Methods: Screening took place during pregnancy and postpartum as part of routine practice in a hospital-based prenatal care clinic. Between April and October 2010, 14 patient participants were identified for a follow-up semi-structured interview if they screened positive for suicidal ideation using the Patient Health Questionnaire short-form (PHQ-9). In-depth interviews, conducted in-clinic with antenatal women and in-home with postnatal women, followed an interview guide and lasted 15 to 90 minutes. Interviews addressed past experiences with suicidality, coping, support, treatment, and beliefs about suicide and self-harm during pregnancy. All interviews were transcribed and analyzed verbatim using thematic network analysis (Attride-Stirling, 2001). Atlas ti 6.2 was used to manage and organize all of the data.
Results: Patient 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. Both antenatal and postnatal women experienced an interruption in thoughts of suicide or interruption in self-harming actions when met with supportive and trusting communication between providers or family support systems. The main themes include relationship to fetus/infant, physical changes, psychiatric history, provider relationship, and communicating needs. One divergent theme for the postnatal participants is the description of challenges bonding with the infant.
Conclusions and Implications: The networks established are congruent with findings in international samples with perinatal women, where antenatal suicidality is a period of rebirth for some women and relates to the treatment adherence and mother infant interactions for other women. The networks of themes shows that pregnancy represents a critical time period to screen for suicide and to establish treatment for mothers. Prior research indicates that systematic and routine screening for suicide in the perinatal period is scarce. These findings identify practice and translational research implications for developing enhanced clinical approaches to screen and identify women at high risk for perinatal suicidality across settings.
