Correlates of Suicidal Ideation During Pregnancy and Postpartum Among Women Living with HIV in Rural South Africa

Abstract

In developing countries, up to 20% of maternal deaths during pregnancy are due to suicide, and being HIV-infected confers additional risk. This manuscript sought to identify perinatal correlates of suicidal ideation among women living with HIV (WLHIV) in rural South Africa. Pregnant WLHIV (N = 681) were recruited and re-assessed at 12-months postpartum. Mean age was 28.3 (SD = 5.7) years and 68% were below the poverty line. Prenatal suicidal ideation was 39%; suicidal ideation continued for 7% at 12 months, 13% experienced incident suicidal ideation, and for 19% suicidal ideation had stopped postnatally. Intimate partner violence (AOR = 1.17) and depression (AOR = 1.14) predicted sustained suicidal ideation. Increased income (AOR = 2.25) and greater stigma (AOR = 1.33) predicted incident suicidal ideation. Younger age (AOR = 0.94), disclosure of HIV status to partner (AOR = 0.60), and greater stigma (AOR = 1.24) predicted postnatal cessation of suicidal ideation. Perinatal care may provide windows of opportunity for identification and treatment of suicidal ideation.

Effects of Maternal Suicidal Ideation on Child Cognitive Development: A Longitudinal Analysis

“…Additionally, children of mothers with emerging suicidal ideation tended to have lower cognitive scores across the developmental domains compared to the other groups. The results here support previous research in which suicidal ideation was associated with marital status, food insecurity, maternal depression and stress [2,[4][5][6]. The lack of a support system or household food security may all contribute to the mother's mental well-being and the likelihood of suicidal thoughts or suicidal behaviour manifestation.…”

“…Suicidal ideation may precede suicide planning and attempted suicide and is a distressing psychological phenomenon, indicative of low mood and poor quality of life [1]. Despite advances in HIV treatment, suicidality (which includes suicidal ideation, suicide attempts, and completed suicides), remains elevated for people living with HIV (PLWH) in comparison with their HIV negative counterparts [2]. Although suicidal ideation is not always an automatic determinant for suicidal behaviour, it is an important risk factor that requires early detection and a potential trigger for intervention [3].…”

British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018

“…Talking about HIV should be encouraged in all women but should be viewed as a process that may take some time . Talking about HIV to a family member, other than a sexual partner, should be encouraged as this has been demonstrated to reduce levels of postnatal depression . There are situations in which a woman given a new diagnosis of HIV may be reluctant to share this with a current sexual partner, or appears to want to delay telling indefinitely.…”

Changes in prenatal depression and anxiety levels in low risk pregnancy among Iranian women: A prospective study

“…A recent report has been presented on the relationship between changes in the brain structure of children and pregnancy anxiety, which can be associated with behavioral problems [6]. In this period, the probability of suicide [7] and disorder in the development of maternal roles also increases. Bonding [8] and postpartum depression [9] are complications reported due to psychological disorders during pregnancy.…”