Mental health issues during and after pregnancy are all too common. The numbers vary, but a 2021 literature review found that postpartum depression affects 17 percent of pregnant people, while prenatal depression affects between 20 and 40 percent. The numbers are even higher among Black pregnant people, 29 to 44 percent of whom experience postpartum depressive symptoms, studies say. And the consequences of pregnancy-related depression can be severe, including intense mood changes, exhaustion, and feelings of worthlessness or hopelessness, according to the CDC.
In some cases, postpartum depression can progress to the point of suicidal thoughts, behaviors, or attempts. With how common these conditions are — and how steep the cost of leaving them untreated — two new, related studies from Sweden published last week set out to quantify the risk for suicide is among those who suffer from it. What they found was alarming.
The two studies, run by overlapping teams of researchers, used the same data set from the Swedish nationwide health registers, looking at data from 2001 to 2017 — making it a true, population-level, long-term look at perinatal and postpartum depression. (FYI: perinatal depression is depression that occurs both during and after pregnancy, while postpartum depression occurs only after pregnancy.)
The first study, published in JAMA Network Open, looked at the association between perinatal depression and suicide attempts. The second, published in BMJ, looked at the association between perinatal depression and all-cause mortality (aka death by any cause), with a focus on death by suicide. Both studies defined a subject with perinatal depression as someone who’d either been specifically diagnosed with perinatal depression, or who filled prescriptions of antidepressants during pregnancy and/or within one year postpartum.
The first study, in JAMA Network Open, found that mothers with perinatal depression had three times the risk of developing suicidal behavior compared to mothers without perinatal depression, with the highest risk coming in the year after diagnosis. As the researchers traced patients’ data through the years, they found that the risk declined over time but mothers who’d had perinatal depression continued to experience an elevated risk of suicide “throughout 18 years of follow-up.” They also maintained a higher risk when compared to biological sisters without perinatal depression, suggesting that the elevated risk of suicide was linked more strongly to perinatal depression than to genetics or childhood upbringing, the researchers said.
As far as demographics, the researchers found that women were an average age of nearly 31 years old when diagnosed with perinatal depression. People with perinatal depression were also more likely to:
- live alone (i.e. not with the father of the child)
- have lower levels of education and income
- be first-time moms
- smoke three months before pregnancy
- have a greater BMI during early pregnancy
- have a history of mental health disorders and suicidal behavior
- have C-sections
- lose a child within one year of birth
The BMJ study, in contrast, focused on the relationship between perinatal depression and death, particularly by suicide (the previous study looked at suicide attempts only, not mortality). The researchers found that, overall, patients diagnosed with perinatal depression were over three times more likely to die of any cause within the 18 years of the study. Suicide was considered “rare” as the cause of death but more common among those with perinatal depression, representing 149 of the 522 deaths in the perinatal depression group (aka 28.5 percent), versus 117 suicides out of 1,568 deaths among those without perinatal depression (7.5 percent).
Still, the researchers noted, the risk of dying by suicide for patients with perinatal depression was more than six times higher than those without the condition. Researchers also found that the risk of dying by suicide was “more pronounced” for those with postpartum depression, specifically, than those who experienced depression during pregnancy.
It’s worth noting that both studies had a few limitations, mostly based on the data set used. Most of the participants in Sweden’s registries were white, for example — particularly notable given the higher risk of pregnancy-related depression among Black people. Swedish people also have access to universal healthcare and live in an affluent country, which may skew results, and researchers said they also couldn’t factor in things like domestic violence or alcohol consumption.
Still, the new research sheds important light on the risks of perinatal depression, a condition that remains not widely studied or understood, and its associated risk of suicide. The new information, according to the JAMA Network Open study, “highlights the pressing need for vigilant clinical monitoring and prompt intervention for this vulnerable population to prevent such devastating outcomes.”
If you or a loved one are experiencing depression or having thoughts of suicide, resources are available. To get help, call or text 988 to reach the the Suicide & Crisis Lifeline. You can also visit their website for more resources.
If you’re struggling with mental health, these apps can help: