Persistence of Depression and Suicide Risk Within and Across Pregnancies [7I]

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Abstract

INTRODUCTION:

Little is known about how perinatal depression risk, including suicidal ideation, changes within and across pregnancies.

METHODS:

62,080 Edinburgh Postnatal Depression Scales (EPDS) were administered. We studied a subset of 6,836 representing 1,709 women screened during gestation and postpartum in two successive pregnancies, totaling four screens per patient. “At-risk” EPDS (12 or more, or positive suicidal ideation-SI) were examined by multivariable logistic regression to model predictors of depression risk/SI adjusting for labor/delivery/infant variables, determined by Akaike information criterion and likelihood ratios.

RESULTS:

First pregnancy antepartum at-risk EPDS predicted risk in both the corresponding postpartum (aOR=4.2; 95% CI 1.2–15.0, P<.05) and the next pregnancy's antepartum (aOR=4.8; 95% CI 1.7–13.5, P<.01). Second pregnancy antepartum at-risk EPDS also predicted subsequent postpartum at-risk EPDS (aOR=18.6; 95% CI 8.1–42.8, P<.0001). Similarly, first pregnancy antepartum SI predicted both the index postpartum SI (aOR=9.5; 95% CI 2.4–38.6. P<.01) and subsequent antepartum SI (aOR=9.9; 95% CI 3.1–31.6, P=.0001). Second pregnancy antepartum SI strongly predicted the corresponding postpartum SI (aOR=29.9; 95% CI 8.1–110.1, P<.0001). The mean inter-pregnancy interval was 2.6 years (range 0.5–8.8).

CONCLUSION:

Antepartum depression risk and suicidal ideation are strongly correlated with postpartum risk as well as persistent risk in a subsequent pregnancy. Although phone-based mental health assessment and acuity-based treatment of symptomatic women was provided to all at-risk women in this series, the chronicity of depressive risk and SI suggests that more effective and durable therapeutic interventions may be required for these women.

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