Perinatal suicidal ideation and behaviour: psychiatry and adversity

Abstract

Pregnant women are at increased risk for suicidal ideation and behaviours (SIB) compared to the general population. To date, studies have focused on the psychiatric correlates of SIB with lesser attention given to the associated contextual risk factors, particularly in low- and middle-income countries. We investigated the prevalence and associated psychiatric and socio-economic contextual factors for SIB among pregnant women living in low resource communities in South Africa. Three hundred seventy-six pregnant women were evaluated using a range of tools to collect data on socio-economic and demographic factors, social support, life events, interpersonal violence and mental health diagnoses. We examined the significant risk factors for SIB using univariate, bivariate and logistic regression analyses (p ≤ 0.05). The 1-month prevalence of SIB was 18%. SIB was associated with psychiatric illness, notably major depressive episode (MDE) and any anxiety disorder. However, 67% of pregnant women with SIB had no MDE diagnosis, and 65% had no anxiety disorder, while 54% had neither MDE nor anxiety disorder diagnoses. Factors associated with SIB included lower socio-economic status, food insecurity, interpersonal violence, multiparousity, and lifetime suicide attempt. These findings focus attention on the importance of socio-economic and contextual factors in the aetiology of SIB and lend support to the idea that suicide risk should be assessed independently of depression and anxiety among pregnant women.

The development of an ultra-short, maternal mental health screening tool in South Africa

“…These associations have been described and discussed in detail elsewhere (Onah et al . 2016 a , b; van Heyningen et al . 2016, 2017; Field et al .…”

“…Also, analysis of the dataset showed that a large proportion of women with suicidal thoughts and/or behaviour had neither depression nor anxiety diagnoses (Onah et al . 2016 a ). SIB that occurs outside of the context of depression and anxiety diagnosis is an important public health issue, and has been described in greater detail in another paper arising from the same dataset (Onah et al .…”

“…SIB that occurs outside of the context of depression and anxiety diagnosis is an important public health issue, and has been described in greater detail in another paper arising from the same dataset (Onah et al . 2016 a ). The inclusion of SIB item in our ultra-short tool offers an opportunity to provide care for these high-risk women who may otherwise remain undetected.…”

Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women

“…Where such ultra short screening instruments are used, it is advised to follow-up with more in-depth screening or clinical assessment. This is especially important considering the high rate of women expressing suicidal ideation and behaviour [ 59 ].…”

‘Don’t push me aside, Doctor’: Suicide attempters talk about their support needs, service delivery and suicide prevention in South Africa

“…These critiques have spurned a number of studies which have attempted to examine more broadly the role of contextual factors in the aetiology of suicide. Examples include the systematic review on the relationship between poverty and suicidal behaviour in LMICs ( Iemmi et al, 2016 ) and a study among perinatal women living in a low-resource environment in SA which found that socio-economic adversity was a better predictor of suicidal behaviour than psychiatric conditions ( Onah et al, 2016 ).…”