A prospective study of thoughts of self-harm and suicidal ideation during the postpartum period in women with mood disorders

Abstract

Individuals with mood disorders are at higher risk for self-harm and suicidal ideation than other psychiatric group. However, the risk of self-harm and suicidal ideation after pregnancy for women with mood disorders is unknown. This investigation assessed the prevalence of thoughts of self-harm and suicidal ideation during the 1-year postpartum period in women with major depressive disorder or bipolar II disorder. Data were collected between June 2005 and March 2010 from a convenience sample of women participating in a study on the course of mood disorders during pregnancy and postpartum. Participant diagnosis was confirmed using the Structured Clinical Interview for DSM-IV. Thoughts of self-harm were assessed using the Edinburgh Postnatal Depression Scale item 10 and suicidal ideation was assessed using the Hamilton Depression Rating Scale item 3. During the 1-year postpartum period, 16.97 % reported thoughts of self-harm while 6.16 % reported suicidal ideation. Further, those reporting thoughts of self-harm or suicidal ideation postpartum also reported higher levels of depression and hypomanic symptoms. We found that a number of women in our sample of women with a diagnosed mood disorder report experiencing thoughts of self-harm and suicidal ideation during the postpartum.

Using the Patient Health Questionnaire (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS) to assess suicidal ideation among pregnant women in Lima, Peru

“…The PHQ-9 assesses suicidal ideation and depressive symptoms experienced by participants in the past 14 days, whereas the EPDS assesses suicidal ideation and depressive symptoms experienced by participants in the past 7 days. Item 9 of the PHQ-9 inquires about both “passive” (thoughts that you would be better off dead) and “active” (thoughts of hurting yourself in some way) thoughts for suicide, whereas item 10 of the EPDS only asks about the “active” thoughts of self-harm, which might not be limited to the construct of suicidality (Pope et al 2013; Razykov et al 2013b; Yawn et al 2009). Several studies found that most of the responses to item 9 of the PHQ-9 appeared to endorse the passive thoughts of “being better off dead.” (Corson et al 2004; Dube et al 2010; Kroenke et al 2010; Razykov et al 2013a; Walker et al 2011) Simon et al (Simon et al 2013) found that each higher response to item 9 of the PHQ-9 was associated with a stepwise increase in the cumulative risk of suicide attempt and suicide death over the following year (0.4% among outpatients reporting thoughts of death or self-harm “not at all” to 4% among those reporting “nearly every day”).…”

“…To our best knowledge, no analogous data for the EPDS has been reported. Future studies should determine the appropriate duration of reporting period for suicidal ideation screening among pregnant women, evaluate the individuals who report thoughts of self-harm contemplating self-harm with lethal intent (Pope et al 2013), and assess the percentage of individuals with positive responses to the two suicidal ideation items at high risk of planning and attempting suicide.…”

“…Item 9 of the PHQ-9 addresses suicidal ideation with both “passive” and “active” thoughts. However, item 10 of the EPDS only includes the active thoughts of self-harm, which can exist independently of suicidal ideation (Pope et al 2013). Future studies are needed to identify additional predictors of antepartum suicidality, determine the appropriate duration of reporting period for suicidal ideation screening, evaluate the individuals who report thoughts of self-harm contemplating self-harm with lethal intent, and assess the percentage of individuals with positive responses to the two suicidal ideation items at high risk of planning and attempting suicide.…”

Suicidal ideation in depressed postpartum women: Associations with childhood trauma, sleep disturbance and anxiety

“…After delivery, women with postpartum major depression, puerperal psychosis and recurrent episodes of Bipolar Disorder (BD), often had thoughts of self-harm or SI (Wisner et al, 2013) (Howard et al, 2011) (Sit et al, 2006) (Pope et al, 2013). Findings from a postpartum depression screening program of 10,000 women, indicated postpartum women who screened positive for depression had high rates of self-harm ideation (19.3%) and frequent thoughts of self-harm (3.2%)(Wisner et al, 2013).…”

“…Given the compelling findings from our group (Wisner et al, 2013) and others (Howard et al, 2011; Paris et al, 2009; Pope et al, 2013), we conducted secondary analyses to determine whether the known risk factors for suicidal symptoms in adults with and without mood disorders also applied to women after childbirth. Our study aim was to examine associations between SI and plausible risk factors (trauma history i.e.…”