Suicidal ideation in the postpartum period: A population-based study of prevalence and risk factors using data from two national maternity surveys in England.

BACKGROUND: Suicide is an important cause of maternal mortality. We estimated the prevalence of suicidal ideation (SI) in women six months postpartum, identified factors associated with SI, and assessed whether SI occurred in women without depression. METHODS: Analysis used data from national maternity surveys from 2018 and 2020 in England. The Edinburgh Postnatal Depression Scale (EPDS) measured depression symptoms and SI. Weighted SI prevalence estimates were calculated. Adjusted odds ratios (aOR) estimated the association between risk factors and SI. The prevalence of possible (EPDS 10-12) and probable (EPDS ≥13) depression among women with SI was calculated. FINDINGS: Among 8037 women, SI prevalence was 3.1 % in 2018 and 4.8 % in 2020 (difference: +1.8 %; 95 % CI: 0.7-2.9; p = 0.002). Risk factors for SI were maternal age < 25 years (aOR: 1.68; 95 % CI: 1.01-2.81), history of mental health problems (aOR: 2.87; 95 % CI: 1.92-4.29), antenatal mental health problems (aOR: 1.90; 95 % CI: 1.29-2.81), being unable to consult a professional about sensitive issues (aOR: 1.94; 95 % CI: 1.30-2.91), negative reaction to pregnancy (aOR: 2.79; 95 % CI: 1.10-7.10), low (aOR: 4.27; 95 % CI: 2.86-6.39) or moderate social support (aOR: 3.27; 95 % CI: 2.26-4.73), early postpartum sleep problems (aOR: 2.22; 95 % CI: 1.56-3.16), and giving birth in 2020 (aOR: 1.42; 95 % CI: 1.04-1.95). 11.4 % of women with SI did not meet the cut-off for probable depression. CONCLUSIONS: Awareness of risk factors facilitates identification and provision of support for women at risk of suicide. Screening for SI among women not meeting the cut-off for probable depression may be considered.