Self-harm thoughts among postpartum women - associated factors

ABSTRACT

Background

Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented.

Aim

We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs.

Method

1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables.

Results

Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs.

Conclusion

The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.

KEYWORDS:

• Suicide
• thoughts of self-harm
• risk factor

Highlights

• Approximately 2% of our participants reported experiencing SHTs.

• Within the group of postpartum mothers who self-reported SHTs, 65.60% manifested the symptoms of PPD, and 56.40% - of anxiety. One-third of the participants who reported SHTs were not at risk of the symptoms of depression, and 43.60% - of anxiety.

• Even if the total score in EPDS suggests no risk of mental health problems, a healthcare professional should examine the response to item 10, so that women experiencing SHTs are not overlooked.

• PPD, a mood disorder diagnosed in the past, and younger age were all predictors of experiencing SHTs.

• Healthcare professionals must be aware that some of the mothers experiencing SHTs may not reveal them directly to another person in face-to-face contact, and create a safe environment for open communication or provide opportunities for more anonymous responses.

Acknowledgments

This study is a part of a programme: “The Next Stop: Mum” which was implemented on the basis of the contract with the Ministry of Health for co-financing project No. POWR.05.01.00-00-0023/18 under the Operational Programme: Knowledge Education Development 2014-2020, co-financed from the European Social Fund. However, the sponsors did not have any involvement in the study design, collection, analysis and interpretation of data, writing of the report nor the decision to submit the article for publication.

We would like to thank all participants of the “Next Stop: MUM” PPD prevention project for their involvement in the project

Disclosure statement

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

Notes

1. Chrzan-Dętkoś and Walczak-Kozłowska (2021) reported initial evaluations of the PPD screening programme made by 150 randomly selected mothers. Authors evaluated the Postpartum Depression Prevention Strategy in Poland after the first two years of its implementation (Chrzan-Dętkoś et al., 2022). The authors (Chrzan-Dętkoś & Murawska, 2024) examined the co-occurrence of PPD and anxiety disorders.