Perinatal depression linked with long-term suicide risk and all-cause mortality

Perinatal depression, either antenatal (during pregnancy) or postpartum, affects 10% to 20% of pregnant women and is linked with numerous adverse health outcomes. One such outcome, suicide, accounts for as many as 20% of postpartum deaths in high-income countries. In two new studies, researchers used a Swedish dataset to investigate overall mortality and suicidal behavior (attempted or completed suicide) in women with perinatal depression.

A total of 86,000 women with a first diagnosis of perinatal depression who received specialized care or antidepressant medication were matched by age and year of delivery with 865,000 unaffected controls. To address potential familial confounders, 24,000 affected women were compared with 250,000 unaffected full sisters.

During a median 7 years of follow-up, affected women had significantly greater mortality than unaffected women (adjusted hazard ratio, 2.11), independent of pre-existing psychiatric conditions. Risk for suicidal behaviour was also significantly greater among affected women (aHR, 3.15), with a somewhat higher risk among those without pre-existing psychiatric conditions than among those with such conditions. Elevated risks for both all-cause death and suicide were most pronounced in the first year after diagnosis and were still significant 18 years later. Comparisons between sisters yielded similar results.

Perinatal depression can have devastating consequences and is easily missed without formal screening. The American College of Obstetricians and Gynecologists recommends universal screening at the initial prenatal visit, later in pregnancy, and at postpartum visits, along with effective treatment for affected patients. The Edinburgh Postnatal Depression Scale, a standard screening tool for perinatal depression, is available online.