Conference Agenda

Introduction: Maternal suicide is a leading cause of death during pregnancy and after birth (perinatal period). Perinatal suicidality is associated with significant adverse consequences for mother and baby. It is vital that women experiencing suicidality are identified early and given access to appropriate care. Screening measures are one way to identify women requiring additional support. No self-report screening measures have been specifically designed to identify suicidality in perinatal women.

Aim: This study sought to determine the content validity, acceptability, and potential clinical utility of 22 suicide-related items that have been adapted and/or developed for use with perinatal women.

Methods: Two-round Delphi study. Thirty panellists with expertise and/or experience in perinatal mental health, suicidality and/or the development of measurement instruments took part. Items were rated against five dimensions, ‘relevance’, ‘clarity’, ‘acceptability’, ‘effectiveness’ and ‘feasibility’. Consensus was determined as ≥ 70% panellists endorsing ‘quite’ or ‘highly’ for all dimensions. Response options were also rated on three dimensions, and qualitive feedback was explored.

Results: Ten items reached consensus ≥70% for all five dimensions in round-one and a further four reached consensus in round-two, totalling 14 items. Twenty-one response scales/items reached consensus ≥70% in both rounds. The top-ranking item for identifying suicidal ideation was "Have you had thoughts about ending your own life?" Qualitative findings highlighted key areas to be addressed. These included the implications of item content, the importance of asking perinatal women about suicidality, and the need for all pregnant and postnatal women to receive appropriate information about perinatal mental health and suicidality.

Conclusions: Specifically developed screening measures to identify perinatal suicidality are warranted. Findings from this study will help to inform the continuing development of suicidality items for measures to be used with pregnant and postnatal women in clinical and research settings.

Background: Unpaid housework and caregiving impose substantial time and psychosocial burdens on married women. However, longitudinal evidence remains limited regarding whether their associations with suicidal ideation vary by age and economic activity status. This study examined the longitudinal associations between housework, caregiving, and suicidal ideation among married women, with a focus on heterogeneity by economic activity status and age.

Methods: We analyzed data from the Korean Longitudinal Survey of Women and Families (KLoWF), including 6,867 married women aged ≥19 years from the 4th–9th waves. Housework and caregiving were measured as self-reported weekly hours; housework was categorized into quartiles and caregiving as none, <33.3, or ≥33.3 hours per week. Suicidal ideation was assessed based on past-year experience. Generalized estimating equations with a logit link were applied, adjusting for relevant covariates, with stratified analyses by economic activity status and age.

Results: In fully adjusted GEE models, moderate levels of housework were associated with lower odds of suicidal ideation compared with the lowest quartile (Q2–Q3 ORs ≈0.82–0.83), whereas the highest quartile showed no significant association. In contrast, caregiving activity was associated with higher odds of suicidal ideation, particularly among women providing ≤33.3 hours per week (OR = 1.25, 95% CI 1.02–1.53). Stratified analyses showed that the inverse association of moderate housework was most evident among economically inactive women, while high housework was associated with increased odds among economically active women (Q4 OR = 1.34, 95% CI 1.05–1.71). Caregiving-related risk was strongest among economically inactive women aged 35–49 years (OR = 1.58, 95% CI 1.05–2.37).

Conclusion: Housework and caregiving showed associations with suicidal ideation, suggesting different implications. While housework showed no adverse association at moderate levels, caregiving was associated with higher odds of suicidal ideation. These findings indicate that mental health impacts should be interpreted in relation to both labor type and socioeconomic context.

Background: Maternal infections during pregnancy may impact offspring brain development, but their impact on suicidal behavior remains unclear. We investigated associations between maternal infections before, during,and after pregnancy and offspring suicide attempt to understand the mechanisms explaining these associations. Paternal infections during these same periods were examined to pinpoint the possible specific role of intra-uterine exposure vs. genetic and socioeconomic confounding factors.

Methods: A cohort design was applied to individual-level register-based data including all persons aged 10+ years and living in Denmark in 1987-2021. Information on maternal infection (bacterial, viral, other, and at different body sites) was obtained from the Medical Birth Register based of diagnoses received during hospital contacts. The main outcome was hospital presentations for suicide attempt. Adjusted Incidence Rate Ratios (IRR) were estimated to quantify associations between exposure to maternal infections and offspring suicide attempt.

Results: Of 2,157,641 individuals (35,047,803 person-years), 38,840 (1.8%), 26,158 (1.2%), and 34,853 (1.6%), had been exposed to maternal infection during, before, and after pregnancy, respectively, while 32,275 attempted suicide. Rates among those exposed to maternal infection during pregnancy and those non-exposed were 141.2 and 90.0 per 100,000 person-years, respectively. Individuals exposed to maternal infections during pregnancy had higher risk of suicide attempt when compared to non-exposed (IRR 1.46 [1.36-1.56]), particularly those exposed in the second and third trimesters. Elevated risks were observed for maternal infections prior and after pregnancy, but not for paternal infections during, before, or after pregnancy.

Conclusions: Maternal, but not paternal, infections were associated with later risk of offpring suicide attempt, pointing out to a possible role of the intra-uterine environment. Similar estimates obtained for exposure to maternal infections before and after pregnancy suggests that part of this risk may stem from an underlying susceptibility to infections or socioeconomic confounding factors and/or measurement errors in the onset of infections

Introduction

Suicide is the leading cause of death in women from 6 weeks to 1 year post-partum in the UK and across several high-income countries. Efforts to understand suicidal ideation in the post-partum period should be prioritised, with a dearth of research investigating psychosocial factors. The current study investigated suicidal ideation in post-partum women through the lens of the IMV model of suicidal behaviour. This well-established framework has feelings of defeat and entrapment central to the motivational phase, with qualitative research finding suicidal post-partum women feel trapped, suggesting the IMV may useful for understanding post-partum suicidality.

Methods

The Wellbeing in Post-Partum Study (WiPPS) is an online survey that was co-designed with women with lived experience of post-partum suicidal ideation. 410 women or birthing people who have given birth within the past year took part in the study. The survey included measures of current and past suicidal ideation and behaviour, mental health (depression, anxiety), IMV variables (defeat and entrapment), birth-related trauma, and other risk (e.g., loneliness) and protective (e.g., social support) factors. The study was promoted by organisations involved with supporting post-partum women from different socioeconomic and ethnic backgrounds.

Results

Initial correlation analysis found defeat and entrapment to be strongly correlated with suicidal ideation in this sample. Multivariate regression analysis found that defeat and entrapment remained associated with suicidal ideation when controlling for demographics, mental health and other risk factors. Additionally, experience of birth-related trauma and loneliness was positively associated suicidal ideation, and higher social support was negatively associated.

Conclusions

The findings from this study improve our understanding of post-partum suicidality. Specifically, we suggest that the IMV model provides a useful framework for understanding suicide risk for women and birthing people during the post-partum period. Feelings of defeat and entrapment should be considered when monitoring suicide risk in this vulnerable group.