Several articles from the Journal of Clinical Psychiatry report on suicidal and self-harm ideation in pregnant and postpartum women.  Not surprisingly, a history of psychiatric illness increases risk; however, other factors play an important role, including history of self-harm and obstetric and neonatal complications.   

In this setting, we still do not know what drives women with suicidal thoughts to attempt suicide.  Clinically we suspect that the severity of symptoms, especially in women with bipolar disorder, is an important determinant of this risk.  However, it is difficult to reliably predict suicide risk; a more complete understanding of risk factors is clearly warranted.  

Later this week, we will be reviewing an article from Luykx and colleagues about strategies proposed to reduce suicide and infanticide in women with bipolar disorder.  

For more detailed descriptions of many of these topics, you can read the CWMH NEWSLETTER which comes out every Thursday.  You can sign up for our newsletter HERE.

Ruta Nonacs, MD PhD


No articles this week


No articles this week


The Prevalence and Correlates of Self-Harm in the Perinatal Period: A Systematic Review.

Ayre K, Gordon HG, Dutta R, Hodsoll J, Howard LM.  J Clin Psychiatry. 2019 Dec 31;81(1). 

Key correlates of self-harm during pregnancy and the postpartum year include mental disorder, substance misuse, younger age, being unmarried, and obstetric and neonatal complications. Additionally, a history of self-harm and fetal/infant loss were associated with postpartum self-harm. 

Self-Harm, Self-Harm Ideation, and Mother-Infant Interactions: A Prospective Cohort Study.

Gordon H, Nath S, Trevillion K, Moran P, Pawlby S, Newman L, Howard LM, Molyneaux E.  J Clin Psychiatry. 2019 Sep 10;80(5). Free Article

Self-harm ideation during pregnancy is associated with elevated depressive symptoms in the perinatal period and with poorer quality mother-infant interactions. 

The course of panic disorder during the peripartum period and the risk for adverse child development: A prospective-longitudinal study.  

Martini J, Beesdo-Baumac K, Garthus-Niegelde S, Wittchenaf H. J Affect Disord January 2020.

PD and panic attacks were commonly observed during the early stages of pregnancy.  Comorbid PD and MDD had the greatest impact and were associated with impaired bonding and regulatory problems.


Trend of antidepressants before, during, and after pregnancy across two decades-A population-based study.

Sun Y, Dreier JW, Liu X, Glejsted Ingstrup K, Maegbaek ML, Munk-Olsen T, Christensen J.  Brain Behav. 2019 Nov;9(11).Free Article

In Denmark, prescription of antidepressants during pregnancy increased steadily from 0.4% in 1997 to 4.6% in 2011, but decreased thereafter to 3.1% in 2016.


Brexanolone For Postpartum Depression: A Novel Approach and a Call for Comprehensive Postpartum Care.

Jarman AF, MacLean JV, Barron RJ, Wightman RS, McGregor AJ.  Clin Ther. 2020 Jan 3.

The authors suggest suggest a comprehensive approach to postpartum wellness that includes investing in evidence-based social interventions that may be much more accessible to the millions of Americans experiencing postpartum mood disturbance.

Symptom profile of postpartum and non-postpartum manic episodes in bipolar I disorder: a within-subjects study.

Gordon-Smith K, et al.  Psychiatry Res January 2020.

Childbirth may act as a pathoplastic trigger in women with bipolar disorder.More mixed features with perplexity occurred during postpartum as opposed to non-postpartum  manic episodes. Classic manic symptoms, specifically pressured speech and increased sociability, were significantly less frequent in postpartum manic episodes.

Luykx JJ, Di Florio A, Bergink V.  Prevention of Infanticide and Suicide in the Postpartum Period-the Importance of Emergency Care.  JAMA Psychiatry. 2019 Jul 31.

Strategies can be used to reduce the risk of suicide and infanticide in postpartum women, focusing specifically on women at risk for postpartum psychosis.  


No articles this week


No articles this week


Adolescents’ Depressive Symptom Experience Mediates the Impact of Long-Term Exposure to Maternal Depression Symptoms on Adolescents’ Body Mass Index.

Cordola Hsu AR, Niu Z, Lei X, Kiresich E, Li Y, Hwang WC, Xie B.Ann Behav Med. 2020 Jan 11. 

Analyses revealed a significant relationship between children’s long-term exposure to maternal depressive symptoms from age 1 month to Grade 6 and adolescents’ BMI z-score at age 15. The adolescents’ experience of depressive symptoms significantly mediated this relationship.


Trajectory analysis of sleep maintenance problems in midlife women before and after surgical menopause: the Study of Women’s Health Across the Nation (SWAN).

Kravitz HM, Matthews KA, Joffe H, Bromberger JT, Hall MH, Ruppert K, Janssen I.  Menopause. 2020 Jan 13. 

Four trajectory patterns of sleep maintenance problems were identified: low (33.5% of women), moderate (33.0%), increasing during presurgery (19.9%), and high (13.6%). One-fifth of women reported a presurgery increase in these problems. 

Prospective Association Between Trans fatty acid intake and Depressive Symptoms: Results from the Study of Women’s Health Across the Nation.

Li D, Zheng H, et al. J Affect Disorder March 2020.

In a nationwide sample of 2376 midlife women in the US, trans fatty acid intake predicted depressive symptoms 5 years later in women with baseline CES-D score <16.


Risk of bipolar disorder in patients with polycystic ovary syndrome: a nationwide population-based cohort study.

Chen S-F, Yang Y-C, Hsu C-Y, Shen Y-C. J Affect Disord. 2020;263: 458-462. 

Compared to unaffected controls, women with PCOS had an 8-fold increased risk of developing bipolar disorder; metformin decreased this risk.

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