Article

A prospective study of thoughts of self-harm and suicidal ideation during the postpartum period in women with mood disorders

Clinical Research Coordinator, Department of Neurology, University of British Columbia, Vancouver, BC, Canada.
Archives of Women s Mental Health (Impact Factor: 2.16). 06/2013; 16(6). DOI: 10.1007/s00737-013-0370-y
Source: PubMed

ABSTRACT

Individuals with mood disorders are at higher risk for self-harm and suicidal ideation than other psychiatric group. However, the risk of self-harm and suicidal ideation after pregnancy for women with mood disorders is unknown. This investigation assessed the prevalence of thoughts of self-harm and suicidal ideation during the 1-year postpartum period in women with major depressive disorder or bipolar II disorder. Data were collected between June 2005 and March 2010 from a convenience sample of women participating in a study on the course of mood disorders during pregnancy and postpartum. Participant diagnosis was confirmed using the Structured Clinical Interview for DSM-IV. Thoughts of self-harm were assessed using the Edinburgh Postnatal Depression Scale item 10 and suicidal ideation was assessed using the Hamilton Depression Rating Scale item 3. During the 1-year postpartum period, 16.97 % reported thoughts of self-harm while 6.16 % reported suicidal ideation. Further, those reporting thoughts of self-harm or suicidal ideation postpartum also reported higher levels of depression and hypomanic symptoms. We found that a number of women in our sample of women with a diagnosed mood disorder report experiencing thoughts of self-harm and suicidal ideation during the postpartum.

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    • "To understand the risk of suicide or thoughts of self-harm in postpartum women, we can begin by exploring the known risk factors for suicide or SI in adults with and without major mood disorders. Given the compelling findings from our group (Wisner et al., 2013) and others (Howard et al., 2011; Paris et al., 2009; Pope et al., 2013), we conducted secondary analyses to determine whether the known risk factors for suicidal symptoms in adults with and without mood disorders also applied to women after childbirth. Our study aim was to examine associations between SI and plausible risk factors (trauma history i.e. the experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms ) in depressed postpartum women. "
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    ABSTRACT: Suicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women. This secondary analysis included 628 depressed mothers at 4-6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms. Of the depressed mothers, 496 (79%) 'never' had thoughts of self-harm; 98 (15.6%) 'hardly ever'; and 34 (5.4%) 'sometimes' or 'quite often'. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR = 1.68, 95% CI = 1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR = 1.15, 95% CI = 1.02, 1.29) and anxiety symptoms (OR = 1.11, 95% CI = 1.01, 1.23). Because women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · May 2015 · Journal of Psychiatric Research
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    • "To understand the risk of suicide or thoughts of self-harm in postpartum women, we can begin by exploring the known risk factors for suicide or SI in adults with and without major mood disorders. Given the compelling findings from our group (Wisner et al., 2013) and others (Howard et al., 2011; Paris et al., 2009; Pope et al., 2013), we conducted secondary analyses to determine whether the known risk factors for suicidal symptoms in adults with and without mood disorders also applied to women after childbirth. Our study aim was to examine associations between SI and plausible risk factors (trauma history i.e. the experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms ) in depressed postpartum women. "
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    ABSTRACT: IMPORTANCE The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression. OBJECTIVES To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions. DESIGN Sequential case series of women who recently gave birth. SETTING Urban academic women's hospital. PARTICIPANTS During the maternity hospitalization, women were offered screening at 4 to 6 weeks post partum by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes. MAIN OUTCOMES AND MEASURES A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: "The thought of harming myself has occurred to me" (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses. RESULTS Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had comorbid anxiety disorders. A striking 22.6% had bipolar disorders. CONCLUSIONS AND RELEVANCE The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00282776.
    Full-text · Article · Mar 2013 · JAMA Psychiatry
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    ABSTRACT: Bipolar disorder is a serious and often chronic disorder characterized by episodes of depression, hypomania, mania or mixed states that affects many individuals worldwide, and is a leading cause of years of 'healthy' life lost as a result of disability and premature mortality. For women, bipolar disorder tends to cluster during the childbearing years. Detection of bipolar disorder can be complicated and therefore it is essential that women presenting with mood episodes after childbirth receive a comprehensive examination to allow for accurate diagnosis, with particular attention to manic symptoms. Once a diagnosis of bipolar disorder is confirmed, pharmacotherapy with consideration made to breastfeeding status may be considered alone or in combination with psychotherapy.
    No preview · Article · Feb 2014 · Expert Review of Neurotherapeutics
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