Arch Suicide Res. 2024 Jan-Mar;28(1):231-249. doi: 10.1080/13811118.2022.2154727. Epub 2022 Dec 19.
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.
Using the Bachpan Cohort study of mothers in Pakistan ( = 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.
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.
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.HIGHLIGHTSSuicidal 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.
自杀在资源匮乏的环境中导致大量死亡，占产妇死亡人数的近 20%。在亚洲，人际冲突是导致自杀念头和行为的一个突出因素，但针对此类冲突的类型和时间以及女性伴随的社会支持，相关研究有限。确定这些风险因素可以为如何确定哪些人需要进行心理社会干预提供信息。
利用巴基斯坦 Bachpan 队列研究中 1154 名母亲的数据，我们调查了妊娠期间最近两周以及产后 3、6 和 24 个月内自杀意念的发生率和人际影响。使用分层混合效应模型，我们分别探讨了人际因素（如社会支持、人际冲突、孤立和过去一年的亲密伴侣暴力）对每个时间点自杀意念的单独和综合影响。
妊娠期间自杀意念的发生率最高（12.2%），随后在产后两年内降至 5%。人际冲突与妊娠和产后 24 个月自杀意念的发生几率增加独立相关。亲密伴侣暴力与妊娠和产后 24 个月自杀意念的发生几率增加相关。孤立与任何时间点的自杀意念均无关。在所有时间点，感知到的社会支持仍然是与自杀意念减少相关的独立因素。
除了对围产期有抑郁症状的女性进行筛查和实施干预措施外，针对那些还经历人际冲突（包括亲密伴侣暴力）的女性实施干预措施，可能会显著降低自杀念头及其相关后果。社会支持是降低女性自杀负担的一个可行且潜在有力的目标。
与产后相比，妊娠期间自杀意念的发生率更高。
感知到的社会支持与自杀意念减少独立相关。
针对自杀的干预措施必须关注女性的家庭和社会环境。
