Suicidal ideation across pregnancy and the postpartum: Trajectories and assessment with commonly used screening tools

Suicidal ideation (SI) is a public health concern that remains poorly characterized during the perinatal period. It is most often assessed by the final items in two depression screening instruments, the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9). We sought to examine and compare SI trajectories identified by these measures and their changes from pregnancy to postpartum. This study reports on data from a supplemental study to the Understanding and Preventing Women's Relapse of Depression (UPWARD) study on perinatal depression (NIMH, NCT03623620; supplement entitled UPWARD-S). Participants were ineligible for UPWARD if they endorsed SI at baseline; but eligible for UPWARD-S if they were pregnant and had a history of major depressive disorder. Participants in UPWARD-S (N = 38) completed phone interviews and surveys from pregnancy through six months postpartum. Group-based trajectory modeling was conducted during pregnancy and postpartum using item 10 of the EPDS and item 9 of the PHQ-9. Trajectory analyses resulted in three group models. For both time periods, there were two groups showing relatively stable trajectories in the frequency of SI endorsement, one high and one low. During pregnancy, a third group began high and declined, and, during postpartum, a third group began low and increased. Trajectory patterns were broadly similar across items; however, the proportion of participants classified within each group differed by measure. Our findings demonstrated distinct and relatively stable trajectories and modest agreement between items. Findings from this study could inform larger studies to advise perinatal screening and intervention strategies.