Suicide Ideation within and outside the Perinatal Period: An Exploration of Interpersonal Factors from a Maternal Cohort in Rural Pakistan to Improve Intervention Targeting

Abstract

Objective

Suicide accounts for substantial mortality in low-resourced settings and contributes to nearly 20% of maternal deaths. In Asia, interpersonal conflict is a salient factor that contributes to suicidal thoughts and actions, yet limited research has been done to explore the type and timing of such conflicts and a woman’s accompanying social support. Identifying such risk factors can inform improved efforts to identify who to target for psychosocial interventions.

Methods

Using the Bachpan Cohort study of mothers in Pakistan (n = 1154), we examined the prevalence and interpersonal influences on SI within the past two weeks of pregnancy and then at 3, 6, and 24 months after birth. Using hierarchical mixed effects models, we explored the separate and combined associations of interpersonal factors [e.g., social support, interpersonal conflict, isolation, and past year intimate partner violence (IPV)] on SI at each timepoint.

Results

SI prevalence was highest in pregnancy (12.2%) and dropped to 5% throughout two years postpartum. The interpersonal conflict was independently associated with increased odds of SI in pregnancy and 24 months postpartum. IPV was associated with increased SI in pregnancy and 24 months postpartum. Isolation was not associated with SI at any timepoint. Perceived social support remained a robust independent factor associated with reduced SI at all timepoints.

Conclusion

In addition to screening and deploying interventions for perinatal women with depression, targeting interventions for those who also experience interpersonal conflict, including intimate partner violence, may significantly reduce suicidal thoughts and related sequelae. Social support is a viable and potentially powerful target to reduce the burden of suicide among women.

HIGHLIGHTS

• Suicidal ideation prevalence was higher in pregnancy compared to postpartum.

• Perceived social support was independently associated with reduced suicidal ideation.

• Interventions addressing suicide must attend to women’s family and social context.

Keywords:

• Intimate partner violence
• low-income
• maternal mental health
• social support
• suicidal ideation

ACKNOWLEDGEMENTS

This research is possible because of the expertise and commitment of the team at Human Development Research Foundation including Rakshanda Liaqat, Tayyiba Abbasi, Maria Sharif, Samina Bilal, Quratul-Ain, Anum Nisar, Amina Bibi, Shaffaq Zufiqar, Sonia Khan, Ahmed Zaidi, and Ikhlaq Ahmad. The foregrounding work of the larger Bachpan Study and SHARE CHILD Study teams supported the development and feasibility of the current research. Most importantly, we acknowledge the expertise, time, and experiences of the women, children, and communities that contribute to the Bachpan Cohort, and we are grateful to have the opportunity to learn from them.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institute of Mental Health (U19MH95687) and Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD) (R01HD075875). AH is supported by NIMH (K01MH125142). The research was also supported by institutional grants awarded to the Carolina Population Center at the University of North Carolina at Chapel Hill from the NICHD (T32HD007168 and P2CHD050924 to AH, KL, and JM).

Notes on contributors

Ashley K. Hagaman

Ashley K. Hagaman, PhD MPH, Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA and Center for Methods in Implementation and Prevention Sciences, Yale School of Public Health, New Haven, CT, USA.

Lisa M. Bates

Lisa M. Bates, Mailman School of Public Health, Columbia University, New York, NY, USA.

Najia Atif

Najia Atif, Human Development Research Foundation, Islamabad, Pakistan and Health Services Academy, Islamabad, Pakistan.

Esther Chung

Esther Chung, Katherine LeMasters, and Joanna Maselko, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Katherine LeMasters

Esther Chung, Katherine LeMasters, and Joanna Maselko, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Atif Rahman

Atif Rahman and Siham Sikander, Human Development Research Foundation, Islamabad, Pakistan, Health Services Academy, Islamabad, Pakistan, and Department of Psychological Sciences, University of Liverpool, Liverpool, UK.

Kiran Saqib

Kiran Saqib, Human Development Research Foundation, Islamabad, Pakistan and Health Services Academy, Islamabad, Pakistan.

Siham Sikander

Atif Rahman and Siham Sikander, Human Development Research Foundation, Islamabad, Pakistan, Health Services Academy, Islamabad, Pakistan, and Department of Psychological Sciences, University of Liverpool, Liverpool, UK.

Joanna Maselko

Esther Chung, Katherine LeMasters, and Joanna Maselko, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.