Measures of suicidality in perinatal women: A systematic review

Dudeney, Elizabeth; Coates, Rose; Ayers, Susan

doi:10.1016/j.jad.2022.12.091

Cited by 9 publications

(5 citation statements)

References 134 publications

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“…A topic guide was developed by ED and RC, which comprised two parts. The first part of the interview used cognitive interviewing techniques to examine the acceptability and content validity of 16 suicide-related items taken from seven different depression and/or mental health screening measures, which have previously been administered and/or validated in perinatal populations ( 23 ). Participants were asked to sequentially read out each item (and its corresponding response options) and to ‘think aloud’ when verbalising their thoughts on the item to the researcher.…”

Section: Methodsmentioning

confidence: 99%

“…The 16 suicide-related items were taken from seven different screening measures of psychological distress, depression, and anxiety. Items were chosen because they have previously been administered and/or validated in perinatal populations to identify suicidal ideation and/or suicidal behaviours ( 23 ). A descriptive summary of the included measures/items is presented in Table 2 .…”

Section: Methodsmentioning

confidence: 99%

“…To date, no self-report screening measures of suicidality have been specifically designed for use with pregnant and postnatal women. When there is concern for a woman’s mental health, the presence or absence of suicidal and/or self-harm ideation is often identified in the context of screening for depression and/or other common mental health problems because: (i) suicidality and depression are frequently comorbid ( 2 , 21 ); (ii) depression is a risk factor for suicide ( 22 ); (iii) many depression measures include an item that asks about suicidal and/or self-harming ideation ( 23 ); and (iv) screening measures are relatively quick to administer and complete. However, although depression screening has become a proxy for identifying possible suicidality in perinatal women, it is important that the broader implications of this approach are not overlooked.…”

Section: Introductionmentioning

confidence: 99%

“…Psychometric validity and reliability of tools for identifying mental health problems in pregnancy and after birth needs to be rigorously tested in diverse settings and contexts ( 30 ). However, a recent systematic review ( 23 ) indicated that the validity and reliability of measures that have been used to identify suicidality in perinatal women is limited, and nearly all were either items or subscales on a measure for depression. Research should continue to evaluate the psychometric properties of suicidality measures in perinatal populations to ascertain the suitability of their use.…”

Section: Introductionmentioning

confidence: 99%

“…Hence, the aims of this study were to: (i) assess the acceptability and content validity of 16 different suicide-related items that have been administered and/or validated in perinatal populations using the TFA; and (ii) explore the potential barriers and facilitators that may affect how women respond to these items when they are administered during pregnancy and after birth. These items were specifically selected from self-report measures for depression and/or common mental health problems because they have previously been used in perinatal populations as either a single item or as a subscale to identify suicidal ideation and/or behaviours ( 23 ). It is therefore important to assess how acceptable their use is to perinatal women, for both clinical and research purposes.…”

Section: Introductionmentioning

confidence: 99%

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Acceptability and content validity of suicidality screening items: a qualitative study with perinatal women

Dudeney,

Coates,

Ayers

et al. 2024

Front. Psychiatry

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BackgroundSuicide is a leading cause of death for perinatal women. It is estimated that up to 50% of women with mental health issues during pregnancy and/or after birth are not identified, despite regular contact with healthcare services. Screening items are one way in which perinatal women needing support could be identified. However, research examining the content validity and acceptability of suicide-related screening items with perinatal women is limited.AimsThis study sought to: (i) assess the acceptability and content validity of 16 suicide-related items that have been administered and/or validated in perinatal populations; and (ii) explore the potential barriers and facilitators that may affect how women respond to these items when administered during pregnancy and after birth.MethodsTwenty-one cognitive and semi-structured interviews were conducted with pregnant and postnatal women in the UK. The sample included women who had experienced self-reported mental health problems and/or suicidality during the perinatal period, and those who had not. Interviews were transcribed verbatim, and a coding framework based on the Theoretical Framework of Acceptability was applied to explore the data using deductive and inductive approaches.ResultsFindings indicated that the acceptability and content validity of suicide-related items were largely unacceptable to perinatal women in their current form. Women found terms such as ‘better off dead’ or ‘killing myself’ uncomfortable. Most women preferred the phrase ‘ending your life’ as this felt less confronting. Comprehensibility was also problematic. Many women did not interpret ‘harming myself’ to include suicidality, nor did they feel that abstract language such as ‘leave this world’ was direct enough in relation to suicide. Stigma, fear, and shame was central to non-disclosure. Response options and recall periods further affected the content validity of items, which created additional barriers for identifying those needing support.ConclusionsExisting suicide-related screening items may not be acceptable to perinatal women. Maternity practitioners and researchers should consider the phrasing, clarity, context, and framing of screening items when discussing suicidality with perinatal women to ensure potential barriers are not being reinforced. The development of specific suicidality screening measures that are acceptable, appropriate, and relevant to perinatal women are warranted.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%