Dorothy Sit1, James Luther2, Daniel Buysse3, John L Dills2, Heather Eng2, Michele Okun4, Stephen Wisniewski2, Katherine L Wisner5. 1. School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: sitdk@upmc.edu. 2. Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA. 3. School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. 4. University of Colorado - Colorado Springs, CO, USA. 5. Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). DISCUSSION: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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). DISCUSSION: 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.
Authors: Robert F Anda; Vincent J Felitti; J Douglas Bremner; John D Walker; Charles Whitfield; Bruce D Perry; Shanta R Dube; Wayne H Giles Journal: Eur Arch Psychiatry Clin Neurosci Date: 2005-11-29 Impact factor: 5.270
Authors: Murray W Enns; Brian J Cox; Tracie O Afifi; Ron De Graaf; Margreet Ten Have; Jitender Sareen Journal: Psychol Med Date: 2006-09-26 Impact factor: 7.723
Authors: Marsha M Linehan; Katherine Anne Comtois; Angela M Murray; Milton Z Brown; Robert J Gallop; Heidi L Heard; Kathryn E Korslund; Darren A Tutek; Sarah K Reynolds; Noam Lindenboim Journal: Arch Gen Psychiatry Date: 2006-07
Authors: Katherine L Wisner; Barbara H Hanusa; James M Perel; Kathleen S Peindl; Catherine M Piontek; Dorothy K Y Sit; Robert L Findling; Eydie L Moses-Kolko Journal: J Clin Psychopharmacol Date: 2006-08 Impact factor: 3.153
Authors: Thomas E Joiner; Natalie J Sachs-Ericsson; LaRicka R Wingate; Jessica S Brown; Michael D Anestis; Edward A Selby Journal: Behav Res Ther Date: 2006-06-12
Authors: Elizabeth H Ferguson; Arianna Di Florio; Brenda Pearson; Karen T Putnam; Susan Girdler; David R Rubinow; Samantha Meltzer-Brody Journal: Arch Womens Ment Health Date: 2017-03-01 Impact factor: 3.633
Authors: Adam K Lewkowitz; Joshua I Rosenbloom; Matt Keller; Julia D López; George A Macones; Margaret A Olsen; Alison G Cahill Journal: Obstet Gynecol Date: 2019-10 Impact factor: 7.661