Increased suicidal behavior risk for women with perinatal depression history

Key takeaways:

• Women with vs. without a history of perinatal depression had an elevated risk for suicidal behavior.
• Suicidal behavior risk was highest in the first year but remained statistically significant up to 18 years.

Women with clinically diagnosed perinatal depression have an increased risk for suicidal behavior, especially within the first year after diagnosis, according to findings published in JAMA Network Open.

“Existing literature suggests that suicidal ideation is common among women with antenatal depression, while data on risk of suicidal behavior, including attempted and completed suicide, are lacking,” Hang Yu, MSc, researcher in the unit of integrative epidemiology at the Institute of Environmental Medicine at Karolinska Institute, Stockholm, and colleagues wrote. “Studies have shown that 3% to 19% of women with postnatal depression endorsed suicidal ideation. However, only a few small studies have examined the risk of suicide attempt or completed suicide among women with postnatal depression.”

Yu and colleagues conducted a nationwide Swedish population-matched cohort study with 86,551 women (mean age, 30.67 years) diagnosed with perinatal depression from 2001 to 2017. Researchers also evaluated data from 865,510 unaffected women who were matched with those with perinatal depression by age and calendar year at delivery. Researchers identified perinatal depression through diagnosis or filled antidepressant prescriptions from pregnancy to 1 year postpartum.

All women were followed up for the first recorded suicidal behavior event.

During a median follow-up of 6.91 years, there were 3,604 suicidal behavior events among women with perinatal depression, with an incidence rate of 5.62 per 1,000 person-years. Among women without perinatal depression, there were 6,445 suicidal behavior events, with an incidence rate of 1.01 per 1,000 person-years.

Compared with matched women without perinatal depression, those with perinatal depression had an elevated risk for suicidal behavior (HR = 3.15; 95% CI, 2.97-3.35). Researchers observed comparable associations with perinatal depression and suicidal behavior when comparing women with perinatal depression with their biological siblings without perinatal depression (HR = 2.75; 95% CI, 2.1-3.61).

In addition, the association between perinatal depression and suicidal behavior was greater among women with postnatal depression (HR = 3.55; 95% CI, 3.26-3.86) and those without psychiatric disorder history (HR = 3.63; 95% CI, 3.36-3.92).

Excess suicidal behavior risk was pronounced during the first year after diagnosis (HR = 7.2; 95% CI, 6.07-8.54), but this risk remained statistically significant during 5 to 18 years of follow-up (HR = 2.34; 95% CI, 2.12-2.57).

“This highlights the pressing need for vigilant clinical monitoring and prompt intervention for this vulnerable population to prevent such devastating outcomes, regardless of prepregnancy history of psychiatric disorders,” the researchers wrote.