Self-Injurious Thoughts and Behaviors From Pregnancy to Postpartum: Risk Factors and Clinical Implications

Suicide is a leading cause of mortality among perinatal populations. Despite increasing rates, research on this topic remains limited. This paper examined (1) change in self-injurious thoughts and behaviors (SITBs) from pregnancy to postpartum, (2) associations between risk factors and SITBs, and (3) whether risk factors moderated change in SITBs.

Participants (N = 223) reported on SITBs, emotion dysregulation, and partner stress at the third trimester and 7 months postpartum, and childhood trauma at the third trimester. We tested study aims with generalized linear models.

While self-injurious thoughts did not change from pregnancy to postpartum, the odds of self-injurious behaviors were 3.56 times higher postpartum (OR = 3.56, p = 0.011), even while accounting for risk factors. Higher concurrent emotion dysregulation was associated with self-injurious thoughts during pregnancy and postpartum (OR = 1.04, p < 0.001; OR = 1.05, p < 0.001) and with behaviors postpartum (OR = 1.05, p = 0.002). Childhood trauma was associated with self-injurious thoughts during pregnancy (OR = 2.54, p = 0.004) and postpartum (OR = 2.05, p = 0.028) and with behaviors postpartum (OR = 3.25, p = 0.009). Partner relationship conflict was not associated with self-injurious thoughts or behaviors at either time point. Higher rates of prenatal risk factors increased the odds of SITBs in the postpartum period.

Findings support interventions addressing childhood trauma and emotion dysregulation for prevention of SITBs before postpartum, when risk is higher.