Self‑harm ideation in perinatal women: Prevalence across gestational and postpartum windows and general risk and protective factors.

INTRODUCTION

The perinatal period is marked by heightened vulnerability to mental health difficulties, including the onset of self-harm ideation (SHI). We aimed to (a) estimate the prevalence of self-harm ideation among perinatal women, (b) explore sociodemographic, clinical, and psychosocial correlates of SHI.

METHODS

This is a cross-sectional study involving pregnant (n = 5,087) and postpartum women (n = 6,550). SHI was measured using item 10 of the Edinburgh Postnatal Depression Scale (EPDS), depressive symptoms using the remaining 9 EPDS items (EPDS-9), and anxiety symptoms using the Generalised Anxiety Disorder-7. Prespecified multivariable logistic models were fitted separately for pregnancy and postpartum.

RESULTS

SHI prevalence was 2.3% during pregnancy and 1.1% postpartum. In pregnancy, risk was independently associated with depressive symptom severity (OR = 1.27, 95%CI [1.21-1.33], p<.001) and immigrant status (OR = 2.08, 95%CI [1.15-3.75], p=.015), whereas better economic conditions were protective (OR = 0.53 per category increase, 95%CI [0.36-0.78], p=.001). In the postpartum period, depressive symptoms remained strongly associated with SHI (OR = 1.32, 95%CI [1.24-1.40], p<.001), and stable paid employment was protective (OR = 0.41, 95%CI [0.23-0.74], p=.003). Phase-specific models showed good to excellent discrimination (AUCpregnancy=.86; AUCpostpartum=.91) and acceptable calibration. No clinically meaningful EPDS-9 × phase interaction emerged.

CONCLUSIONS

A portion of perinatal women experience SHI and report it when asked directly (i.e. through the EPDS self-harm item). Routine screening should include explicit questions about self-harm thoughts and should continue through the first postpartum year. Combining mood screening with assessment of socioeconomic adversity may further improve the identification of individuals who could benefit from additional support.