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.
