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Suicide Risk Among Perinatal Women Who Report Thoughts of Self-Harm on Depression Screens
Abstract
OBJECTIVE: To estimate the incidence and clinical significance of suicidal ideation revealed during perinatal depression screening and estimate the associated suicide risk. METHODS: Retrospective cohort study of women completing the Edinburgh Postnatal Depression Scale at 24-28 weeks of gestation and 6 weeks postpartum through a suburban integrated health system with approximately 5,000 annual deliveries on two hospital campuses. Suicidal ideation on the Edinburgh Postnatal Depression Scale and prediction of suicide risk were examined through multivariable modeling and qualitative analysis of clinical assessments. RESULTS: Among 22,118 Edinburgh Postnatal Depression Scale questionnaires studied, suicidal ideation was reported on 842 (3.8%, 95% confidence interval [CI] 3.5-4.1%) and was positively associated with younger maternal age (antepartum mean age 30.9 compared with 31.9 years, P=.001), unpartnered relationship status (antepartum 29.5% compared with 16.5%, P<.001 and postpartum 25.0% compared with 17.5%, P<.01), non-Caucasian race (antepartum 62.1% compared with 43.8%, P<.001 and postpartum 62.4% compared with 45.2%, P<.001), non-English language (antepartum 11.0% compared with 6.6%, P<.001 and postpartum 12.4% compared with 7.7%, P<.01), public insurance (antepartum 19.9% compared with 12.5%, P<.001 and postpartum 18.2% compared with 14.2%, P<.001), and preexisting psychiatric diagnosis (antepartum 8.4% compared with 4.2%, P<.001 and postpartum 12.0% compared with 5.8%, P<.001). Multivariable antepartum and postpartum models retained relationship status, language, relationship status by language interaction, and race; the postpartum model also found planned cesarean delivery negatively associated with suicidal ideation risk (odds ratio [OR] 0.56, 95% CI 0.36-0.87) and severe vaginal laceration positively associated with suicidal ideation risk (OR 2.1, 95% CI 1.00-4.40). A qualitative study of 574 women reporting suicidal ideation indicated that 330 (57.5%, 95% CI 53.5-61.5%) experienced some degree of suicidal thought. Six patients (1.1%, 95% CI 0.2-1.9%) demonstrated active suicidal ideation with plan, intent, and access to means. Within this highest risk group, three patients reported a suicide attempt within the perinatal period. CONCLUSION: Among perinatal women screened for depression, 3.8% reported suicidal ideation, but only 1.1% of this subgroup was at high risk for suicide. These findings support the need for systematic evaluation of those who report suicidal ideation to identify the small subset requiring urgent evaluation and care.
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“The sixth study28 showed a significant association between PPD and suicidal ideation in an unadjusted analysis, but not in adjusted analysis.”
From Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes (2019) · cites this paper as [28]
In the citing paper
“The sixth study28 showed a significant association between PPD and suicidal ideation in an unadjusted analysis, but not in adjusted analysis.”
From Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes (2019) · cites this paper as [28]
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Yoon, J., Masoumirad, M., Bui, L. N., Richard, P., & Harvey, S. M. (2024) · BMC Women s Health · doi:10.1186/s12905-024-03019-w · Cited by 4
Administration of electroconvulsive therapy for major depression during pregnancy: a case report
Erturk, A., Aktöz, F., Örgül, G., Mutlu, E., Demir, B., & Tuncer, Z. S. (2019) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2019.1628727 · Cited by 3
Perinatal Depression Screening in the Pediatric Emergency Department
Abe, N., Austin-Page, L., Chang, E. L., Lazo-Kim, A. J., Remnick, A., & Nguyen, M. B. (2025) · Pediatric Emergency Care · doi:10.1097/pec.0000000000003452 · Cited by 2
Patient Perspectives Following Obstetric Anal Sphincter Injury
Nutaitis, A. C., Ferrando, C. A., & Propst, K. A. (2024) · Urogynecology · doi:10.1097/spv.0000000000001506 · Cited by 2
The pregnancy as protection for suicidal behavior: a population-based study in south Brazil
Trettim, J. P., de Matos, M. B., da Cunha, G. K., Martins, C. D. S. R., Rubin, B. B., Scholl, C. C., de Mello, D. B., Ardais, A. P., Motta, J. V. D. S., Nedel, F., et al. (2020) · Revista Eletrônica Acervo Saúde · doi:10.25248/reas.e2083.2020 · Cited by 2
Scarth, B., Dudeney, E., Brown, N., & Buist, A. (2026) · Research Square · doi:10.21203/rs.3.rs-10751110/v3 · Cited by 2
Faisal‐Cury, A., Tabb, K. M., Maruyama, J. M., & Matijasevich, A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1029048 · Cited by 1
Susanti, I., Saputra, N. I., Budiyanti, L., Amalia, A., Hikmat, R., & Yosep, I. (2025) · OBM Neurobiology · doi:10.21926/obm.neurobiol.2504309 · Cited by 1
Predictors of antepartum and postpartum suicidal ideation at a diverse urban obstetric setting
Kobylski, L. A., Keller, J., Yeung, E. W., & Le, H. (2026) · BMC Public Health · doi:10.1186/s12889-026-26830-6 · Cited by 1
Matthey, S., Robinson, J., & Vedova, A. M. D. (2021) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2021.2000592 · Cited by 1
Wedajo, L. F., Hajure, M., Abdu, Z., Mulatu, G., Alemayehu, Y., Gezimu, W., Hussen, M. A., Dule, A., Teferi, S. M., & Alemu, S. S. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1384688 · Cited by 2
Detection of Psychological Dysfunction and Suicide Risk Among Postpartum Women
Goller, H. G., Byrd, D. P., Hicks, A. D., & McCord, D. (2024) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-024-10028-2 · Cited by 3
Isobel, S., Dixon, K., Tutt, A., Clay, B., & Lim‐Gibson, S. (2025) · Health Expectations · doi:10.1111/hex.70135 · Cited by 1
Ponting, C., Baer, R. J., Blackman, K. C. A., Blebu, B. E., Felder, J. N., Oltman, S. P., Tabb, K. M., & Jelliffe‐Pawlowski, L. L. (2025) · JMIR Research Protocols · doi:10.2196/70627 · Cited by 1
Vazquez, V. (2015) · OpenCommons at University of Connecticut (University of Connecticut) · Cited by 1
Scarth, B., Dudeney, E., Brown, N., & Buist, A. (2026) · Research Square · doi:10.21203/rs.3.rs-10751110/v1 · Cited by 1
Desesperança e depressão em mulheres com diagnóstico de abortamento
Bordini, D. C. N. (2018) · doi:10.11606/d.5.2018.tde-15032018-101048
Clinical Conundrum: A Complex Case of Postpartum Depression
Chandra, P. S., Ganjekar, S., & Parameshwaran, S. (2018) · Springer eBooks · doi:10.1007/978-3-319-70311-4_5
Primary Care Behavioral Health (PCBH) Model and Suicide
Smith, A. D., Fondow, M. D. M., & Schreiter, E. Z. (2018) · Springer eBooks · doi:10.1007/978-3-319-74391-2_8
Psychosocial Attributes of Maternal Thoughts of Self-harm during Puerperium
Nachane, H. B. (2021) · Eastern Journal of Psychiatry · doi:10.5005/jp-journals-11001-0005
Metadata
- Authors
- Kim, J. J., La Porte, L. M., Saleh, M. P., Allweiss, S., Adams, M. G., Zhou, Y., & Silver, R. K.
- Affiliations
- Endeavor Health (US)
- ORCID
- Venue
- Obstetrics & Gynecology
- Published
- 2015-04
- Volume
- 125
- Issue
- 4
- Pages
- 885-893
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W126586207
- Cited by
- 112
- References
- 21
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 14 · 2023: 7 · 2022: 12 · 2021: 14 · 2020: 9 · 2019: 11 · 2018: 10 · 2017: 8 · 2016: 6 · 2015: 4
- FWCI
- 10.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- suicidal ideation, suicide risk, perinatal depression, Edinburgh Postnatal Depression Scale, antenatal depression, postpartum depression, maternal mental health, relationship status, language barriers, race, public insurance, cesarean section, risk factors, integrated health system
- MeSH terms
- Adult, Mental Disorders, Black or African American, Depression, Female, Hispanic or Latino, Humans, Language, Maternal Age, Medicaid, Pregnancy, Psychiatric Status Rating Scales, Retrospective Studies, Risk Factors, Suicide, Attempted, United States, Vagina, Incidence, Marital Status, Lacerations, White People, Young Adult, Peripartum Period, Suicidal Ideation
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