Suicide in Pregnant Women and New Mothers

Last year, one of the most prominent medical journals, The Lancet, led with an editorial that made a bold assertion, “There is no time in the lifespan that the [World Health Organization’s] statement ‘there is no health without mental health’ rings truer than in the perinatal period.”

For a journal known for publishing the most highly regarded scientific evidence from drug trials, devoting an entire journal edition to perinatal mental health is a refreshing (and needed) stance.

Follow-up study: Suicide in pregnant women and new mothers

In a follow-up study published last month in the Lancet, a group of perinatal psychiatrists from the UK compared rates of suicide and characteristics of women who committed suicide during the perinatal period and those who did so outside of the prenatal and postnatal period. They studied 15 years of records from the UK National Confidential Inquiry into Suicides among individuals with mental illness. They found that twice as many women committed suicide during the perinatal period (4%, 74 of 1485) compared to outside that time (2%, 98 of 4785).

They also found that pregnant and postpartum women who took their own lives were twice as likely to have been diagnosed with depression, but half as likely to be receiving any active treatment as women who were outside of the perinatal period. They had been in contact with some form of psychiatric service, but were not currently receiving treatment.

In other words, pregnant women and new mothers were more likely to be depressed, but less likely to have current access to services that might have intervened to save their lives. These authors found the same thing that previous studies have reported:

“Mental illness is often undetected in perinatal women and, when detected, is often sub-optimally managed.”

The need to screen pregnant and postpartum women for depression and anxiety

These kinds of studies that have brought the mental health needs of pregnant and postpartum women to the forefront have pressed the need to improve perinatal mental healthcare in the United States and Canada.

The UK and Australia have guidelines, mandating (in Australia) and recommending (in the UK) that all pregnant and postpartum women be screened for anxiety and depression. In fact, the UK and Australia have embedded these guidelines in their healthcare systems so that all pregnant and postpartum women are screened and treated for anxiety and depression as part of routine prenatal and postnatal care.

Canada does not have such guidelines.

• That means that pregnant and postpartum women in Canada do not get screened for mental health concerns, like depression and anxiety.
  

• That means that only 1 in 10 pregnant and postpartum women in Canada receive needed treatment for a mental health problem.
  

Why only 1 in 10? Our research shows that the vast majority of pregnant women simply don’t feel comfortable talking to their doctors about their mental health. They aren’t talking. Their doctors aren’t asking.

>> Here is the prenatal health screening you are NOT getting.

New perinatal mental health screening guidelines

Last month, the US Preventive Services Task Force (USPSTF) published their ground-breaking guideline, Screening for Depression in Adults. Scientific guidelines that provide recommendations for health care, like this one, are updated every few years to reflect the change in evidence that might have occurred during that period. The last USPSTF guideline for depression was produced in 2009 – and it did not include screening for depression in pregnant women and new mothers.

This time, however, the panel of experts and scientists who wrote the guideline decided there was enough evidence to support depression screening in pregnant and postpartum women.

They recommended that ALL PREGNANT AND POSTPARTUM WOMEN be screened for depression.

Some key points they noted were:

• Screening leads to treatment. Treatment leads to women getting better.
  

• There is no evidence of harm in screening pregnant and postpartum women for depression.
  

• Screening questionnaires are accurate enough to detect depression in pregnant and postpartum women.
  

I applaud the USPSTF’s position. There is not a ton of evidence, but there is enough to move forward with a decision to recommend routine mental health screening in pregnant and postpartum women.

Help is just around the corner.

>> Try out free self-guided therapies and screeners on the HOPE Platform.