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. 2024 Jan 2;7(1):e2350897.
doi: 10.1001/jamanetworkopen.2023.50897.

Perinatal Depression and Risk of Suicidal Behavior

Hang Yu  1 , Qing Shen  2   3 , Emma Bränn  1 , Yihui Yang  1 , Anna Sara Oberg  4 , Unnur Anna Valdimarsdóttir  1   4   5 , Donghao Lu  1
Affiliations

Perinatal Depression and Risk of Suicidal Behavior

Hang Yu et al. JAMA Netw Open. .

Abstract

Importance: Suicidal ideation is common among women with perinatal depression (PND). However, prospective data are limited on the risk, particularly long-term risk, of suicidal behavior (suicide attempt and completed suicide) among women with perinatal depression.

Objective: To examine the association between PND and risk of short- and long-term suicidal behavior.

Design, setting, and participants: A nationwide population-matched cohort study was conducted in Sweden including 86 551 women with PND from 2001 to 2017 and 865 510 unaffected women individually matched on age and calendar year at delivery. Sibling comparison was used to account for familial confounding. Data were analyzed from January 2022 to November 2023.

Exposure: PND was identified through depression diagnosis or filled prescriptions of antidepressants from pregnancy to 1 year post partum in registers.

Main outcomes and measures: All women were followed up for the first event of suicidal behavior recorded in registers. Hazard ratios (HR) of suicidal behavior were estimated using time-to-event analysis.

Results: Women with PND (86 551 participants) received a diagnosis at a mean (SD) age of 30.67 (5.23) years. During a median (IQR) follow-up of 6.91 (3.62-10.88) years, 3604 events of suicidal behavior (incidence rate [IR], 5.62 per 1000 person-years) were identified among women with PND and 6445 (IR, 1.01 per 1000 person-years) among population-unaffected women. Women with PND had an elevated risk of suicidal behavior when compared with matched unaffected women (HR, 3.15; 95% CI, 2.97-3.35). Comparable, albeit somewhat attenuated, associations were yielded when comparing PND women with their PND-free sisters (HR, 2.75; 95% CI, 2.10-3.61). In the population-matched cohort, the association was greater for postnatal depression and among women without a history of psychiatric disorders. The excess risk was pronounced during the first year after diagnosis (HR, 7.20; 95% CI, 6.07-8.54), yet remained statistically significant during 5 to 18 years of follow-up (HR, 2.34; 95% CI, 2.12-2.57).

Conclusions and relevance: In this nationwide cohort study, women with PND were at an increased risk of suicidal behavior, particularly within the first year after diagnosis with persistent risk elevations throughout the 18 years of follow-up, highlighting the need for vigilant clinical monitoring of this vulnerable group.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shen reported receiving grants from Outstanding Clinical Discipline Project of Shanghai Pudong and from Fundamental Research Fund for the Central Universities in China outside the submitted work. Dr Oberg reported receiving personal fees from Abbott for serving on Scientific Medical Advisory Committee outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Hazard Ratios of Suicidal Behavior Among Women With Perinatal Depression Compared With Matched Unaffected Women
Time-varying hazard ratios (solid line) and 95% CIs (shaded area) were derived from flexible parametric survival models allowing relative risk to vary over time. A spline with 5 degrees of freedom was used for the baseline hazard, and one with 3 degrees of freedom was used for the time-varying effect. Models were adjusted for maternal age, calendar year at delivery, educational level, annual household income, country of birth, cohabitation status, parity, body mass index, smoking 3 months before pregnancy, history of psychiatric disorders, history of suicidal behavior, and hypertensive and diabetic disorders.
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