregnancy in industrialized countries, there are few research regarding the prevalence and risk factors of suicidal ideation during pregnancy, especially in Spain.

METHOD

In a multicenter study, the sample included 1,524 pregnant women recruited from an obstetrics setting from two Spanish tertiary-care public hospitals. The prevalence of prenatal suicidal ideation was estimated by analyzing their responses to item 9 on the Patient Health Questionnaire (PHQ-9). The risk factors (which increases the probability of having suicidal ideation) included sociodemographic and biomedical variables, and the stress subscale from the revised prenatal version of the Postpartum Depression Predictors Inventory (PDPI-R).

RESULTS

A total of 2.6% of pregnant women reported suicidal ideation. Risk factors of suicidal ideation during pregnancy include sociodemographic, such as prior history of depression (β = 0.120, p < .05), unemployment (β = 0.149, p < .05), and being an immigrant (β = 0.140, p < .01), and biomedical variables, such as previous abortion (β =0.169, p < .01) and assisted reproduction (β = -0.100, p < .05).

DISCUSSION

Given that the prevalence of suicidal ideation is higher than expected, the results of the study suggest the critical need for screening and designing preventive interventions adapted to pregnant women to decrease risk of associated suicidal behavior. In protocols carried out by midwives, specific risk factors should be included in health screenings during pregnancy.

Posttraumatic Stress Symptoms Among Chinese College Students During the COVID-19 Pandemic: A Longitudinal Study

A longitudinal assessment of the prevalence of posttraumatic stress symptoms (PTSS) and risk factors is indispensable for further prevention and/or treatment. The longitudinal web-based survey enrolled 1,164 college students in China. Measured at two time points (February and August 2020), PTSS, demographic information, adverse childhood experiences (ACEs), resilience and self-compassion information were collected to explicate the prevalence and predictors of PTSS concurrently and over time. Results showed that although PTSS generally declined throughout the 6 months after the outbreak of COVID-19, the prevalence remained relatively high. Resilience and self-compassion negatively predicted PTSS concurrently and longitudinally. While subjective family socioeconomic status (SES) and ACEs at Wave 1 did not predict PTSS under COVID-19 at Wave 1, but both significantly predicted PTSS at Wave 2. Findings implicate potential targets for detecting and intervening on symptoms of trauma in this vulnerable population.

Perinatal suicidality: prevalence and correlates in a South African birth cohort

Suicidal ideation and behaviour (SIB) in the perinatal period is prevalent in low- and middle-income countries (LMICs). Past work has been limited by reliance on self-rated scales, and there are few data on SIB severity in such settings. We collected cross-sectional data on SIB using a clinician-administered scale and explored risk factors associated with the presence of SIB and SIB severity. Data were collected from the Drakenstein Child Health Study cohort antenatally and at 6 months postpartum. SIB was measured using the Mini International Neuropsychiatric Interview, and potential sociodemographic, psychosocial, and psychiatric risk factors were assessed. Multivariable analysis determined cross-sectional risk factors. Multinomial regressions determined predictors of SIB risk categories. Among 748 women, the antenatal SIB prevalence was 19.9% and postpartum 22.6%. SIB was associated with younger age (antepartum), PTSD (postpartum), and depression (ante- and postpartum). Depression and PTSD predicted belonging to the high-risk SIB group. The medium-risk group was more likely to have depression, alcohol use during pregnancy, and substance abuse. Depression, PTSD, food insecurity, recent intimate partner violence (IPV), and childhood trauma were associated with the low-risk group versus the no-risk group. Screening is needed for perinatal SIB. Associations of perinatal SIB with younger age and major depression are consistent with previous work. The association with PTSD is novel, and underscores the importance of assessment of trauma exposure and outcomes in this population. Different risk categories of SIB may have different causal pathways and require different interventions.

Intimate partner violence and health outcomes experienced by women who are pregnant: a cross-sectional survey in Sanma Province, Vanuatu

Background

We aimed to describe the association between ni-Vanuatu women's experiences of violence perpetrated by their intimate partner (IPV) during pregnancy, and health outcomes, including self-reported general health, antenatal care attendance, psychological distress and suicidal thoughts/behaviours.

Methods

A cross-sectional survey of a consecutive cohort of women attending the antenatal clinic at Northern Provincial Hospital, Vanuatu from May to July 2019. Psychological, physical and sexual IPV were measured using the WHO Violence Against Women Instrument. Psychological distress was measured using the 20-item WHO Self-Reporting Questionnaire. Data were collected in confidential individual interviews with a trained local interviewer. Logistic regression models were used to investigate the relationship between IPV and health outcomes while controlling for confounding variables.

Findings

192 women contributed data, among whom 188 answered the questions about IPV. Of these, 80 women had experienced any form of IPV during the current pregnancy. Women who experienced IPV were more likely than those who did not to report poorer general health (aOR:2.97, 95%CI:1•42-6•22), higher levels of psychological distress (aOR:4.77, 95%CI:2•02-11.24) and suicidal thoughts (aOR:3•78, 95%CI:1•71–8.33) and/or behaviours (aOR:1.98, 95%CI:0•69–5.64) in the previous four weeks. Late antenatal attendance was widespread, but not related to IPV.

Interpretation

IPV perpetrated against women who are pregnant is a serious public health problem in Vanuatu and is related to worse antenatal physical and psychological health.

Funding

JF is supported by the Finkel Professorial Fellowship, funded by the Finkel Family Foundation; TT is supported by a Monash Strategic Bridging Fellowship. Monash University provided a student research grant to SMcK. Soroptimist International Gippsland provided a grant to fund small gifts for the participants.

The role of personality dimensions and trait anxiety in increasing the likelihood of suicide ideation in women during the perinatal period

INTRODUCTION

Increasing amount of data reveal that suicide risk is a real phenomenon among perinatal women, determined by several other psychopathological conditions with depression being just one of them. This study aimed to investigate the role of personality dimensions on the occurrence of suicide ideation during the perinatal period.

METHODS

A longitudinal prospective study was performed in pregnant women who were monitored at university-based obstetrical care units in our county. Recruited women were reassessed between 6 and 8 weeks into their postnatal period. Trait and state anxiety, five-factor based dimensions of personality, and depressive symptoms were assessed using established psychometric measures. Appropriate statistical analyses were conducted, depending on the distribution of variables.

RESULTS

Significant levels of state anxiety (33.7% vs. 15.5%), depressive symptoms (19.8% vs. 8.5%), and suicide risk (13.9% vs. 6.3%) have halved in the postnatal period compared to the antenatal assessment. A lower level of education was associated with the presence of postnatal suicide ideation (p = .041), while an unemployed professional status was more frequent in pregnant women presenting antenatal suicide ideation (p = .021). Trait anxiety was predictive for the appearance of suicide ideation within the entire perinatal period assessed (p < .001 and p = .007, respectively). Agreeableness and conscientiousness predicted antenatal suicide ideation (p = .033 and p = .032, respectively).

DISCUSSIONS

Different dimensions of personality may play a contributing role in the development of suicide ideation in perinatal women. Consequently, personality dimensions and trait anxiety, not only depressive symptoms, should be investigated when attempting to identify perinatal women at risk of suicide.

Suicidal ideation and associated factors among pregnant women attending antenatal care in Jimma medical center, Ethiopia

BACKGROUND

Suicidal ideation (SI) among pregnant women is a major public health concern worldwide and is associated with a higher risk of completed suicide. However, there are limited studies that determined the prevalence and the potential determinants of suicidal ideation in Sub-Saharan Africa, including Ethiopia. Therefore, this study aimed to explore the prevalence of suicidal ideation and associated factors among pregnant women attending antenatal care in Jimma, Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted among 423 pregnant women attending Jimma medical center in Southwest, Ethiopia. A systematic random sampling technique was used to select the study participants. Suicidal ideation assessed using the Suicidality Module of the World Mental Health survey initiative version of the World Health Organization Composite International Diagnostic Interview (CIDI). Other tools used are EPDS, Abuse Assessment Scale (AAS), DASS -21, PSS, Maternity Social Support Scale (MSSS), and Pittsburgh Sleep Quality Index (PSQI). A multivariable logistic regression analysis was used to explore the potential determinants of suicidal ideation among the participants.

RESULT

The prevalence of SI among women who are on antenatal care was found to be 13.3% (95% CI (10.1,16.4). In multivariable analysis, marital status with lack of cohabiting partners (AOR = 2.80,95%CI:1.23,6.37), history of abortion (AOR = 2.45,95% CI:1.03,5.93), having depression (AOR = 4.28,95% CI:1.75,10.44),anxiety(AOR = 2.99,95% CI:1.24,7.20), poor sleep quality (AOR = 2.85,95% CI:1.19,6.79), stress (AOR = 2.50, 95% CI:1.01,5.67), and intimate partner violence (AOR = 2.43, 95% CI:1.07,5.47) were found to be significant predictors of suicidal ideation.

CONCLUSION

The prevalence of SI among pregnant women was found to be huge. Lack of cohabiting partners, previous history of abortion, depression, anxiety, intimate partner violence, poor sleep quality, and stress were variables that are independent predictors of suicidal ideation. Screening and interventions of antenatal SI are needed.

Racial/Ethnic Disparity in Suicidal Ideation, Suicide Attempt and Non-suicidal Intentional Self-harm Among Pregnant Women in the United States

We examined the prevalence of suicidal ideation, suicide attempt and non-suicidal intentional self-harm among pregnant women in the United States stratified by race/ethnicity. Data on hospital admissions among pregnant women 15-49 years during 2016-2017 compiled in the Nationwide Inpatient Sample were used for this study. We assessed the prevalence and factors of suicidal ideation, suicide attempt and non-suicidal intentional self-harm among different race/ethnicities. The prevalence of suicidal ideation, suicide attempt and non-suicidal intentional self-harm was greatest among hospitalized Non-Hispanic (NH) Black pregnant women. As compared to pregnant women who were routinely discharged, those who died during the course of hospitalization had about eight times the odds for NH-Whites, four times the odds for NH-Blacks and five times the odds for Hispanics of suicidal ideation or attempt. Appropriate measures are needed for prompt diagnosis and management of mental health issues in pregnant women belonging to vulnerable sub-groups.

Acute psychiatric illness and drug addiction during pregnancy and the puerperium

Pregnancy and the puerperium do not protect against acute psychiatric illness. During puerperium, the chance of acute psychiatric illness, such as a psychotic episode or relapse of bipolar disorder, is greatly increased. Suicide is a leading cause of maternal death. Both psychiatric disease and ongoing drug addiction impact not only the pregnant woman's somatic and mental health but also impact short-term and long-term health of the child. Indeed, prompt recognition and expeditious treatment of acute psychiatric illness during pregnancy and the puerperium optimize health outcomes for two patients. Pregnancy and puerperium represent a stage of life of great physiologic adaptations, as well as emotional and social changes. This conjunction of changes in somatic, emotional health and social health may mitigate the occurrence, clinical presentation, and clinical course of acute psychiatric illness and call for a multidisciplinary approach, taking into account both the medical and social domains. This chapter describes acute psychiatric illnesses during pregnancy and the puerperium and illicit substance abuse, from a clinical perspective, while also describing general principles of diagnosis and clinical management during this stage of life, which is an important window of opportunity for both the pregnant woman and the child.

Prevalence and correlates of suicidal behaviors during pregnancy: evidence from the National Survey on Drug Use and Health

Suicidal behaviors during pregnancy are prevalent and have the potential to adversely affect a woman's health and her developing infant. The purpose of this study was to examine prevalence and correlates of suicidal behaviors in a national sample of pregnant women. Using data from the 2009-2018 National Survey on Drug Use and Health, a sample of 7479 pregnant women was analyzed. Multiple logistic regression was used to examine associations between sample characteristics and suicidal behaviors overall and by pregnancy trimester. In this sample, 3.4% of women exhibited suicidal behaviors such as ideation, planning, and attempt. Suicidal behaviors were more prevalent at 4.4% among women in the first trimester compared to the second/third trimesters (2.9%). Of those exhibiting suicidal behavior, 63.0% were ideators, 18.9% planned suicide, and 18.1% attempted suicide. Logistic regression analyses revealed that all racial/ethnic groups of women in the third trimester were less likely to be suicidal relative to black non-Hispanic women. Alcohol abuse (OR 3.70, 95% CI 1.97, 6.81) and major depressive episode (OR 4.91, 95% CI 3.10, 7.84) in the past year significantly increased the odds of suicidality for all pregnant women. Perceived unmet need for treatment increased the likelihood (OR 5.64, 95% CI 3.55, 8.97) of suicidal behavior regardless of trimester. These findings underscore the importance of screening for suicidal behaviors in the first trimester, especially among those with existing mood disorders and substance abuse. Racial/ethnic differences should be considered in targeted interventions for suicide prevention.

Prevalence and Correlates of Prenatal Depression, Anxiety and Suicidal Behaviours in the Volta Region of Ghana

Pregnancy is associated with several physical and psychosocial challenges that influence women's health and wellbeing. However, prenatal mental health has received little attention. Therefore, this study examined the prevalence and correlates of prenatal depression, anxiety and current suicidal behaviors among pregnant women in the Volta Region of Ghana. Two hundred and fourteen (n = 214) pregnant women recruited from two hospitals responded to the hospital depression and anxiety scale (HADS), the insomnia severity index, and a set of psycho-behavioral, socioenvironmental and demographic characteristic questions. Chi-squared, bivariate and multivariate logistic regression were used for data analysis. Prevalence of prenatal depression, anxiety and current suicidal behaviors was 50.5%, 35.5% and 3.3%, respectively. After controlling for other variables, average monthly income, insomnia, non-nutritious food consumption (pica), and body image satisfaction were significantly associated with depression. Marital status, insomnia, lifetime suicidal behavior and partner support were significantly associated with anxiety. Current partner abuse was the only factor significantly associated with current suicidal behavior. The high prevalence rates of anxiety and depression among pregnant women and intimate partner violence remain important maternal health issues in the region. Therefore, brief mental health screening and counseling services should be integrated into prenatal healthcare services.

Prevalence and Correlates of Suicide Ideation and Attempt among Pregnant Women Attending Antenatal Care Services at Public Hospitals in Southern Ethiopia

BACKGROUND

Suicide ideation and attempt are common among pregnant women, risk factors for completed suicide, and associated adverse maternal and fetal outcomes. It is under-recognized and has not been investigated well in low-income countries like Ethiopia. This study aimed to assess the prevalence and factors associated with suicide ideation and attempt among pregnant women attending antenatal care services at public hospitals in southern Ethiopia.

METHODS

A group of 762 pregnant women who were attending the antenatal service at public hospitals in Hawassa, southern Ethiopia, selected by a systematic random sampling technique, took part in an interview. A Composite International Diagnostic Interview (CIDI) was used to measure suicide ideation and attempt. Chi-square and binary logistic regression analyses were performed to identify the associated factors. An adjusted odds ratio with a 95% confidence interval was used for reporting the result with a p-value<0.05 statistical significance level.

RESULTS

The prevalence of suicide ideation and attempt among pregnant women was 11.8% and 2.7%, respectively. Unplanned pregnancy (AOR=2.01, 95% CI=1.04-3.88), poor social support (AOR=3.29, 95% CI=1.62-6.68), common mental disorders (AOR=2.77, 95% CI=1.50-5.09), and lifetime suicide ideation (AOR=4.63, 95% CI=2.63-8.16) were factors significantly associated with suicide ideation. Social support was the only correlated factor with suicide attempt among pregnant mothers.

CONCLUSION

The prevalence of suicide ideation and attempt among pregnant women was found to be high. Intervention strategies towards suicidal ideation and attempt should consider improving social support and antenatal related common mental disorders with a primary focus on women with unplanned pregnancy and prior history of suicide ideation.

[Suicidality in the perinatal period: Descriptive study on factors associated with suicidal ideation among women hospitalized in the perinatal period at the specialized hospital center]

OBJECTIVES

Suicide is the leading cause of maternal mortality in high-resource countries. The onset of suicidal ideation is a major risk factor for suicide attempts. Suicidality has a major impact on the mother-baby relationship and on child development. The main objective of the study was to identify factors associated with the occurrence of perinatal suicidal ideation in women requiring hospitalization. The secondary objectives of the study were to describe the socio-demographic and clinical characteristics of this specific population, to specify the follow-up procedures at hospital discharge and to develop a semi-directed interview framework for psychiatric evaluation of perinatal patients admitted to a psychiatric hospital in order to better identify those at risk of suicide and improve overall management, particularly in terms of referral to existing perinatal care services.

METHODS

Descriptive and retrospective study carried out at the Specialized Hospital Center of women hospitalized in the perinatal period between 2014 and 2019. The inclusion criteria were: inpatient pregnant or postpartum within one year of delivery, 16 to 43 years. A keyword search was performed to retrieve the computerized records. All records matching the inclusion criteria were included. We studied the occurrence of suicidal ideation according to the main known clinical and socio-demographic risk factors.

RESULTS

The sample included 25 pregnant patients and 57 post-partum patients. The presence of a psychiatric history increased the risk of suicidal ideation by 4.38 (P<0.03). The association between the occurrence of a stressful life event and the risk of suicidal ideation onset was close to significant (P<0.10). One third of the patients had been admitted for a reason related to suicidality. Less than one-third of the patients had been referred to existing perinatal services.

CONCLUSIONS

Suicidality in the perinatal period has a major impact on the dyad as well as on the whole family. The search for suicidal ideas must be systematic during psychiatric interviews, a fortiori when a psychiatric history has been authenticated. Every patient hospitalized in adult psychiatry should be referred to specialized outpatient perinatal psychiatry services. Prevention involves raising awareness and training of all health professionals, networking, but also informing the general public.