Association between perinatal depressive symptoms and suicidal risk among low-income South African women: a longitudinal study
The aim of this study was to assess the association between depressive symptoms and suicidal risk over time among perinatal women at risk for depression antenatally, and assess modifying effects of age, perinatal stage and depressive symptom trajectory.
A total of 384 adult pregnant women were recruited from two antenatal clinics in an informal settlement near Cape Town, South Africa, and followed up at eight months gestation, and at 3- and 12-month postpartum. The MINI 6.0 Suicidality module and the Hamilton Depression Rating Scale (HDRS) were used to measure suicidal risk and depression, respectively. Generalised Estimating Equations were used to assess the association between change in depressive symptoms from one assessment to the next (predictor) and change in suicide score or change in suicidal risk (score ≥ 9) (outcomes).
HDRS scores were positively correlated with suicide score (95% CI 0.35, 0.78; p < 0.001), and with odds of being at moderate risk for suicide, after controlling for risk of suicide at the previous assessment (adjusted odds ratio = 1.15; 95% CI 1.09, 1.22; p < 0.001). Age was a significant effect modifier: change in HDRS scores was not associated with change in suicide scores among participants aged 35–45 years. Secondary analyses indicated that a decrease in HDRS score was associated with a decrease in suicide scores, but an increase in HDRS score was not associated with change in suicide score.
Depression and suicide are overlapping but relatively independent phenomena, especially among older or more chronically depressed perinatal women.
KeywordsSuicide Depression Perinatal Longitudinal South Africa
The original RCT was supported by the National Institute of Mental Health of the National Institutes of Health [U19MH095699]. This study is an output of the PRogramme for Improving Mental health carE (PRIME), supported by the UK Department for International Development . The funders did not have any role in the study design, data collection, analysis or interpretation of the data, or in the writing of the report. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the UK Governments’ official policies.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All participants recruited in the randomized-controlled trial and included in the present study provided informed written consent. The original randomized-controlled trial received ethical approval from the University of Cape Town (UCT)’s Human Research Ethics Committee (HREC REF 226/2011), and so did this present study (HREC REF 835/2015).
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