Women with depression during or after pregnancy are at greater risk of suicide, even years later

What the research shows

A research team analyzed data from almost a million women in Sweden’s national medical registers from 2001 through 2017, comparing 86,551 women with perinatal depression with 865,510 women who did not. The groups were matched based on the age and year in which they gave birth.

In two studies, the team discovered that depression that starts during pregnancy or shortly afterwards can have disturbing consequences for up to eighteen years.

A study, published Tuesday in JAMA Network OpenResearch found that women with perinatal depression had three times the risk of suicidal behavior, defined as attempted or completed suicide, than women who did not experience perinatal depression. The risks were greatest in the year after their diagnosis, but although they decreased over time, the risks were still twice as high years later compared to women without the condition.

The other study, published Wednesday in BMJResearch found that women with perinatal depression were more than six times more likely to die by suicide than women without that diagnosis. The number of suicides was small but accounted for a large proportion of deaths among women diagnosed with perinatal depression: 149 of 522 deaths in that group, or 28.5 percent. In women without perinatal depression, there were 117 suicides out of 1,568 deaths, or 7.5 percent.

Suicide was a major reason why women with perinatal depression were twice as likely to die from any cause during the 18-year study, compared with women without the disorder.

The researchers also compared more than 20,000 women with perinatal depression with their biological sisters who had given birth during the same time period and did not have the disorder. The risk of suicidal behavior for the sisters with perinatal depression was almost three times that of their sisters without the diagnosis – almost as high as the difference between women with the disease and those without it to whom they were not related. That suggests that depression plays a larger role in these outcomes than genetics or the child’s environment, the researchers wrote.

Behind the numbers

The average age at which women suffered from perinatal depression was 31 years. They were more likely than women without the disease to live alone, to have lower income and less formal education, to have recently smoked and not to have previously given birth, among other characteristics. the researchers reported.

They were also more likely to have previously had psychiatric disorders or suicidal behavior. But the studies found that regardless of whether women had other mental health problems, perinatal depression increased the risk of suicidal behavior and death. That suggests that pregnancy-related depression may be different and more serious than other mental disorders.

“This highlights the urgent need for vigilant clinical surveillance and prompt intervention for this vulnerable population to prevent such devastating outcomes, regardless of history of psychiatric disorders before pregnancy,” the JAMA Open Network study concluded.

There may be differences in the experiences of women who develop depression during pregnancy – just over half of those in the study – and women with postpartum depression that develops within a year of giving birth. The researchers found that women with postpartum depression were at greater risk of suicidal behavior and death, but it was unclear why.

The data did not show that pregnancy complications or a newborn’s birth weight or gestational age affected a mother’s suicidal behavior.

More to learn

Perinatal depression, which is estimated to affect 10 to 20 percent of women during or shortly after pregnancy, still under-researched, under-treated and probably under-diagnosed. Some reports have suggested that the condition became even more common during the coronavirus pandemic due to social isolation and reduced access to care.

Although the new studies shed some light on the effects of perinatal depression, many questions still remain. For example, the researchers said they could not capture factors such as domestic violence or alcohol use. And the studies may not be representative of experiences in other countries, because, for example, most women in the Swedish registries were white and Sweden is relatively prosperous with universal health care.

The role of treatment and therapy is not yet fully understood. The studies classified women as suffering from perinatal depression if doctors gave them that diagnosis or if they filled prescriptions for antidepressants during pregnancy or a year later, indicating they received some treatment. The consequences can be greater for people without treatment or therapy.

If you are having suicidal thoughts, call or text 988 to reach the 988 Suicide and Crisis Lifeline or visit SpeakingOfSuicide.com/resources for a list of additional resources. To go here for sources outside the United States.