Postpartum Suicidality beyond Depression: a Systematic Review of Risk Profiles and Prevention Gaps

Suicidal ideation and behavior during the postpartum period are increasingly recognized as important contributors to maternal morbidity and mortality, particularly in high-income countries. Although postpartum depression is a well-established risk factor, emerging evidence suggests that suicidality may also occur independently and therefore remain underrecognized in clinical practice. This systematic review aimed to synthesize current evidence regarding the prevalence of suicidal ideation and behavior in the postpartum period and to identify associated risk factors.

A systematic search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted up to March 2025 following PRISMA guidelines. Twenty studies met inclusion criteria, encompassing 352,726 postpartum women across diverse international settings. Reported prevalence of suicidal ideation ranged from 2.2% to over 50%, depending on the population studied and assessment methods used. The most frequently identified risk factors included postpartum depression, anxiety, trauma history, intimate partner violence, unplanned pregnancy, low socioeconomic status, low social support, and adverse childhood experiences. Notably, several studies reported suicidal ideation even in the absence of clinical depression. Only a limited number of studies addressed preventive interventions. Postpartum suicidality appears to be a multifactorial phenomenon that cannot be explained solely by depressive symptomatology. The findings highlight the need for broader screening strategies that incorporate psychosocial and trauma-related factors in addition to depression. Integrated and trauma-informed approaches to screening and prevention may improve early identification of at-risk individuals. Future research should prioritize longitudinal designs and culturally sensitive investigations to better inform prevention and intervention strategies.