Perinatal depression linked to long-term suicidal behaviour

By Rebecca Jenkins

Women with perinatal depression (PND) are at a particularly increased risk of suicidal behaviour in the first year after diagnosis, but some risk remains for a further 18 years, a study finds. Suicidal ideation was common among women with PND, but prospective data, particularly on the long-term risk of suicide attempt and completed suicide, were limited, Swedish researchers wrote in JAMA Network Open.

In a nationwide population-matched cohort study of 952,061 women with up to 18 years’ follow up, researchers found mothers with clinically diagnosed PND had a three times higher risk of suicidal behaviour compared with matched mothers without PND.

‘The excess risk was pronounced during the first year after diagnosis (hazard ratio [HR], 7.20), yet remained statistically significant during 5 to 18 years of follow up (HR, 2.34),’ the researchers wrote.

‘These findings suggest that vigilant clinical monitoring and interventions are needed for this vulnerable population to prevent such devastating events.’

In the cohort, women with antenatal and postnatal depression were both at increased risk for suicidal behaviour throughout follow up, but the association was strongest for postnatal depression, the researchers found.

‘Importantly, such excess risk was apparent among women regardless of their history of psychiatric disorders, suggesting that PND is linked to an added risk of suicidal behavior beyond the risk associated with psychiatric disorders occurring before the perinatal period,’ the researchers added.

The researchers also performed a sibling comparison to account for familial confounding and found an attenuated but still substantially elevated risk of suicidal behaviour among women with PND compared with their PND-free sisters (HR, 2.75).

Professor Anne Buist, Professor of Women’s Mental Health at Austin Health and the University of Melbourne, said the study had some real strengths, including the number of participants and the length of follow up.

‘As always big numbers result in weakened methodology of identification; they rely on scripts for antidepressants and hospital coding rather than actual diagnosis, but it still provides important information,’ she told Medicine Today.

‘The main contribution from this research is the 18-year timeline, highlighting that the women who struggle in the first postnatal year are worth putting time and effort into so as to improve outcomes.’

The sibling comparison was also useful, Professor Buist added, with the finding suggesting it was likely a mixture of genes and environment that ‘sent one sister along a mental illness path but not the other’.

‘The key advice to GPs is to take postnatal mental illness seriously – with early identifi­cation and assertive treatment that includes support and child care,’ she said.

JAMA Netw Open 2024; 7(1): e2350897.