Suicide Ideation within and Outside the Perinatal Period: An Exploration of Interpersonal Factors from a Maternal Cohort in Rural Pakistan to Improve Intervention Targeting

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Citation

Hagaman, Ashley K.; Bates, Lisa M.; Atif, Najia; Chung, Esther O.; LeMasters, Katherine; Rahman, Atif; Saqib, Kiran; Sikander, Siham; & Maselko, Joanna (2024). Suicide Ideation within and Outside the Perinatal Period: An Exploration of Interpersonal Factors from a Maternal Cohort in Rural Pakistan to Improve Intervention Targeting. Archives of Suicide Research, 28(1), 231-249. PMCID: PMC10277318

Abstract

OBJECTIVE: Suicide accounts for substantial mortality in low-resourced settings and contributes to nearly 20% of maternal deaths. In Asia, interpersonal conflict is a salient factor that contributes to suicidal thoughts and actions, yet limited research has been done to explore the type and timing of such conflicts and a woman's accompanying social support. Identifying such risk factors can inform improved efforts to identify who to target for psychosocial interventions.
METHODS: Using the Bachpan Cohort study of mothers in Pakistan (n = 1154), we examined the prevalence and interpersonal influences on SI within the past two weeks of pregnancy and then at 3, 6, and 24 months after birth. Using hierarchical mixed effects models, we explored the separate and combined associations of interpersonal factors [e.g., social support, interpersonal conflict, isolation, and past year intimate partner violence (IPV)] on SI at each timepoint.
RESULTS: SI prevalence was highest in pregnancy (12.2%) and dropped to 5% throughout two years postpartum. The interpersonal conflict was independently associated with increased odds of SI in pregnancy and 24 months postpartum. IPV was associated with increased SI in pregnancy and 24 months postpartum. Isolation was not associated with SI at any timepoint. Perceived social support remained a robust independent factor associated with reduced SI at all timepoints.
CONCLUSION: In addition to screening and deploying interventions for perinatal women with depression, targeting interventions for those who also experience interpersonal conflict, including intimate partner violence, may significantly reduce suicidal thoughts and related sequelae. Social support is a viable and potentially powerful target to reduce the burden of suicide among women.
HIGHLIGHTS: Suicidal ideation prevalence was higher in pregnancy compared to postpartum.Perceived social support was independently associated with reduced suicidal ideation.Interventions addressing suicide must attend to women's family and social context.

URL

http://dx.doi.org/10.1080/13811118.2022.2154727

Reference Type

Journal Article

Year Published

2024

Journal Title

Archives of Suicide Research

Author(s)

Hagaman, Ashley K.
Bates, Lisa M.
Atif, Najia
Chung, Esther O.
LeMasters, Katherine
Rahman, Atif
Saqib, Kiran
Sikander, Siham
Maselko, Joanna

Article Type

Regular

PMCID

PMC10277318

Data Set/Study

Bachpan Cohort Study

Continent/Country

Pakistan

Sex/Gender

Women

ORCiD

Chung, E - 0000-0002-2866-949X
LeMasters - 0000-0002-1754-1730
Maselko - 0000-0002-6270-8237