Perinatal depression leads to increased risk of death: Study

New research out of Sweden has highlighted the life-saving benefits of long-term support for parents, revealing some women are at higher risk of dying by suicide long after their baby is born.
 
The study followed 86,551 women with a perinatal depression diagnosis and 865,510 unaffected women for a maximum of 18 years, with both groups individually matched on age and calendar year at delivery.
 
It found the risk of dying by suicide was greatest within one year of receiving a diagnosis and although it declined over time, the risk remained doubled even five or more years later.
 
‘This finding highlights the urgent need to actively monitor suicidality among women who recently received a diagnosis of perinatal depression,’ the study concluded.
 
Women diagnosed with perinatal depression were more likely to live alone, have lower levels of education and income, smoke three months before pregnancy, have a greater BMI during early pregnancy, and have a history of psychiatric disorders or suicidal behaviour.
 
RACGP Specific Interests – Antenatal and Postnatal Care former Chair Dr Wendy Burton told newsGP the research highlights the need for sustained care, well after a baby is born.
 
‘[The research] also notes that the increased risk continues in the long term and is greater in those without a past history of psychiatric illness, which is not intuitive,’ she said.
 
‘Clearly, it is very important to consider the immediate, short- and long-term potential for devastating consequences following a diagnosis of depression in or after pregnancy.’
 
According to Perinatal Anxiety and Depression Australia (PANDA), at least 20% of women experience anxiety, depression, or both during pregnancy and/or following birth.
 
It says populations more at risk include LGBTIQ+ parented families, Aboriginal and Torres Strait Islander families, and culturally and linguistically diverse families.
 
‘Experiences of discrimination and isolation, and the fear they create of further discrimination, increase isolation and discourage help-seeking at a time of particular risk for these vulnerable families,’ PANDA said.
 
Almost three-quarters of PANDA’s 55,326 callers last year had been experiencing challenges for up to three months before reaching out for help. 
 
Dr Burton said perinatal depression can look different depending on the person, but there is potential for the impacts to be severe.
 
‘Like all conditions, it depends upon the intensity of the condition and the support network around the women and their families,’ she said.
 
‘It can be devastating in its severity, resulting in suicide, but for those with a lower level of intensity, it disrupts bonding, strains relationships and can make a difficult time of adjustment – the newborn period – unbearably difficult.’
 
The study’s researchers also warned healthcare professionals to remain vigilant of their pregnant patients, and the medications they are being prescribed.
 
‘Given that these women are often prescribed antidepressants, healthcare clinicians should be alert to potential misuse of medications,’ they said.
 
Dr Burton’s advice to GPs treating perinatal patients is to ‘ask, ask, and ask again’.
 
‘It’s never “check and forget, one and done”, it’s “do and review”,’ she said.
 
‘Follow up referrals, be prepared to work with women who can’t afford or don’t have access to psychology or psychiatry care. 
 
‘“Are you ok?” is a well-accepted phrase and there are multiple validated tools that we can use to help assist us and our practice teams to screen for perinatal depression.
 
‘Continuity of care matters as it helps us to remember this part of their journey, but as patients move around frequently, we have to ensure that our summaries and/or notes have sufficient detail in them to flag concerns about the long-term.’
 
If you or anyone you know needs help, support is available now. Call Lifeline on 131 114 or Beyond Blue on 1300 22 4636.
 
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