Predictors of antepartum and postpartum suicidal ideation at a diverse urban obstetric setting

BACKGROUND: Perinatal suicidality is a leading contributor to maternal mortality, and is associated with adverse outcomes for birthing individuals and children. Further research is needed to establish risk factors for perinatal suicidal ideation (SI), particularly among diverse populations. This study explored risk factors for perinatal SI within a diverse urban obstetric setting. METHODS: Data were derived from the electronic medical records of 3,983 perinatal individuals (41.8% Black/African American, 34.6% utilizing public health insurance) who completed the Edinburgh Postnatal Depression Scale (EPDS). 2,297 antepartum screens and 1,686 postpartum screens were assessed for SI via a positive endorsement of the EPDS’ item 10. Bivariate analyses were used to compare characteristics among individuals with and without SI, and multivariable logistic regression was used to examine predictors of SI. RESULTS: Prevalence of antepartum and postpartum SI was 4.7% and 3.1%, respectively. After adjustment for race, ethnicity, employment status, type of health insurance, and age, unemployment (aOR 3.01, 95% CI 1.06–8.50, p=.038) and lifetime mood disorder diagnosis (aOR 5.05, 95% CI: 1.89–13.48, p=.001) remained significant risk factors for antepartum SI. Prescription of psychiatric medications at screening (aOR 3.55, 95% CI 1.56–8.06, p=.003) was a significant predictor of postpartum SI after adjusting for type of health insurance, age, lifetime mood disorder diagnosis, term vs. preterm delivery, infant birthweight, and Neonatal Intensive Care Unit (NICU) admission. CONCLUSIONS: Findings suggest that systematic and comprehensive screening in obstetric practices will facilitate the identification of individuals at risk for SI. Further research is needed to develop preventive interventions to mitigate perinatal SI risk.