Clinician note: The risk of suicide is significantly increased among depressed women during the perinatal period. While suicide deaths and attempts are lower during the postpartum than in the general population of women, when deaths do occur, suicides account for as many as 20 percent of postpartum deaths (Lindahl, Pearson,& Colpe, 2005).
Recent media attention to suicide attempts and tragic deaths by new mothers has raised public and congressional awareness about the potential devastating consequences of depression during the postpartum period. It is a risk that postpartum women and their families as well as the clinicians who treat them must take very seriously at all times. Passive suicidal ideation is also worrisome. Do not dismiss this.
If you do not ask every single postpartum woman who comes into your office if she is having thoughts of hurting herself, you have no idea whether she is feeling suicidal or not.
Ask every woman.
Below are some guidelines for assessing suicidality with your postpartum client:
IMPORTANT POINTS TO KEEP IN MIND:
Demonstrates significantly impaired functioning.Expresses suicidal thoughts with a developed or intended plan.Is ambivalent about her ability to keep herself and her baby safe.Expresses intent to herself or her baby.Reports physical or sexual abuse or any unsafe living situation.Demonstrates signs of psychosis.
A woman who has recently given birth and reports not feeling like herself should be closely monitored. Do not make the mistake of reassuring her that she will be fine until she is adequately assessed. A postpartum woman who is struggling with severe depression believes that her children would be better off without her.
Be informed. Ask the hard questions. Have excellent referral information for her.
In the U.S., call 1-800-273-8255 National Suicide Prevention Lifeline.
Adapted from Therapy and the Postpartum Woman (Routledge, 2009)