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

Abstract

Background Suicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women. Methods This secondary analysis included 628 depressed mothers at 4–6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms.. Results Of the depressed mothers, 496 (79%) ‘never’ had thoughts of self-harm; 98 (15.6%) ‘hardly ever’; and 34 (5.4%) ‘sometimes’ or ‘quite often’. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR=1.68, 95% CI=1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR=1.15, 95%CI=1.02, 1.29) and anxiety symptoms (OR=1.11, 95%CI=1.01, 1.23). Discussion Because women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers.

Longitudinal suicidal ideation across 18-months postpartum in mothers with childhood maltreatment histories

“…This is concerning, given our study is not limited to mothers experiencing postpartum depression or other psychiatric morbidities. Our study supports the findings of Sit et al (2015) that postpartum endorsement of SI is amplified in the context of CM history and extends this research to include longitudinal observation, and validated assessments of trauma history. Additionally, the high rates of SI throughout later postpartum (i.e., 12-, 15-, and 18-months postpartum), suggest that parenting a toddler may confer continued stressors for mothers beyond the early infancy period.…”

“…It may also be that particular types of CM confer particular longitudinal risk. For example, Sit et al, (2015) observed that childhood physical abuse but not childhood sexual abuse was associated with SI at 6-weeks postpartum. Future research needs to examine if different types of maltreatment are associated with SI among postpartum women with maltreatment histories.…”

“…The frequency and severity of CM are known to predict increased psychopathology in adult postpartum populations (Choi and Sikkema, 2015; Grekin and O’Hara, 2014; Leigh and Milgrom, 2008; Muzik et al, 2013; Sexton et al, 2015). Sit et al’s (2015) investigation established a relationship between CM and SI in mothers with postpartum depressive disorder (PPD). They found 21% of women with PPD 4–6 weeks postpartum described some thoughts of suicide on the Edinburgh Postnatal Depression Scale (EPDS).…”

The Relationship between Childhood Trauma and Suicidal Ideation: Role of Maltreatment and Potential Mediators

“…Some previous studies have reported that childhood physical and emotional abuse and childhood neglect are directly related to suicidal ideation, whereas some studies have reported that childhood physical and emotional abuse are associated with anxiety 474849. Recently it was reported that among women with postpartum depression, having frequent thoughts about self-harm was associated with childhood physical abuse and anxiety symptom 50. In light of these findings our results suggest that anxiety plays an important role as a mediator of the relationship between childhood maltreatment and suicidal ideation.…”

Reference ranges of the WHO Disability Assessment Schedule (WHODAS 2.0) score and diagnostic validity of its 12-item version in identifying altered functioning in healthy postpartum women

“…The postpartum period is characterized by multiple concerns involving self‐confidence, mother–infant interaction, body image experiences, adjustment to maternal roles, and attitudes . These concerns—which are not only dependent on the presence or diagnosis of morbidity, but also on the inadequate assessment of such issues or even their misinterpretation—may contribute to the deterioration of maternal and newborn health …”