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The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study

  • E. Gelabert
  • A. Gutierrez-Zotes
  • R. Navines
  • J. Labad
  • M. Puyané
  • M. F. Donadon
  • R. Guillamat
  • F. Mayoral
  • M. Jover
  • F. Canellas
  • M. Gratacós
  • M. Guitart
  • I. Gornemann
  • M. Roca
  • J. Costas
  • J. L. Ivorra
  • S. Subirà
  • Y. de Diego
  • F. L. Osorio
  • L. Garcia-Esteve
  • J. Sanjuan
  • E. Vilella
  • R. Martin-SantosEmail author
Original Article
  • 41 Downloads

Abstract

Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck’s personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01–1.06; and OR, 1.03; 95%CI 1.01–1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11–1.26), personal psychiatric history (OR 2.1; 95%CI 1.33–3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12–3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.

Keywords

Suicidal ideation Postpartum Depression Neuroticism Psychoticism Personality dimensions 

Notes

Acknowledgements

This work was carried out with the Instituto Carlos III (Spanish Ministry of Health) grants, FIS (PI041635, PI041783, PI041779, PI041761, PI041791, PI041766 and PI041782), as well as the Spanish Psychiatric Genetics and Genotyping network GO3/184. We also acknowledge the support of the Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Instituto Carlos III (Spanish Ministry of Health) and the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement, Generalitat de Catalunya (SGR2014/1114; SGR2017/1798). We would like to thank all women who agreed to participate in the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Alhusen JL, Frohman N, Purcell G (2015) Intimate partner violence and suicidal ideation in pregnant women. Arch Womens Ment Health 18:573–578PubMedPubMedCentralCrossRefGoogle Scholar
  2. Austin M-P, Fisher J, Reilly N (2015) Psychosocial assessment and integrated perinatal care. In: Milgrom J, Gemmill AW (eds) Identifying Perinatal Depression and Anxiety: Evidence-based Practice in Screening, Psychosocial Assessment and Management. Wiley-Blackwell, Chichester, pp 121–138Google Scholar
  3. Baca-Garcia E, Parra CP, Perez-Rodriguez MM et al (2007) Psychosocial stressors may be strongly associated with suicide attempts. Stress Health 23:191–198CrossRefGoogle Scholar
  4. Bellón JA, Delgado A, Luna JD, Lardelli P (1996) Validity and reliability of the Duke-UNC-11 questionnaire of functional social support | Validez y fiabilidad del cuestionario de apoyo social functional Duke-UNC-11. Aten Primaria 18:151–207Google Scholar
  5. Bi B, Xiao X, Zang H et al (2012) A comparison of the clinical characteristics of women with recurrent major depression with and without suicidal symptomatology. Psychol Med 42:2591–2598PubMedPubMedCentralCrossRefGoogle Scholar
  6. Bodnar-Deren S, Klipstein K, Fersh M et al (2016) Suicidal ideation during the postpartum period. J Women's Health 25:1219–1224CrossRefGoogle Scholar
  7. Brent DA, Melhem N (2008) Familial transmission of suicidal behavior. Psychiatr Clin N Am 31:157–177CrossRefGoogle Scholar
  8. Brezo J, Paris J, Turecki G (2006) Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review. Acta Psychiatr Scand 113:180–206PubMedCrossRefGoogle Scholar
  9. Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH (1988) The Duke-UNC functional social support questionnaire: measurement of social support in family medicine patients. Med Care 26:707–721CrossRefGoogle Scholar
  10. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression scale. Br J Psychiatry 150:782–786PubMedCrossRefGoogle Scholar
  11. Esscher A, Essén B, Innala E et al (2016) Suicides during pregnancy and 1 year postpartum in Sweden, 1980-2007. Br J Psychiatry 208:462–469PubMedCrossRefGoogle Scholar
  12. Eysenck S (1985) Eysenck Personality Questionnaire-Revised (EPQ-R) and Short-Scale (EPQ-RS). Hooder and Stoughton, LondonGoogle Scholar
  13. Eysenck H, Eysenck S (2001) Cuestionario revisado de personalidad de Eysenck: versiones completa (EPQ-R) y abreviada (EPQ-RS). TEA, MadridGoogle Scholar
  14. Farmer A, Redman K, Harris T et al (2001) The Cardiff sib-pair study: suicidal ideation in depressed and healthy subjects and their siblings. Crisis 22:71–73PubMedCrossRefPubMedCentralGoogle Scholar
  15. Garcia-Esteve L, Ascaso C, Ojuel J, Navarro P (2003) Validation of the Edinburgh Postnatal Depression Scale (EPDS) in Spanish mothers. J Affect Disord 75:71–76PubMedCrossRefPubMedCentralGoogle Scholar
  16. Gavin AR, Tabb KM, Melville JL et al (2011) Prevalence and correlates of suicidal ideation during pregnancy. Arch Womens Ment Health 14:239–246PubMedPubMedCentralCrossRefGoogle Scholar
  17. Gelaye B, Kajeepeta S, Williams MA (2016) Suicidal ideation in pregnancy: an epidemiologic review. Arch Womens Ment Health 19:741–751PubMedPubMedCentralCrossRefGoogle Scholar
  18. Giallo R, Pilkington P, Borschmann R et al (2018) The prevalence and correlates of self-harm ideation trajectories in Australian women from pregnancy to 4-years postpartum. J Affect Disord 229:152–158PubMedCrossRefPubMedCentralGoogle Scholar
  19. Girardi P, Pompili M, Innamorati M et al (2011) Temperament, post-partum depression, hopelessness, and suicide risk among women soon after delivering. Women Health 51:511–524PubMedCrossRefPubMedCentralGoogle Scholar
  20. Goodwin RD, Gotlib IH (2004) Gender differences in depression: the role of personality factors. Psychiatry Res 126:135–142PubMedCrossRefGoogle Scholar
  21. Grigoriadis S, Wilton A, Kurdyack E et al (2017) Perinatal suicide in Ontario, Canada: a 15 year population -based study. CMAJ 28:189 E1085-92.  https://doi.org/10.1503/cmaj.170088 PubMedCrossRefGoogle Scholar
  22. Guillard V, Gressier F (2017) Suicidalité en période périnatale. Press Medicale 46:565–571CrossRefGoogle Scholar
  23. Horon IL, Chen D (2011) Effectiveness of pregnancy check boxes on the death certificates in indentifying pregnancy-associated mortality. Public Health Ret 126:195–200Google Scholar
  24. Hosmer DW, Hosmer T, Le Cessie S, Lemeshow S (1997) A comparison of goodness-of-fit tests for the logistic regression model. Stat Med 16:965–980PubMedCrossRefGoogle Scholar
  25. Howard LM, Flach C, Mehay A et al (2011) The prevalence of suicidal ideation identified by the Edinburgh Postnatal Depression Scale in postpartum women in primary care: findings from the RESPOND trial. BMC Pregnancy Childbirth 11:1–10CrossRefGoogle Scholar
  26. Kim JJ, La Porte LM, Saleh MP et al (2015) Suicide risk among perinatal women who report thoughts of self-harm on depression screens. Obstet Gynecol 125:885–893PubMedCrossRefGoogle Scholar
  27. Knight M, Nair M, Tuffnell D et al (2017) Saving lives, improving mothers’ care. National Perinatal Epidemiology Unit, University of Oxford, OxfordGoogle Scholar
  28. Limburg K, Watson HJ, Hagger MS, Egan SJ (2017) The relationship between perfectionism and psychophathology: a meta-analysis. J Clin Psychol 73:1301–1326PubMedCrossRefGoogle Scholar
  29. Lindahl V, Pearson JL, Colpe L (2005) Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health 8:77–87PubMedCrossRefGoogle Scholar
  30. Mandelli L, Nearchou FA, Vaiopoulos C et al (2015) Neuroticism, social network, stressful life events: association with mood disorders, depressive symptoms and suicidal ideation in a community sample of women. Psychiatry Res 226:38–44PubMedCrossRefGoogle Scholar
  31. Mann JJ, Waternaux C, Haas GL, Malone KM (1999) Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 156:181–189PubMedPubMedCentralGoogle Scholar
  32. Martín-Santos R, Gelabert E, Subirà S et al (2012) Research letter: is neuroticism a risk factor for postpartum depression? Psychol Med 42:1559–1565PubMedPubMedCentralCrossRefGoogle Scholar
  33. Mauri M, Oppo A, Borri C, Banti S (2012) Suicidality in the perinatal period: comparison of two self-report instruments. Results from PND-ReScU. Arch Womens Ment Health 15:39–47PubMedCrossRefPubMedCentralGoogle Scholar
  34. Moore Simas TA, Brenckle L, Sankaran P et al (2019) The Program in support of Moms (PRISM): study potocol for a cluster randomized controlled trial of two active interventions addressing perinatal depression in obstetric settings. MBC Pregnancy Childbirth 19:256.  https://doi.org/10.1186/s12884-019-2387-3
  35. Navarro P, Ascaso C, Garcia-Esteve L et al (2007) Postnatal psychiatric morbidity: a validation study of the GHQ-12 and the EPDS as screening tools. Gen Hosp Psychiatry 29:1–7PubMedCrossRefPubMedCentralGoogle Scholar
  36. Nock MK, Borges G, Bromet EJ et al (2008) Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 192:98–105PubMedCrossRefPubMedCentralGoogle Scholar
  37. Nurnberger JI, Blehar MC et al (1994) Diagnostic interview for genetic studies: rationale, unique features, and training. Arch Gen Psychiatry 51:849–859PubMedCrossRefPubMedCentralGoogle Scholar
  38. Oates M (2003) Suicide: the leading cause of maternal death. Br J Psychiatry 183:279–281PubMedCrossRefPubMedCentralGoogle Scholar
  39. Onah MN, Field S, Bantjes J, Honikman S (2017) Perinatal suicidal ideation and behaviour: psychiatry and adversity. Arch Womens Ment Health 20:321–331PubMedCrossRefPubMedCentralGoogle Scholar
  40. Orsolini L, Valchera A, Vecchiotti R et al (2016) Suicide during perinatal period: epidemiology, risk factors, and clinical correlates. Front Psychiatry 12.  https://doi.org/10.3389/fpsyt.2016.00138
  41. Paris R, Bolton RE, Weinberg MK (2009) Postpartum depression, suicidality, and mother-infant interactions. Arch Womens Ment Health 12:309–321PubMedCrossRefPubMedCentralGoogle Scholar
  42. Paykel ES (1983) Methodological aspects of life events research. J Psychosom Res 27:341–352PubMedCrossRefPubMedCentralGoogle Scholar
  43. Pickles A, Aglan A, Collishaw S et al (2010) Predictors of suicidality across the life span: The Isle of Wight study. Psychol Med 40:1453–1466PubMedCrossRefPubMedCentralGoogle Scholar
  44. Pope CJ, Xie B, Sharma V, Campbell MK (2013) A prospective study of thoughts of self-harm and suicidal ideation during the postpartum period in women with mood disorders. Arch Womens Ment Health 16:483–488PubMedCrossRefGoogle Scholar
  45. Rappaport LM, Flint J, Kendler KS (2017) Clarifying the role of neuroticism in suicidal ideation and suicide attempt among women with major depressive disorder. Psychol Med 47:2334–2344PubMedPubMedCentralCrossRefGoogle Scholar
  46. Reilly N, Kingston D, Loxton D et al (2019) A narrative review of studies addressing the clinical effectiveness of perinatal depression screening programs. Women Birth 3.  https://doi.org/10.1016/jwombi.2019.03.004
  47. Roca M, Martin-Santos R, Saiz J et al (2007) Diagnostic Interview for Genetic Studies (DIGS): inter-rater and test-retest reliability and validity in a Spanish population. Eur Psychiatry 22:44–48PubMedCrossRefGoogle Scholar
  48. Sanjuán J, Martin-Santos R, Garcia-Esteve L et al (2008) Mood changes after delivery: role of the serotonin transporter gene. Br J Psychiatry 193:383–388PubMedCrossRefGoogle Scholar
  49. Schuitemaker N, Van Roosmalen J, Dekker J et al (1997) Underreporting of materanl mortality in the Netherlands. Obstet Gynecol 90:68–82CrossRefGoogle Scholar
  50. Serafini G, Muzio C, Piccinini G et al (2015) Life adversities and suicidal behavior in young individuals: a systematic review. Eur Child Adolesc Psychiatry 24(12):1423–1446CrossRefGoogle Scholar
  51. Sit D, Seltman H, Wisner KL (2011) Seasonal effects on depression risk and suicidal symptoms in postpartum women. Depress Anxiety 28:400–405PubMedPubMedCentralCrossRefGoogle Scholar
  52. Sit D, Luther J, Buysse D et al (2015) Suicidal ideation in depressed postpartum women: associations withchildhood trauma, sleep disturbance and anxiety. J Psychiatr Res 66–67:95–104PubMedCrossRefGoogle Scholar
  53. The Lancet. Editorial (2016) Screening for perinatal depression: a missed opportunity. Lancet 387:505CrossRefGoogle Scholar
  54. Voracek M, Loibl LM (2007) Genetics of suicide: a systematic review of twin studies. Wien Klin Wochenschr 119:463–475PubMedCrossRefGoogle Scholar
  55. Vrshek-Schallhorn S, Czarlinski J, Mineka S et al (2011) Prospective predictors of suicidal ideation during depressive episodes among older adolescents and young adults. Personal Individ Differ 50:1202–1207PubMedPubMedCentralCrossRefGoogle Scholar
  56. WHO; World Health Organization (2019) Mental health. Suicide data. https://www.who.int/gho/publications/world_health_statistics/2019/EN_WHS_2019_Annex2.pdf?ua=1. Accessed August 2019
  57. Woody CA, Ferrari AJ, Siskind DJ et al (2017) A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord 219:86–92PubMedCrossRefGoogle Scholar
  58. Zhong QY, Gelaye B, Rondon MB et al (2014) Using the Patient Health Questionnaire (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS) to assess suicidal ideation among pregnant women in Lima, Peru. Arch Womens Ment Health 18:783–792PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  • E. Gelabert
    • 1
    • 2
  • A. Gutierrez-Zotes
    • 3
  • R. Navines
    • 2
  • J. Labad
    • 4
  • M. Puyané
    • 1
  • M. F. Donadon
    • 5
  • R. Guillamat
    • 6
  • F. Mayoral
    • 7
  • M. Jover
    • 8
  • F. Canellas
    • 9
  • M. Gratacós
    • 10
  • M. Guitart
    • 4
  • I. Gornemann
    • 7
  • M. Roca
    • 9
  • J. Costas
    • 11
  • J. L. Ivorra
    • 8
  • S. Subirà
    • 1
  • Y. de Diego
    • 7
  • F. L. Osorio
    • 5
  • L. Garcia-Esteve
    • 2
  • J. Sanjuan
    • 8
  • E. Vilella
    • 3
  • R. Martin-Santos
    • 2
    • 5
    Email author
  1. 1.Department of Clinical and Health PsychologyUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain
  2. 2.Department of Psychiatry and Psychology, Hospital Clinic, Institut of NeuroscienceUniversity of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut MarBarcelonaSpain
  3. 3.Hospital Universitari Institut Pere Mata, IISPVUniversitat Rovira i Virgili, CIBERSAMReusSpain
  4. 4.Parc Taulí Hospital Universitario, Instituto de Investigación Sanitaria Parc Taulí (I3PT)UAB, CIBERSAMSabadellSpain
  5. 5.Department of Neuroscience and Behavior, Ribeirão PretoUniversity of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil)São PauloBrazil
  6. 6.Departamento de Psiquiatria, Departamento de Salud MentalConsorci Sanitari de TerrassaTerrassaSpain
  7. 7.Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de MálagaUGC Salud MentalMálagaSpain
  8. 8.Hospital ClinicUniversidad de Valencia, CIBERSAMValenciaSpain
  9. 9.Institut Universitari d’Investigació en Ciències de la Salut, Red en Asistencia Primaria (RediAPP)Hospital de Son DuretaPalma de MallorcaSpain
  10. 10.Centro de Regulación Genómica (CRG) y UPFBarcelonaSpain
  11. 11.Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servizo Galego de Saúde (SERGAS)Complexo Hospitalario Universitario de Santiago (CHUS)GaliciaSpain

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