The association between childhood adversity and perinatal suicidality

Abstract

Suicide is a leading contributor of maternal mortality, however identification of individuals at risk is challenging. Adverse childhood experiences (ACEs) are associated with negative health outcomes in adulthood in the general population, including suicide attempts. Our objective was to determine whether ACEs are associated with suicidality in the perinatal period. This cohort study included pregnant and postpartum people who enrolled in a collaborative care model (CCM) for mental health support between 2017-2021. At enrollment, participants completed an ACE screen; a high ACE score was defined as > 3. CCM participants were followed from enrollment until up to 12 months postpartum with serial depression screens, including self-reported assessments of suicidal ideation. For these analyses, reported suicidal ideation within any completed assessment was considered representative of perinatal suicidality. The relationship between a high ACE score and perinatal suicidality was assessed. Other exposures evaluated included ACE screen score as an ordinal variable and categories of reported ACEs (i.e., abuse, neglect, and household challenges). A propensity score was used in multivariable models to control for covariates that significantly differed by ACE screen score. Of the 1,767 pregnant or postpartum people enrolled in the CCM with a completed ACE screen, 333 (19%) reported a high ACE score and 299 (13%) endorsed suicidality. Those with a high ACE screen score had an increased likelihood of suicidality (33.6% vs 12.9%, p< 0.001). The ACE screen score had a graded association with suicidality (p< 0.001; Table 1). Subcategories of ACEs were each associated with an increased odds of suicidality, however no meaningful differences in the odds of suicidality were observed across ACE categories (Table 2). Within a population of individuals enrolled in a perinatal CCM for mental health care, childhood adversity is associated with suicidality with a dose-response relationship. Screening for ACEs may represent an opportunity to identify individuals at risk for perinatal suicide.View Large Image Figure ViewerDownload Hi-res image Download (PPT)