(720) Perinatal suicidality among high-risk individuals: evaluating trends to inform policy

The CDC recently reported that mental health conditions, inclusive of suicide, were the leading contributor to maternal mortality from 2017-2019. Suicidal ideation (SI) is an antecedent to suicide and can serve as a proximate indicator of population-level trends to inform public health responses. We aimed to evaluate trends in SI among individuals enrolled in a collaborative care model (CCM) for mental health care.

Study Design: This retrospective cohort study included all birthing people referred to a CCM for mental health care between 2017-2022. In the CCM, participants are asked to complete a PHQ-9 at least every 4 weeks, wherein SI is assessed. Any affirmative response, irrespective of frequency, was considered SI. Individuals enrolled in the CCM were divided into 6-month epochs based on their EDD, reflecting their general temporal engagement with the CCM. Tests of linear trend in SI over time were performed in both bivariate and multivariate modes. Linear trend curves of SI prevalence were created. Analyses were performed both for the overall sample and stratified by race/ethnicity.

Results:

Of the 2031 individuals enrolled in the CCM, 318 (11.7%) reported SI. The overall prevalence of SI decreased across each epoch (epochs 1 vs 10 = 12.8% vs 6.4%, respectively; aOR of SI by epoch = 0.92, 95% CI 0.88-0.97). Similar trends reflecting a steady linear decrease in SI were observed in the subset of individuals who identify as non-Hispanic Black (aOR = 0.90, 95% CI 0.83-0.98) and non-Hispanic White (aOR = 0.92, 95% CI 0.85 - 0.99). However, the prevalence of SI did not change over time among birthing people who identified as Hispanic (aOR = 1.01, 95% CI 0.84 – 1.22) or Asian (aOR = 0.97, 95% CI 0.84-1.11). Point estimates with overlayed linear trend curves are shown in the Figure.

Conclusion: SI is decreasing over time among high-risk perinatal individuals, mirroring recent population-level improvements in suicide rates across the United States. However, Latinx and Asian subgroups did not experience these same trends. These data can be used to inform targeted perinatal suicide prevention efforts.