Questionnaire Items to Identify Suicidality in Perinatal Women: A Delphi Study

Maternal suicide is a leading cause of death during pregnancy and after birth (perinatal period). Perinatal suicidality is associated with significant adverse consequences for mother and baby. It is vital that women experiencing suicidality are identified early and given access to appropriate care. Screening measures are one way to identify women requiring additional support. No self-report screening measures have been specifically designed to identify suicidality in perinatal women. This study sought to determine the content validity, acceptability, and potential clinical utility of 22 suicide-related items that have been adapted and/or developed for use with perinatal women.

Two-round Delphi study. Thirty panelists with expertise and/or experience in perinatal mental health, suicidality and/or the development of measurement instruments took part. Items were rated against five dimensions, "relevance," "clarity," "acceptability," "effectiveness," and "feasibility." Consensus was determined as ≥70% panelists endorsing "quite" or "highly" for all dimensions. Response options were also rated on three dimensions, and qualitative feedback was explored.

Ten items reached consensus ≥70% for all five dimensions in round-one and a further four reached consensus in round-two, totaling 14 items. Twenty-one response scales/items reached consensus ≥70% in both rounds. The top-ranking item for identifying suicidal ideation was "Have you had thoughts about ending your own life?" Qualitative findings highlighted key areas to be addressed. These included the implications of item content, the importance of asking perinatal women about suicidality, and the need for all pregnant and postnatal women to receive appropriate information about perinatal mental health and suicidality.

Specifically developed screening measures to identify perinatal suicidality are warranted. Findings from this study will help to inform the continuing development of suicidality items for measures to be used with pregnant and postnatal women in clinical and research settings.