title: Suicidal ideation in depressed postpartum women: Associations with childhood trauma, sleep disturbance and anxiety.
abstract: BACKGROUND
  Suicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women.
  
  
  METHODS
  This secondary analysis included 628 depressed mothers at 4-6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms.
  
  
  RESULTS
  Of the depressed mothers, 496 (79%) 'never' had thoughts of self-harm; 98 (15.6%) 'hardly ever'; and 34 (5.4%) 'sometimes' or 'quite often'. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR = 1.68, 95% CI = 1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR = 1.15, 95% CI = 1.02, 1.29) and anxiety symptoms (OR = 1.11, 95% CI = 1.01, 1.23).
  
  
  CONCLUSIONS
  Because women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers.
authors.affiliation: School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: sitdk@upmc.edu.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Sit
authors.affiliation: Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Luther
authors.affiliation: School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Buysse
authors.affiliation: Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Dills
authors.affiliation: Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Eng
authors.affiliation: University of Colorado - Colorado Springs, CO, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Okun
authors.affiliation: Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Wisniewski
authors.affiliation: Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Wisner
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology*; D002648:Child; D002649:Child Abuse; D019052:Depression, Postpartum / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D049590:Postpartum Period / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012742:Sex Offenses; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D059020:Suicidal Ideation
keywords: Anxiety; Childhood abuse; Postpartum depression; Sleep disturbance; Suicidal ideation