Suicidal ideation in depressed postpartum women: Associations with childhood trauma, sleep disturbance and anxiety

• We report on suicidality and abuse history, sleep disturbance and anxiety in 648 depressed women at 4–6 weeks postpartum.
• Women were assessed for abuse history and with the Edinburgh Postnatal Depression Scale and the SIGH-ADS depression scale.
• Women with frequent thoughts of self-harm were at increased odds (1.68) for a history of childhood physical abuse.
• In the evaluation of depressed postpartum mothers, a key component is the assessment of safety.
• Assessing safety in new mothers should include inquiry of childhood abuse history, sleep disturbance and anxiety levels.

BackgroundSuicide 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.MethodsThis 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.ResultsOf 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).DiscussionBecause 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.