Intergenerational Health Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.
PANDA Perinatal Anxiety and Depression Australia, Fitzroy North, VIC Australia.
Qual Health Res. 2023 May;33(6):521-530. doi: 10.1177/10497323231164278. Epub 2023 Mar 23.
There is an urgent need to generate deeper understandings of how suicidality manifests and evolves during pregnancy and the following year. Several perinatal studies have examined the incidence of suicidal thoughts and behaviours and associated social and obstetric risk factors; however, there is very limited research offering insights into women's experiences of suicidality at this time in their lives. This study aimed to generate a theory to explain how suicidality evolves in the perinatal period. A grounded theory design was used with data generated using anonymous online surveys (119 participants) and in-depth interviews (20 participants) with women who received pregnancy care in the past 5 years in Australia. The developed theory holds shame as a core concept. Origins and contexts of shame reflect current epidemiological understandings of risk for perinatal suicide, including experiences of gender-based violence, adverse childhood experiences, and a history of mental health difficulties. When women feel that they are defective, are unworthy of love and belonging, and do not possess what it takes to be a good mother, they can conclude that their family is better off without them. Pathways beyond shame were facilitated by compassionate and rehumanising care from family, friends, and care providers. Findings demonstrate that perinatal suicidality is a complex multidimensional phenomenon, influenced by socio-cultural expectations of motherhood and interpersonal, systemic, and intergenerational experiences of trauma. Increasing the prominence of perinatal suicide prevention within health professional education and practice, and addressing systemic barriers to compassionate health care are critical first steps to addressing perinatal suicide.
迫切需要深入了解自杀意念在怀孕期间及其后一年是如何表现和演变的。一些围产期研究已经检查了自杀念头和行为的发生率以及相关的社会和产科风险因素；然而，非常有限的研究提供了在女性生命中的这个时候自杀意念的经验。本研究旨在生成一个理论来解释围产期自杀意念是如何演变的。使用扎根理论设计，使用匿名在线调查（119 名参与者）和深入访谈（20 名参与者）的数据，对过去 5 年在澳大利亚接受过妊娠护理的女性进行研究。所开发的理论以羞耻为核心概念。羞耻的起源和背景反映了当前围产期自杀风险的流行病学理解，包括性别暴力、不良童年经历和心理健康困难的历史。当女性感到自己有缺陷、不值得爱和归属，并且没有成为好母亲的条件时，她们可能会得出结论，她们的家庭没有她们会更好。来自家庭、朋友和护理提供者的富有同情心和重新人性化的关怀促进了超越羞耻的途径。研究结果表明，围产期自杀意念是一种复杂的多维现象，受到母性的社会文化期望以及人际、系统和代际创伤经历的影响。在卫生专业人员教育和实践中提高围产期自杀预防的重要性，并解决富有同情心的卫生保健方面的系统性障碍，是解决围产期自杀的关键第一步。
