Prevalence and risk factors for suicidal intent in pregnancy and after birth
Rose Meades, Elizabeth Dudeney, Andrea Sinesi, Helen Cheyne, Margaret Maxwell, Catherine Best, Stacey McNicol, Judy Shakespeare, James Walker, Fiona Alderdice, Julie Jomeen, Louise R. Williams, Susan Ayers,Background
Suicide is one of the leading causes of maternal mortality in high-income countries. Suicide prevention policy calls for maternity care providers to actively explore potential risk factors and self-reported suicidal intent with perinatal women. However, longitudinal research establishing the prevalence of suicidal intent and associated risk factors with representative cohorts of perinatal women in the UK is lacking.
Aims
This secondary analysis aimed to determine the prevalence of suicidal intent in pregnancy and postpartum, and examine factors associated with suicidal intent.
Method
A total of 2210 women completed self-report assessments in early, mid- and late pregnancy and early postpartum. Suicidal intent was measured with the item ‘I have made plans to end my life’ (Clinical Outcomes in Routine Evaluation-10). Other variables included anxiety (Generalised Anxiety Disorder-7, Stirling Antenatal Anxiety Scale), depression (Whooley Questions), health status (EuroQoL EQ-5D-5L), mental health history, and sociodemographic and pregnancy variables.
Results
Suicidal intent was indicated by 72 participants (3.26%, 95% CI 2.56–4.09) on at least one occasion. Suicidal intent was significantly associated with having negative feelings about pregnancy (odds ratio 3.63, 95% CI 1.99–6.63), unplanned pregnancy (odds ratio 2.03, 95% CI 1.25–3.30), previous and current mental health problems (odds ratio 3.70 95% CI 2.19–6.25), symptoms causing daily difficulties (odds ratio 5.94 95% CI 3.32–10.66) and being of Asian (odds ratio 2.62, 95% CI 1.44–4.77) or mixed ethnicity (odds ratio 3.43, 95% CI 1.49–7.93). Poor physical health in early pregnancy was also associated with suicidal intent ( t = 6.37, d.f. = 2108, p < 0.001).
Conclusions
These findings indicate that daily difficulties associated with mental health, and negative feelings about pregnancy are important and underexplored risk factors for experiencing suicidal intent. The findings also corroborate previous research indicating that previous and existing mental health problems and ethnicity are significant risk factors.