Maternal suicide is a preventable cause of death that is tragically understudied. Because pregnancy and motherhood are often viewed as protective against self-injurious thoughts and behaviors (SITBs), there is a widely held assumption that parenthood is incongruous with suicide risk. However, even though the transition to parenthood is momentous, it is also potentially a distressing milestone for many mothers, heightening risk for psychopathology via dynamic disruptions to social and biological processes. In fact, suicide is the second leading cause of mortality among postpartum women and accounts for at least 20% of deaths in the first year after birth. This Linked Standard Research between the University of Oregon and the University of Utah represents an important first study toward significantly advancing the field’s understanding of SITBs during the perinatal period. This team brings shared expertise using an intergenerational framework to study high risk maternal populations with a focus on emotion dysregulation (ED) and employing longitudinal designs. The Utah team has considerable experience with perinatal populations and the Oregon team with subsequent periods of development. Utah has experience with daily diary collection and Oregon with qualitative methods, multi-site data collection, uploading to the NIMH Data Archives, and forming a Data and Safety Monitoring Board.
Using an intensive longitudinal burst design, we plan to assess 150 mothers during their 3rd trimester of pregnancy (T1), and re-assess mothers at 6 weeks (T2) and 4 months postpartum (T3). Two-thirds of women will be selected based upon current suicide ideation and a history of at least one self-injurious behavior with the remaining 1/3 of women matched on ED but without current or historic SITBs. At each time point, women will complete a 30-minute electronic survey on 5 prominent perinatal risk factors (ED, sleep disturbances, financial hardship, partner conflict, and infant-specific parenting stress symptoms), followed by a telehealth intake in order for women’s SITBs to be thoroughly assessed. Last, mothers will complete 14 daily diaries on these perinatal risk factors and SITB fluctuations. We hypothesize that perinatal risk factors will be associated with increases in SITBs across the perinatal period as well as on a daily basis and that protective factors will reduce this risk. At T3, mother will also complete a qualitative interview about her lived experiences of being a mother who engages in SITBs and her experience participating in the study. The team will document all suicide risk management procedures.
If awarded, we have a plan to apply for NIMH funding to follow our AFSP participants through the early parenting years as the role of parenting across different child developmental milestones may impact SITB risk. Overall, the use of a longitudinal design, focus on ED and targetable perinatal specific risk factors, capturing the full range of SITBs, assessing for protective factors, and incorporating women’s voices will produce one of the most nuanced examinations of SITBs during this period. Our long-term vision is to prevent suicide and SITBs in mothers, with the potential to reduce the intergenerational transmission of SITB risk.
