Perinatal suicidal ideation and behaviour: psychiatry and adversity

Michael Nnachebe Onah,Sally Field,Simone Honikman,Jason Bantjes

doi:10.1007/s00737-016-0706-5

Michael Nnachebe Onah, Sally Field + Show 2 more

Open Access

https://doi.org/10.1007/s00737-016-0706-5

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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.

Highlights

Suicide has been identified as one of the major contributors to the global mortality burden (Goldsmith et al 2002; Nock et al 2008; Turecki and Brent 2016), and there is a growing concern over the increase in suicidal ideation and behaviour (SIB) among pregnant women (Frautschi et al 1994; Gagliardi et al 2014)
We developed three distinct suicide nomenclatures: suicidal ideation, suicidal behaviour and SIB, while lifetime suicide attempt was populated from question c9
With a 1-month prevalence of 18% for SIB, this study has confirmed high rates of suicidal ideation and behaviour among pregnant women living in adversity

Summary

Introduction

Suicide has been identified as one of the major contributors to the global mortality burden (Goldsmith et al 2002; Nock et al 2008; Turecki and Brent 2016), and there is a growing concern over the increase in suicidal ideation and behaviour (SIB) among pregnant women (Frautschi et al 1994; Gagliardi et al 2014). Diagnoses of depression, anxiety, alcohol misuse and substance abuse have been shown to be the strongest risk factors for SIB (Dumais et al 2005; Nock et al 2010) in the general population, among pregnant women (Bayatpour et al 1992; Bonari et al 2004) and in the postpartum period (Gold et al 2012), in both high and LMIC settings. Borderline personality disorder (BPD) is one of two DSM-IV diagnoses for which suicidal behaviour is a criterion (American Psychiatric Association 2013). Among these individuals, the behaviour manifests as severe emotional distress and inability to control behaviour (Linehan et al 2006). The focus on contextual determinants of mental health problems and SIB is important, in low resource environments, where the scarcity of mental health professionals necessitates the use of suicide prevention interventions that do focus on the psychiatric determinants of SIB

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