Maternal Care Clinic Patients and the Experience of Perinatal Suicidality

Background: Perinatal suicidality, the thoughts of death, suicide attempts, or self-harm during the period immediately before and up to 12 months after the birth of a child, is a significant public health concern. In 2006, the American College of Obstetricians and Gynecologists recommended screening for psychosocial risk factors during the perinatal period. Few investigations examine the patients' own views and experiences of maternal suicidality.

Methods: Between April and October 2010, 14 patient participants at a single university based medical center were identified for a follow-up semi-structured interview if they screened positive for suicidal ideation using the Patient Health Questionnaire short-form. In-depth interviews, were conducted with patients either in-clinic with antenatal women and in-home with postnatal women, followed an interview guide and lasted 15 to 90 minutes. All interviews were transcribed and analyzed verbatim using thematic network analysis (Attride-Stirling, 2001).

Results: Participants described the experience of suicidality during pregnancy as related to somatic symptoms, past diagnoses, infanticide, family psychiatric history (e.g., completed suicides and attempts in the family), and pregnancy complications. The network of themes includes suicidality and the perinatal experience, patient descriptions of changes in mood symptoms, illustrations of situational coping, and reported mental health service use.

Discussion: The interview themes show that pregnancy represents a critical time period to screen for suicide and to establish treatment for mothers. Study findings may assist clinicians including physicians, nurses, and social workers in the development of interventions designed to identify, assess and prevent suicidality among perinatal women.