Suicidal Ideation in Pregnant and Postpartum Women Veterans: An Initial Clinical Needs Assessment

Abstract

Introduction Pregnancy and postpartum, or the perinatal period, are times when women are particularly vulnerable to mental health concerns, including suicidal ideation. Risk factors for suicidal ideation during this period of a woman’s life are depression and exposure to trauma, the latter of which may occur during military operations. The number of women veterans in the United States continues to rise, as does their use of maternity benefits. In this pilot study, we examined the feasibility of recruiting pregnant veterans for longitudinal research. We hypothesized that hopelessness and depressive symptoms would be related to suicidal ideation during the perinatal period, and we investigated a possible relationship between post-traumatic stress symptoms (PTSS) and suicidal ideation. Materials and Methods Using the designated Veterans Affairs (VA) maternity care coordinator’s census, we contacted pregnant women veterans for assessment during the 3rd trimester of pregnancy and 6 weeks postpartum at the San Diego VA. Between September 2017 and October 2018, 28 women volunteers completed the following measures: the Columbia-Suicide Severity Rating Scale (C-SSRS); the Beck Hopelessness Scale (BHS); the Edinburgh Postnatal Depression Scale (EPDS); and the PTSD Checklist for DSM-5 (PCL-5). We used correlational analyses and descriptive statistics to determine associations among the measures. Results As gathered from the C-SSRS, over 30% of the veteran women had past lifetime suicide attempts, and over 10% of the veterans had suicidal ideation in the perinatal period. Both depression and PTSS rates neared 30% during pregnancy and postpartum. Hopelessness and depressive symptoms were positively correlated at both time points. While the intensity of lifetime suicidal ideation was correlated with postpartum depressive symptoms, there was no correlation with current suicidal ideation and depressive symptoms. PTSS correlated with both depressive symptoms and hopelessness, but not suicidal ideation, at both time points. There was no correlation between hopelessness and suicidal ideation during the perinatal period in this cohort. Conclusions It is important to understand the mental health needs of perinatal veterans given their vulnerability to develop mental health concerns, including suicidal ideation. The unpredicted pattern of correlations determined in this study implies the need for multifaceted measures for safety-related mental health assessment of perinatal veterans, including assessment for PTSS. Strengths of this study include its longitudinal assessment and a sampling from a general population of veterans. Limitations include small sample size, a single gestational time point, and loss of participants who did not return for their postpartum assessment. We demonstrated the feasibility of longitudinal research with pregnant and postpartum veterans, but additional assessment points during the perinatal period could help identify critical times for mental health intervention in this population.

Exposure therapy for PTSD during pregnancy: a feasibility, acceptability, and case series study of Narrative Exposure Therapy (NET)

“…Suicide risk The Columbia-Suicide Severity Rating Scale (C-SSRS) is a clinician-administered interview that assesses suicidal ideation and suicidal behavior over the lifetime and within the last month [48]. This measure is a brief, thorough assessment of suicidal risk that has been found to be reliable and valid across populations [48,49], including in pregnant and postpartum populations [50].…”

The prevalence of suicide ideation and predictive factors among pregnant women in the third trimester

“…The findings revealed symptoms of prenatal depression were also a risk factor for suicidal ideation, which was consistent with findings in a study on 1517 pregnant women [ 35 ]. Previous researches also showed that suicidal ideation was associated with higher levels of depressive symptoms during prenatal and postpartum period [ 47 , 48 ]. Suicidal ideation of pregnant women is usually assessed in conjunction with maternal depression.…”

Are alterations in estradiol, cortisol, and inflammatory cytokines associated with depression during pregnancy and postpartum? An exploratory study

“…From November 2017 until October 2018, 18 pregnant veterans were recruited from a census maintained by the VA maternity care coordinator. We have previously described recruitment details as part of a larger study ( Szpunar et al., 2020 ). Briefly, written informed consent as well as sociodemographic, medical, obstetrical, and military history were obtained from the participants at the initial encounter during the 3rd trimester of pregnancy, mean 36.4 weeks gestation (SD ​= ​1.8 weeks), and in the postpartum period at 6.7 weeks post-birth (SD ​= ​0.9 weeks).…”