Suicide is a leading cause of maternal mortality in the developed world, accounting for 10% of maternal deaths. We examined the relationship between suicidal ideation during pregnancy and after delivery in a large cohort of consecutively screened women to identify maternal demographic characteristics and obstetric outcomes that correlate with this vulnerable state of mind.
The Edinburgh Postnatal Depression Scale was completed at 24–28 weeks of gestation and at 6 weeks postpartum. Edinburgh Postnatal Depression Scale item 10 queries for suicidal ideation. Multivariable analyses determined predictors of suicidal ideation separately for during pregnancy and after delivery timeframes.
A total of 22,118 patients completed the Edinburgh Postnatal Depression Scale (2003–2011) with 842 women endorsing suicidal ideation. A during pregnancy language by marital status interaction emerged (P<.05) with English-speaking, partnered patients less likely to report suicidal ideation (odds ratio [OR] 0.75) compared with non-English-speaking, partnered women with increased suicidal ideation risk (OR 1.55). Asians were also more likely to reveal suicidal ideation during pregnancy (OR 1.64, P<.001). Planned cesarean delivery reduced suicidal ideation after delivery risk compared with vaginal delivery (OR 0.56, P<.01), whereas perineal laceration increased suicidal ideation reporting (OR 2.10, P<.05). Asian women also endorsed suicidal ideation after delivery more often than other ethnic groups (OR 1.63, P<.01).
When asked, women commonly report suicidal thoughts during and after pregnancy. Non-English-speaking, partnered patients manifest higher suicidal ideation endorsement as do Asian women. Perineal laceration increases suicidal ideation risk, whereas planned cesarean delivery has the opposite effect. Because 1% of women with suicidal ideation are estimated to attempt suicide, knowledge of these risk profiles and identification of vulnerable patients through screening may help to avert some instances of maternal mortality.