Perinatal depression (PND) increases the risk of suicidal behavior, especially within the first year after diagnosis, according to a recent study published in JAMA Network Open.
Takeaways
- The study reveals that perinatal depression (PND) significantly increases the risk of suicidal behavior, especially within the first year after diagnosis.
- Approximately 13% to 16% of maternal deaths are attributed to suicide, highlighting the substantial impact on offspring and families. Factors contributing to maternal suicide include psychiatric disorder history, limited healthcare access, and socioeconomic disparities.
- PND and suicidal ideation often coexist, with suicidal thoughts being part of PND screenings. However, the study suggests that PND, antenatal depression, and postnatal depression have distinct causes and symptom clusters.
- The investigators used data from the National Medical Birth Register in Sweden, analyzing information from 1973 onwards. The study utilized various registers, including hospitalization, prescribed drug, and cause of death registers, to evaluate the association between PND and suicidal behavior.
- Women with PND had a 3-fold increased risk of suicidal behavior compared to those without PND. The risk remained significant for up to 18 years, with the most substantial risk observed within the first year.
Of maternal deaths, 13% to 16% are attributable to suicide, leading to significant consequences for offspring and family. Factors linked to maternal suicide include psychiatric disorder history, inadequate health care access, and socioeconomic disparities. Identifying suicide risk is vital to prevent suicidal attempts.
PND and suicidality often co-exist, with suicidal ideation included in PND screenings. However, data has risen indicating PND, antenatal depression, and postnatal depression have different causes and symptom clusters, and there is little data evaluating suicidal ideation based on this context.
Investigators conducted a study to evaluate the association between PND and suicidal behavior using data from the National Medical Birth Register, which contains data on all births in Sweden since 1973. Additionally, the National Patient Register (NPR) was evaluated for hospitalization data, the Swedish Prescribed Drug Register for pharmaceutical prescriptions and the National Cause of Death Register for mortality data.
The first depression diagnosis or antidepression prescription filed during pregnancy or within 1 year was used to define PND. Participants with PND were matched 1:10 to women with the same gestational age or postnatal day but without PND. Follow-up occurred until first suicide behavior event, emigration, death, or December 31, 2018.
Along with the NPR, International Classification of Diseases, 10th Revision codes were used to determine suicidal behavior. Covariates included calendar year at delivery, maternal age, cohabitation status, country of birth, education level, family annual household income, body mass index (BMI), parity, smoking 3 months before pregnancy, and hypertensive and diabetic diseases.
There were 86,551 women with PND included in the analysis, 47,642 with PND in the antenatal period and 38,909 in the postnatal period. Women were aged a mean 30.67 years when diagnosed with PND, and women with PND were more often born in Sweden, living alone, and had decreased levels of education and income.
Women with PND were also more often primiparous, had smoked 3 months before pregnancy, had psychiatric disorder or suicidal behavior history, had a greater BMI in early pregnancy, and experienced cesarean delivery and loss of offspring within 1 year of birth.
The risk of suicidal behaviors during an 18-year follow up was 5.62 per 1000 person-years among women with PND and 1.01 per 1000 person-years among women without PND. The risk of suicidal behavior was increased 3-fold among women with PND, with a hazard ratio (HR) of 3.15.
An increased association was observed among women without a history of psychiatric disorders, while women with a history of depression and those with a history of other psychiatric disorders had a comparable association. The HRs for these populations were 3.63, 2.52, and 2.47, respectively.
The most significant risk was observed within 1 year of follow-up, with an HR of 7.20. However, an HR of 2.34 remained after 5 or more years, indicating the risk was still doubled. Women with antenatal and postnatal depression also had increased risks of suicidal behavior. However, the risk was not as significant as in women with PND, with HRs of 2.83 and 3.55, respectively.
These results indicated a significantly increased risk of suicidal behavior among women with PND for up to 18 years. Investigators concluded interventions to prevent severe consequences in this population are necessary.
Reference
Yu H, Shen Q, Bränn E, et al. Perinatal depression and risk of suicidal behavior. JAMA Netw Open. 2024;7(1):e2350897. doi:10.1001/jamanetworkopen.2023.50897
