Racial Discrimination Experiences During Pregnancy Are Associated with Suicidal Ideation in Depressed Postpartum Women.

Objective: Self-directed violence with suicidal intent is one of the main causes of maternal mortality. We aimed to evaluate the impact of several predictors on suicidal ideation (SI) in postpartum women.

Methods: A cohort of 1,822 women, over 18 years old, was assessed in two Brazilian cities with contrasting sociodemographic profiles. Participants were followed from pregnancy (22nd-25th weeks) until postpartum (mean = 116.8 days, SD = 81.5 after delivery). The main outcome was SI assessed using item-10 of the Edinburgh Postpartum Depression Scale. Potential predictors of SI were allocated into seven different domains: sociodemographic characteristics, environmental stressors and social support during pregnancy, maternal mental health during pregnancy and postpartum, substance use during pregnancy, obstetric data, and newborn characteristics.

Results: SI prevalence was 3.1%. In the univariate analysis, having more children, lower family income, lower education, history of depression, stressors during pregnancy (perceived stress, hopelessness, anxiety, depression, alcohol use, smoking and history of violence, greater number of stressful events, lower social support, and racially discriminatory experience), newborn with low APGAR in the first minute, non-breastfeeding, and postpartum depression, were positively associated with SI. In the multiple predictors model (X² = 136,502; df = 6; p < 0.001), only racial discrimination during pregnancy (PR: 1.13; 95% CI 1.01-1.27) and postpartum depression (PR: 1.23; 95% CI 1.20-1.27) remained associated with SI.

Conclusions: Although racial discrimination was not assessed in the postpartum, such experiences during pregnancy seem to contribute to an increased risk of SI among depressed postpartum women. This underscores the importance of addressing racial disparities and fostering an inclusive and supportive environment to safeguard maternal mental health.