Suicidal ideation and intentional self-harm in pregnancy as neglected agenda in maternal health; an experience from rural Sri Lanka

Abstract

Plain English SummaryMental disturbances are common during pregnancy. Most of the time, these are normal.However, these disturbances may become serious and lead to self-harm and suicide. In this study, we estimated the proportion of pregnant women who had depression and idea of self-harming during pregnancy.Respondents were pregnant women admitted to two large hospitals for the childbirth.They answered a list o questions about the thought of self-harm and attempts of self-harm during the present as well as past pregnancies.Respondents included 475 pregnant women. Of them, 3.1% reported that "the thought of self-harming has occurred to them during last seven days quite a lot (0.8%) or sometimes"(2.3%). Four (0.8%) pregnant women reported that they actually did it to some extent. Of the 475 pregnant women included in the study, 126 (26.5%) had symptoms of anxiety/depression. Level of education seemed to have an association with anxiety and depression. When women reported that they had thought of self-harm prior to pregnancy, they were about 6.4 times more likely to have depression/anxiety during the pregnancy.Adding a simple screening question (as we used in this study) during the initial pregnancy assessment to detect history of suicidal thoughts will be helpful in identification of highrisk mothers for depression and suicide.Reported suicidal ideation prior to pregnancy had a OR of 6.4 (95% CI 2.3-17.5). ConclusionsBased on our data, we conservatively estimate around 3000 ISH annually in Sri Lanka, which should be considered as a high priority for an urgent intervention.

Suicide and Maternal Mortality

“…Among pregnant and postpartum adolescents in Bangladesh, 6.5% (61/940) reported suicide attempts in the past 12 months, with the majority (88.5%) of the attempts occurring in the first postpartum year [ 45 ]. Among 475 women in their third trimester, 0.8% reported self-harm in the current pregnancy [ 46 ]. Prevalence of self-harm is as high as 20% among perinatal women with severe mental illness [ 47 ], and Vigod et al found the rate of self-harm in the postpartum period to be 1.11 per 1000 births [ 48 ].…”

“…Those with perinatal loss had higher EPDS score compared to those w/o; however, there was no significant difference in diagnosis of depression or suicidal ideation Ammerman et al [ 88 ] Interpersonal trauma and suicide attempts in low-income depressed mothers in home visiting Cross-sectional Low-income young, depressed mothers enrolled in an early childhood home visiting program 170 Suicide history questionnaire SA 31.8% of mothers had previous suicide attempts; median number of lifetime attempts was 2. Those who had attempted suicide had more MDD symptoms and more childhood trauma Arachchi et al [ 46 ] Suicidal ideation and intentional self-harm in pregnancy as a neglected agenda in maternal health; an experience from rural Sri Lanka Cross-sectional Pregnant women in tertiary care center in Sri Lanka, 3rd trimester 475 EPDS SI, self-harm 0.8% answered “yes quite a lot” to SI question, 2.3% answered “yes sometimes,” and 2.7% answered “hardly ever.” 0.8% of women reported having a history of intentional self-harm during the current pregnancy. The study estimates around 500 pregnant women each year having SI and 130 Intentional Self Harm (ISH) annually in Anuradhapura Ayre et al [ 47 ] The Prevalence and Correlates of Self-harm in the Perinatal Period Systematic Review Women in pregnant/postpartum period up to 1 year 39 articles, reporting 19,191,431 pregnancies N/A Self-harm Self-harm prevalence during pregnancy ranged from 0 to 2.39%, self-harm during postpartum year 0 to 2.41%, and self-harm during postpartum year in women with severe mental illness from 0 to 21.9%.…”

Antenatal depression in Sri Lanka: a qualitative study of public health midwives’ views and practices

“…However, literature regarding the state of antenatal mental healthcare in Sri Lanka is still extremely limited, despite evidence of high prevalence of antenatal depression at 16.2%, with 0.8% expressing suicidal ideation [1,6]. Suicide in 2013 was identified as the most common cause of maternal mortality in Sri Lanka, yet there has still there has been limited research investigating how the antenatal mental health system works and how it should be reformed to prevent these deaths in the future [2].…”

Social determinants of health pave the path to maternal deaths in rural Sri Lanka: reflections from social autopsies

“…Suicides, self-harm and suicidal ideation of reproductive age females is a huge problem in Sri Lanka [22]. It is well known that maternal suicides have been within 2 consecutive years, in district A (pseudonymized) in Sri Lanka.…”