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Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 10, pp 1219–1230 | Cite as

Association between perinatal depressive symptoms and suicidal risk among low-income South African women: a longitudinal study

  • Emily C. GarmanEmail author
  • Annibale Cois
  • Marguerite Schneider
  • Crick Lund
Original Paper

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

Depression and suicide are overlapping but relatively independent phenomena, especially among older or more chronically depressed perinatal women.

Keywords

Suicide Depression Perinatal Longitudinal South Africa 

Notes

Acknowledgements

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 [201446]. 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.

Ethical standards

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Emily C. Garman
    • 1
    Email author
  • Annibale Cois
    • 2
    • 3
  • Marguerite Schneider
    • 1
  • Crick Lund
    • 1
    • 4
  1. 1.Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
  2. 2.Division of Epidemiology and Biostatistics, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
  3. 3.Burden of Disease Research UnitSouth African Medical Research CouncilTygerbergSouth Africa
  4. 4.Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK

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