Perinatal depression associated with threefold risk of suicidal behaviour

1. Perinatal depression (PND) was found to be associated with a 3-fold increased risk for suicidal behaviours compared to a non-PND cohort at 18-year follow-up.

2. PND most significantly increased risk for suicidal behaviours for 1 year after diagnosis, with certain suicide methods being much more common than in the general population. 

Evidence Rating Level: 2 (Good)

Among several important public health issues is that of maternal mental health. Up to one-third of postnatal mortality has been attributed to maternal suicide, and thus, identifying at-risk groups for maternal suicide is thought to be a priority in prevention. At-risk groups may involve mothers with a psychiatric history prior to pregnancy, lower socioeconomic status, and those with perinatal depression (PND). The current matched cohort study and analysis included 86,551 women with PND (55% affected in the antenatal period, and the rest affected postnatally; mean [SD] age 30,67 [5.23] years) and 1,029,215 matched cohorts without PND. Women with PND were more likely to be primiparous, smoked within the 3 months prior to pregnancy, had greater BMIs, and psychiatric histories. At 18-year follow-up, women who were identified to have PND were 3 times more at-risk for suicidal behaviour (HR, 3.15; 95% CI, 2.97-3.35), and this risk was even higher for women without a previous history of psychiatric disorders. Risk was greatest in the first year following PND diagnosis (HR, 7.20; 95% CI, 6.07-8.54), lasting up to 5 years later (HR, 2.34; 95% CI, 2.12-2.57). With respect to suicidal behaviours, women in the PND group were over 7 times more likely to use the method of hanging (HR, 7.29; 95% CI, 4.42-12.03) and within the first year, risk was highest for self-poisoning (HR, 11.76; 95% CI, 9.86-14.02). A sibling-matched cohort also revealed similar results in that those with PND were at higher risk for suicidal behaviours than non-PND counterparts. This study has strengths in that the lengthy follow-up period of 18 years allowed for a longitudinal approach to assessing maternal suicide risk, which remained elevated if one had been diagnosed with PND. However, results are somewhat limited in that they may be underestimating the impact of suicidal behaviour; of those who attempt suicide or experience suicidal ideation, a large proportion never seek medical help. Future studies should also assess the impact of PND on psychiatric hospitalizations, and control for other environmental factors that may be at play in the development of PND (e.g., domestic violence, birth trauma, etc.). 

Click to read the study in JAMA Network Open

Image: PD

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