Abstract
Suicidal ideation and behaviour (SIB) in the perinatal period is prevalent in low- and middle-income countries (LMICs). Past work has been limited by reliance on self-rated scales, and there are few data on SIB severity in such settings. We collected cross-sectional data on SIB using a clinician-administered scale and explored risk factors associated with the presence of SIB and SIB severity. Data were collected from the Drakenstein Child Health Study cohort antenatally and at 6 months postpartum. SIB was measured using the Mini International Neuropsychiatric Interview, and potential sociodemographic, psychosocial, and psychiatric risk factors were assessed. Multivariable analysis determined cross-sectional risk factors. Multinomial regressions determined predictors of SIB risk categories. Among 748 women, the antenatal SIB prevalence was 19.9% and postpartum 22.6%. SIB was associated with younger age (antepartum), PTSD (postpartum), and depression (ante- and postpartum). Depression and PTSD predicted belonging to the high-risk SIB group. The medium-risk group was more likely to have depression, alcohol use during pregnancy, and substance abuse. Depression, PTSD, food insecurity, recent intimate partner violence (IPV), and childhood trauma were associated with the low-risk group versus the no-risk group. Screening is needed for perinatal SIB. Associations of perinatal SIB with younger age and major depression are consistent with previous work. The association with PTSD is novel, and underscores the importance of assessment of trauma exposure and outcomes in this population. Different risk categories of SIB may have different causal pathways and require different interventions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request. Some restrictions may apply as DCHS data analysis is ongoing.
References
Bernstein D, Fink L (1998) Childhood trauma questionnaire: a retrospective self-report. The Psychological Corporation, San Antonio
Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, Sapareto E, Ruggiero J (1994) Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 151(8):1132–1136. https://doi.org/10.1176/ajp.151.8.1132
Bertolote JM, Fleischmann A, De Leo D, Bolhari J, Botega N, De Silva D, Thanh HTT, Phillips M, Schlebusch L, Vijayakumar L, Wasserman D (2005) Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey. Psychol Med 35(10):1457–1465. https://doi.org/10.1017/S0033291705005404
Binder EB, Bradley RG, Liu W, Epstein MP, Deveau TC, Mercer KB, Tang Y, Gillespie CF, Heim CM, Nemeroff CB, Schwartz AC, Cubells JF, Ressler KJ (2008) Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. JAMA 299(11):1291–1305. https://doi.org/10.1001/jama.299.11.1291
Coates J, Swindale A, Bilinsky P (2007) Household Food Insecurity Access Scale (HFIAS) for Measurement of household food access: indicator guide, 3rd ed.; Food and Nutrition. Technical Assistance Project: Washington, DC
Cox JL, Holden JM, Sagovsky R (1987) (1987) Detection of postnatal depression: development of the 10- item Edinburgh Postnatal Depression Scale. Br J Psychotherapy 150:782–786. https://doi.org/10.1192/bjp.150.6.782
Chang J, Berg C, Saltzman LE, Herndon J (2005) Homicide: a leading cause of injury deaths among pregnant and postpartum women in the United States, 1991–1999. Am J Public Health 95(3):471–477. https://doi.org/10.2105/AJPH.2003.029868
De Bruin GP, Swartz L, Tomlinson M, Cooper PJ, Molteno C (2004) The factor structure of the Edinburgh Postnatal Depression Scale in a South African peri-urban settlement. S Afr J Psychol 34(1):113–121. https://doi.org/10.1177/008124630403400107
Dewing S, Tomlinson M, le Roux IM, Chopra M, Tsai AC (2013) Food insecurity and its association with co-occurring postnatal depression, hazardous drinking, and suicidality among women in peri-urban South Africa. J Affect Disord 150(2):460–465. https://doi.org/10.1016/j.jad.2013.04.040
Doi S, Fujiwara T (2019) Combined effect of adverse childhood experiences and young age on self-harm ideation among postpartum women in Japan. J Affect Disord 25:410–418. https://doi.org/10.1016/j.jad.2019.04.079
Dunkle LK, Jewkes RK, Brown HC, Gray GE, Mcintyre JA, Harlow SD (2004) Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet 363(9419):1415–1421. https://doi.org/10.1016/S0140-6736(04)16098-4
Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Samuelsen SO (2001) Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand 104(4):243–249. https://doi.org/10.1034/j.1600-0447.2001.00187.x
Foa EB, Riggs DS, Dancu CV, Rothbaum BO (1993) Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Traum Stress 6:459–473. https://doi.org/10.1002/jts.2490060405
Freitas GV, Bottega NJ (2002) Prevalence of depression, anxiety and suicide ideation in pregnant adolescents. Rev Assoc Med Bras 48(3):245–249. https://doi.org/10.1590/s0104-42302002000300039
Fuhr DC, Calvert C, Ronsmans C, Chandra PS, Sikander S, De Silva MJ, Patel V (2014) Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Psychiatry 1(3):213–225. https://doi.org/10.1016/S2215-0366(14)70282-2
Gelaye B, Kajeepeta S, Williams MA (2016) Suicidal Ideation in pregnancy, an epidemiologic review. Arch Womens Ment Health 19:741–751. https://doi.org/10.1007/s00737-016-0646-0
Giallo R, Pilkington P, Borschmann R, Seymour M, Dunning M, Brown S (2018) The prevalence and correlates of self-harm ideation trajectories in Australian women from pregnancy to 4-years postpartum. J Affect Disord 229:152–158. https://doi.org/10.1016/j.jad.2017.12.064
Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, Le Roux I, Mbewu N, Rotheram-Borus MJ (2011) Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health 8:9. https://doi.org/10.1186/1742-4755-8-9
Herman AA, Stein DJ, Seedat S, Heeringa SG, Moomal H, Williams DR (2009) (2009) The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders. S Afr Med J 99(5 Pt 2):339–344
Howard LM, Flach C, Mehay A et al (2011) (2011) The prevalence of suicidal ideation identified by the Edinburgh Postnatal Depression Scale in postpartum women in primary care: findings from the RESPOND trial. BMC Pregnancy Childbirth 11:57. https://doi.org/10.1186/1471-2393-11-57
Humeniuk R, Ali R, Babor TF, Farrell M, Formigoni ML, Jittiwutikarn J, de Lacerda RB, Ling W, Marsden J, Monteiro M, Nhiwatiwa S, Pal H, Poznyak V, Simon S (2008) Validation of the Alcohol, Smoking And Substance Involvement Screening Test (ASSIST). Addiction (Abingdon, England) 103(6):1039–1047. https://doi.org/10.1111/j.1360-0443.2007.02114.x
Jewkes R (2002) Intimate partner violence: causes and prevention. Lancet 359(9315):1423–1429. https://doi.org/10.1016/S0140-6736(02)08357-5
Joe S, Baser RS, Neighbors HW, Caldwell CH, Jackson JS (2009) 12-month and lifetime prevalence of suicide attempts among black adolescents in the National Survey of American Life. J Am Acad Child Adolesc Psychiatry 48(3):271–282. https://doi.org/10.1097/CHI.0b013e318195bccf
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):617–627. https://doi.org/10.1001/archpsyc.62.6.617
Khasakhala L, Sorsdahl KR, Harder VS, Williams DR, Stein DJ, Ndetei DM (2011) Lifetime mental disorders and suicidal behaviour in South Africa. Afr J Psychiatry (Johannesbg) 14(2):134–139. https://doi.org/10.4314/ajpsy.v14i2.5
Kim JJ, La Porte LM, Saleh MP, Allweiss S, Adams MG, Zhou Y, Silver RK (2015) Suicide risk among perinatal women who report thoughts of self-harm on depression screens. Obstet Gynecol 125:885–893. https://doi.org/10.1097/AOG.0000000000000718
Koen N, Wyatt GE, Williams JK, Zhang M, Myer L, Zar HJ, Stein DJ (2014) Intimate partner violence: associations with low infant birthweight in a South African birth cohort. Metab Brain Dis 29(2):281–299. https://doi.org/10.1007/s11011-014-9525-4
Kubany ES, Leisen MB, Kaplan AS, Watson SB, Haynes SN, Owens JA, Burns K (2000) Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: the Traumatic Life Events Questionnaire. Psychol Assess 12(2):210–224. https://doi.org/10.1037/1040-3590.12.2.210
Lawrie TA, Hofmeyr GJ, de Jager M, Berk M (1998) Validation of the Edinburgh Postnatal Depression Scale on a cohort of South African women. S Afr Med J = Suid-Afrikaanse Tydskrif Vir Geneeskunde 88(10):1340–1344
Lecrubier Y, Sheehan D, Weiller E, Amorim P, Bonora I, Sheehan K, Janavs J, Dunbar G (1997) The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry 12(5):224–231. https://doi.org/10.1016/S0924-9338(97)83296-8
Lindahl V, Pearson JL, Colpe L (2005) Prevalence of suicidality during pregnancy and the postpartum. Arch Women’s Ment Health.https://doi.org/10.1007/s00737-005-0080-1
Mauri M, Oppo A, Borri C, Banti S, PND-ReScU group (2012) SUICIDALITY in the perinatal period: comparison of two self-report instruments. Results from PND-ReScU. Arch Women’s Ment Health 15(1):39–47. https://doi.org/10.1007/s00737-011-0246-y
Muzik M, Brier Z, Menke RA, Davis MT, Sexton MB (2016) Longitudinal suicidal ideation across 18-months postpartum in mothers with childhood maltreatment histories. J Affect Disord 204:138–145. https://doi.org/10.1016/j.jad.2016.06.037
Myer L, Stein DJ, Grimsrud A, Seedat S, Williams DR (2008) Social determinants of psychological distress in a nationally-representative sample of South African adults. Soc Sci Med (1982) 66(8):1828–1840. https://doi.org/10.1016/j.socscimed.2008.01.025
Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, de Girolamo G, Gluzman S, de Graaf R, Gureje O, Haro JM, Huang Y, Karam E, Kessler RC, Lepine JP, Levinson D, Medina-Mora ME, Ono Y, … Williams D (2008) Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 192(2), 98–105. https://doi.org/10.1192/bjp.bp.107.040113
Oates M (2003) Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. Br Med Bull 67(1):219–229. https://doi.org/10.1093/bmb/ldg011
Onah MN, Field S, Bantjes J, Honikman S (2017) (2017) Perinatal suicidal ideation and behaviour: psychiatry and adversity. Arch Womens Ment Health 20:321–331. https://doi.org/10.1007/s00737-016-0706-5
Pellowski JA, Barnett W, Kuo CC, Koen N, Zar HJ, Stein DJ (2017) Investigating tangible and mental resources as predictors of perceived household food insecurity during pregnancy among women in a South African birth cohort study. Soc Sci Med 187:76–84. https://doi.org/10.1016/j.socscimed.2017.06.022
Pope CJ, Xie B, Sharma V, Campbell MK (2013) A prospective study of thoughts of self-harm and suicidal ideation during the postpartum period in women with mood disorders. Arch Womens Ment Health 16(6):483–488. https://doi.org/10.1007/s00737-013-0370-y
Rochat TJ, Bland RM, Tomlinson M, Stein A (2013) Suicide ideation, depression and HIV among pregnant women in rural South Africa. Health 05(03):650–661. https://doi.org/10.4236/health.2013.53a086
Rodriguez VJ, Mandell LN, Babayigit S, Manohar PR, Weiss SM, Jones DL (2018) Correlates of suicidal ideation during pregnancy and postpartum among women living with HIV in rural South Africa. AIDS Behav 2018(22):3188–3197. https://doi.org/10.1007/s10461-018-2153-y
Shamu S, Abrahams N, Temmerman M, Musekiwa A, Zarowsky C (2011) A systematic review of african studies on intimate partner violence against pregnant women: prevalence and risk factors. PLoS ONE 6(3):e17591. https://doi.org/10.1371/journal.pone.0017591
Shamu S, Zarowsky C, Roelens K, Temmerman M, Abrahams N (2016) High-frequency intimate partner violence during pregnancy, postnatal depression and suicidal tendencies in Harare, Zimbabwe. Gen Hosp Psychiatry 38:109–114. https://doi.org/10.1016/j.genhosppsych.2015.10.005
Sheehan DV, Lecrubier Y, Sheehan KH, Janavs J, Weiller E, Keskiner A, Schink J, Knapp E, Sheehan MF, Dunbar GC (1997) The validity of the Mini International Neuropsychiatric Interview according to the SCID-P and its reliability. Eur Psychiatry 12(5):232–241. https://doi.org/10.1016/S0924-9338(97)83297-X
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33
Sit D, Luther J, Buysse D, Dills JL, Eng H, Okun M, Wisniewski S, Wisner KL (2015) Suicidal ideation in depressed postpartum women: associations with childhood trauma, sleep disturbance and anxiety. J Psychiatr Res 66–67:95–104. https://doi.org/10.1016/j.jpsychires.2015.04.021
Stein DJ, Koen N, Donald KA, Adnams CM, Koopowitz S, Lund C, Marais A, Myers B, Roos A, Sorsdahl K, Stern M, Tomlinson M, van der Westhuizen C, Vythilingum B, Myer L, Barnett W, Brittain K, Zar HJ (2015) Investigating the psychosocial determinants of child health in Africa: the Drakenstein Child Health Study. J Neurosci Methods 252:27–35. https://doi.org/10.1016/j.jneumeth.2015.03.016
Spies G, Stein D, Roos A, Faure S, Mostert J, Seedat S, Vythilingum B (2009) Validity of the Kessler 10 (K-10) in detecting DSM-IV defined mood and anxiety disorders among pregnant women. Arch Women’s Ment Health 12:69–74. https://doi.org/10.1007/s00737-009-0050-0
Tavares D, Quevedo L, Jansen K, Souza L, Pinheiro R, Silva R (2012) Prevalence of suicide risk and comorbidities in postpartum women in Pelotas. Rev Bras Psiquiatria (Sao Paulo, Brazil : 1990) 34(3):270–276. https://doi.org/10.1016/j.rbp.2011.12.001
Van der Westhuizen C, Brittain K, Koen N, Maré K, Zar HJ, Stein DJ (2018) Sensitivity and specificity of the SRQ-20 and the EPDS in diagnosing major depression ante- and postnatally in a South African Birth Cohort Study. Int J Ment Health Addict 16(1):175–186. https://doi.org/10.1007/s11469-017-9854-8
Vaz JS, Kac G, Nardi AE, Hibbeln JR (2014) Omega-6 fatty acids and greater likelihood of suicide risk and major depression in early pregnancy. J Affect Disord 152–154:76–82. https://doi.org/10.1016/j.jad.2013.04.045
Villano CL, Cleland C, Rosenblum A, Fong C, Nuttbrock L, Marthol M, Wallace J (2004) Psychometric utility of the childhood trauma questionnaire with female street-based sex workers. J Trauma Dissociation 5(3):33–41. https://doi.org/10.1300/j229v05n03_03
WHO Assist Working Group (2002) The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction 97(9):1183–1194. https://doi.org/10.1046/j.1360-0443.2002.00185.x
Zar HJ, Barnett W, Myer L, Stein DJ, Nicol MP (2015) Investigating the early-life determinants of illness in Africa: the Drakenstein Child Health Study. Thorax 70(6):592–594. https://doi.org/10.1136/thoraxjnl-2014-206242
Acknowledgements
We thank the entire onsite Drakenstein clinical and research team for its tireless work and commitment and all the mothers and infants enrolled in the Drakenstein Child Health Study (DCHS).
Funding
Support for this study was provided by the Bill and Melinda Gates Foundation (Grant OPP1017641), the National Institute of Mental Health Brain Disorders in the Developing World: Research Across the Lifespan program (Grant 1R21MH098662- 01), and the National Research Foundation and the South African Medical Research Council.
Author information
Authors and Affiliations
Contributions
KT Mare, L Workman, J Pellowski, and DJ Stein conceived and designed the analysis. C vd Westhuizen and KT Mare collected the data. J Pellowski and L Workman performed the analysis. KT Mare wrote the paper in collaboration with J Pellowski with contributions and editing by all co-authors. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval
The DCHS received approval from the University of Cape Town (UCT: HREC 401/2009) and Stellenbosch University (SU) Human Research Ethics Committees (HREC) as well as from the Western Cape Provincial Research Committee. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.
Consent to participate and for publication
Study participants provided written informed consent before data collection commenced. This included consent for data analysis and publication of research findings with the understanding that personal identifying information will be kept strictly confidential.
Competing interests
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Maré, K.T., Pellowski, J.A., Koopowitz, SM. et al. Perinatal suicidality: prevalence and correlates in a South African birth cohort. Arch Womens Ment Health 24, 737–748 (2021). https://doi.org/10.1007/s00737-021-01121-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-021-01121-8