Pregnant Women Struggling With Suicidal Thoughts May Not Be Identified During Screening, New Study Finds
A state mandate requires all pregnant women in Illinois be screened for depression as part of their prenatal care.
But a new research study from the University of Illinois at Urbana-Champaign finds that those screenings may overlook a significant proportion of women who have suicidal thoughts.
That’s because not all mental health screening tools ask about suicidal thoughts.
About a third of women experiencing suicidal ideation do not have signs of depression, said Karen Tabb, associate professor of social work at the U of I. She led the study that involved more than 700 low-income pregnant women in Central Illinois, in collaboration with the Champaign-Urbana Public Health District.
“Meeting a threshold for depression is important, because that's how clinical follow up is established,” Tabb said. “But if she's only asked about depression, nobody's going to know to follow up about those thoughts of suicide.”
The study also finds that nearly 1 in 20 women in the study reported having suicidal thoughts, which is more than double the general population. All the women in the study were enrolled in the Women, Infants and Children Special Supplemental Nutrition Program, which serves nearly half of all pregnant women in the U.S.
Tabb said she hopes the study leads to improvements in the way prenatal mental health screenings are done.
She spoke with Illinois Public Media about the findings, which are published in the Journal of Affective Disorders.
This interview has been edited and condensed for clarity.
CH: You find that women with depression were 13 times more likely to report suicidal thoughts. But at the same time, more than a third of the women who reported thoughts of self harm did not have elevated levels of depression. Why is that significant?
KT: From a clinical standpoint, you would expect women who are experiencing elevated depressive symptoms, to possibly also be experiencing things like self-harm, harm to others, or suicidal ideation.
If a woman is only asked about depression, nobody's going to know to follow up about those thoughts of suicide."Karen Tabb, U of I social work professor
For us, we are a bit surprised that so many of the women who reported suicidal ideation were not having those other symptoms of depression, such as anger, sadness, irritability; they were simply reporting and thoughts of self-harm.
CH: Can you tell me a little bit about the screening method that you used in this study?
KT: Yes. There is no required screening tool in Illinois’ mandate requiring mental health screening, but it says there are some suggested instruments.
In our region of Central Illinois, many people use the Edinburgh postnatal depression scale. It’s unique in that it asks about suicidal ideation as the last item or item 10 of the questionnaire. Not all tools are going to ask about suicidal thoughts or self-harm.
Another tool is the Patient Health Questionnaire. The nine-item version of this questionnaire has one question about suicidal ideation; but not all clinics use that tool.
CH: Would you say the takeaway from this study is that the way these mental health screenings are done, health care providers are not using a tool that specifically looks at suicidal ideation, some of these pregnant women might be falling through the cracks?
KT: Yes, exactly. Right now, in our maternal mortality crisis, we're trying to find all of those risk factors, and all of those predictors that we can use to reduce those risks for death in the first year after delivering an infant.
Suicide is up there; in the United States it’s the third leading cause of death in the first year that's not a physiological complication.
If we can screen women for suicidal ideation during pregnancy, we can capture a unique subset of women who are going to have those greater risks when they go home with infants.
Clinicians need support to be more effective using a screening tool, to know how important it is, to know how to have a conversation about it. Karen Tabb, U of I social work professor
CH: How does being a mother yourself affect the way that you approach this research?
I really appreciate that question. I've been doing this work now for 11 years, and I approach it differently now that I'm a mother myself.
Screening is one of the most important tools that we have to identify women in need of further support and resources during the perinatal period, and to address one of the most common pregnancy complications, which are perinatal mental health disorders.
So now that I am in clinics myself, for the past five years as a patient, I see the process more intimately than I did when I was just thinking about the importance of screening.
I've heard from clinicians for several years, and we've done some research about the comfort level that providers have in delivering the screen. But now, as a patient and mother, I've seen that level of discomfort from some providers in discussing mental health issues such as depression and anxiety during pregnancy.
We have a lot of work to do in terms of providing support to clinicians. They need support to be more effective using a screening tool, to know how important it is, to know how to have a conversation about it.
Christine Herman is a 2018-19 Rosalynn Carter Mental Health Journalism fellow. Follow her on Twitter: @CTHerman