By Heather Martin
Medical Assistant at Children’s Hospital at Dartmouth-Hitchcock in Manchester, NH

Suicide prevention is always important, but maternal suicide prevention is especially important to me. Twelve years ago, my sister died by suicide just three weeks after the birth of her first and only child. Like many new mothers, my sister was so excited for her first child. She had an ideal life filled with family and a loving home. But the signs were all there: she was withdrawn, wasn’t sleeping well, and had a lost stare in her eyes that I will never forget.

Up to one in five women will suffer from a maternal mental health disorder like depression or anxiety. Less than 15% of those diagnosed ever receive treatment.¹ Some women, like my sister, never get diagnosed and suffer in agonizing silence. I now believe my sister suffered from postpartum psychosis, a rare but very serious maternal mental health disorder. Our family has a history of bipolar disorder, and I now suspect that she may have had bipolar disorder. In fact, many women are first diagnosed with bipolar disorder during the perinatal period.² Research notes bipolar disorder is tied to 86% of postpartum psychosis cases (Robertson, 2002 in Misri 2005). Moms with bipolar disorder are at risk for postpartum psychosis, a significant risk factor for maternal suicide.³

As 2020 Mom shared during this year’s maternal suicide awareness week campaign, research suggests that suicide is a leading cause of maternal death in the postpartum period, making it more common than postpartum hemorrhage or hypertension disorders.⁴

As the pandemic has increased the probability of mothers suffering from postpartum depression I’m deeply concerned about an even greater risk for maternal suicide in our mothers.

A study done last year by Brigham and Women’s Hospital in Boston showed that one in three women suffered from postpartum depression/anxiety for up to six months postpartum, compared to one in five women pre-pandemic.⁵

Consistent screenings for maternal mental health disorders during pregnancy and the postpartum period can help to identify women at risk or struggling with a maternal mental health disorder and proper treatment can help prevent tragic outcomes. These screenings also provide an opportunity for providers like obstetricians and pediatricians to initiate a conversation about maternal mental health disorders with moms and their families.

In 2019, I approached my employer, Dartmouth-Hitchcock Manchester, about implementing this approach as a standard part of newborn checkups. In January 2020, we began screening moms for postpartum depression. At the beginning of each visit, moms confidentially complete a screening questionnaire on a secure tablet for their baby’s pediatrician to review. If they screen positive for postpartum depression, their pediatrician initiates a conversation asking if the mom has contacted her OB/GYN or primary care provider and whether she has a mental health provider. If the mother is not already receiving mental health care, she is referred to local mental health providers, resources, and postpartum groups. This initiative has been critical to improving patient care.

We can all prevent suicide by reaching out to our friends who struggle with mental health or are simply having a tough time. Let’s do this together, for Jennifer’s sake.

You can find more facts about maternal suicide at https://www.2020mom.org/maternal-suicide, suicide prevention at https://nami.org and postpartum depression information at Postpartum Support International at https://postpartum.net.

¹California Task Force on the Status of Maternal Mental Health Care. (2017, April). California’s Strategic Plan: A catalyst for shifting statewide systems to improve care across California and beyond [White Paper]. Retrieved September 27, 2021 from 2020 Mom: https://www.2020mom.org/s/Report-CATaskForce-718.pdf

²Tebeka, S., Godin, O., Mazer, N., Bellivier, F., Courtet, P., Etain, B., Gard, S., Leboyer, M., Llorca, P. M., Loftus, J., Olié, E., Passerieux, C., Polosan, M., Schwan, R., Belzeaux, R., Dubertret, C., & FondaMental Advanced Centers of Expertise in Bipolar Disorders (FACE-BD) Collaborators (2021). Clinical characteristics of bipolar disorders with postpartum depressive onset. Progress in neuro-psychopharmacology & biological psychiatry, 107, 110225. https://doi.org/10.1016/j.pnpbp.2020.110225

³Osborne L. M. (2018). Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Providers. Obstetrics and gynecology clinics of North America, 45(3), 455–468. https://doi.org/10.1016/j.ogc.2018.04.005

⁴Palladino, C. L., Singh, V., Campbell, J., Flynn, H., & Gold, K. J. (2011). Homicide and suicide during the perinatal period: Findings from the National Violent Death Reporting System. Obstetrics and Gynecology, 118(5), 1056–1063. Retrieved from https://doi.org/10.1097/AOG.0b013e31823294da

⁵Liu, C. H., Erdei, C., & Mittal, L. (2021). Risk factors for depression, anxiety, and PTSD symptoms in perinatal women during the COVID-19 pandemic. Psychiatry Research, 295, 113552. https://doi.org/10.1016/j.psychres.2020.113552