Perinatal Depression and Risk of Suicidal Behavior

Abstract

ImportanceSuicidal ideation is common among women with perinatal depression (PND). However, prospective data are limited on the risk, particularly long-term risk, of suicidal behavior (suicide attempt and completed suicide) among women with perinatal depression.ObjectiveTo examine the association between PND and risk of short- and long-term suicidal behavior.Design, Setting, and ParticipantsA nationwide population-matched cohort study was conducted in Sweden including 86 551 women with PND from 2001 to 2017 and 865 510 unaffected women individually matched on age and calendar year at delivery. Sibling comparison was used to account for familial confounding. Data were analyzed from January 2022 to November 2023.ExposurePND was identified through depression diagnosis or filled prescriptions of antidepressants from pregnancy to 1 year post partum in registers.Main Outcomes and MeasuresAll women were followed up for the first event of suicidal behavior recorded in registers. Hazard ratios (HR) of suicidal behavior were estimated using time-to-event analysis.ResultsWomen with PND (86 551 participants) received a diagnosis at a mean (SD) age of 30.67 (5.23) years. During a median (IQR) follow-up of 6.91 (3.62-10.88) years, 3604 events of suicidal behavior (incidence rate [IR], 5.62 per 1000 person-years) were identified among women with PND and 6445 (IR, 1.01 per 1000 person-years) among population-unaffected women. Women with PND had an elevated risk of suicidal behavior when compared with matched unaffected women (HR, 3.15; 95% CI, 2.97-3.35). Comparable, albeit somewhat attenuated, associations were yielded when comparing PND women with their PND-free sisters (HR, 2.75; 95% CI, 2.10-3.61). In the population-matched cohort, the association was greater for postnatal depression and among women without a history of psychiatric disorders. The excess risk was pronounced during the first year after diagnosis (HR, 7.20; 95% CI, 6.07-8.54), yet remained statistically significant during 5 to 18 years of follow-up (HR, 2.34; 95% CI, 2.12-2.57).Conclusions and RelevanceIn this nationwide cohort study, women with PND were at an increased risk of suicidal behavior, particularly within the first year after diagnosis with persistent risk elevations throughout the 18 years of follow-up, highlighting the need for vigilant clinical monitoring of this vulnerable group.

Suicide Mortality During the Perinatal Period

“…For example, both were more likely than their comparison groups to experience mental health–related circumstances, such as depressed mood, substance abuse (perinatal), depression diagnosis, and current mental illness treatment or past mental illness treatment (post partum). In prior research, investigators found that mental health–related circumstances increased the risk of suicide or self-harm among perinatal individuals . Within this context, our study highlights the importance of perinatal mental health screening, including for suicidal ideation, and clinical follow-up …”

“…Previous studies that have examined quantitative factors associated with pregnancy-related deaths 8 , 9 , 10 , 11 have reported that mental health problems, substance use disorders, and intimate partner problems (IPPs) preceded suicide and homicide in pregnancy. Limitations of the aforementioned studies include sole use of older quantitative data sources, which typically reflect a limited number of states, smaller sample sizes, or both.…”

Perinatal depression and risk of mortality: nationwide, register based study in Sweden

“…Consistent with previous studies,67 we found that suicide mortality, although rare, yielded the highest risk elevations. Emerging data have also shown that women with PND are at increased risk of suicide attempt 36. Previous studies have often investigated deaths due to unnatural causes as a combined category, including accidents, suicides, and homicides, most likely due to small sample size 678.…”

“…Emerging data have also shown that women with PND are at increased risk of suicide attempt. 36 Previous studies have often investigated deaths due to unnatural causes as a combined category, including accidents, suicides, and homicides, most likely due to small sample size. 6 7 8 Our data are the first, to our knowledge, to show that women with perinatal depression were at an increased risk of death due to accidents alone.…”

Stratifying Risk for Postpartum Depression at Time of Hospital Discharge

“…Postpartum depression (PPD) is common, affecting approximately 15% of recently pregnant individuals, and represents a major contributor to both morbidity and mortality following pregnancy. [1][2][3][4][5][6] It is associated with an increased risk for suicide and self-harm and is estimated to be responsible for 10% or more of all pregnancy-related deaths. [7][8][9] Compared to other causes of pregnancy-related deaths, those due to mental health conditions are considered preventable by many Maternal Mortality Review Committees.…”