It is estimated that suicide accounts for about 10% of all maternal deaths. While we have a fair amount of information to help us predict which women are at risk for depression during pregnancy and the postpartum period, few studies have attempted to identify risk factors for suicide in this population.
In a recent study, a total of 22,118 women completed the Edinburgh Postnatal Depression Scale (EPDS) at 24-28 weeks of gestation and at 6 weeks postpartum; suicidal ideation was fairly common, with 842 (3.8%) women endorsing suicidal ideation.
Suicidal ideation was more common during pregnancy and after delivery among Asians vs. other groups (ORs 1.64 and 1.63, respectively).
Planned cesarean delivery reduced suicidal ideation after delivery compared with vaginal delivery (OR 0.56, P<.01), whereas perineal laceration increased suicidal ideation reporting (OR 2.10, P<.05).
While this data is interesting, it is unclear how to use this information. Only a small number of women who report suicidal thoughts will go on to make a suicide attempt. Therefore, we cannot assume that these risk factors identify the women at greatest risk for suicide. At this point, we recommend monitoring women who report suicidal ideation and providing interventions targeted to perinatal depression.
Ruta Nonacs, MD PhD
Kim JJ, Silver RK, La Porte LM, et al. Suicide risk among perinatal women who report thoughts of self-harm on depression screens. Obstet Gynecol. 2014; 123 Suppl 1:60S.