Depression and psychosis rise after childbirth while suicide risk declines

Depression and psychosis are more common in women after childbirth than before, but the risk of suicide attempts decreases. This is shown by two new studies from Karolinska Institutet. The results suggest that national guidelines for screening can help women get help earlier.

Mental ill health in connection with pregnancy and childbirth can have long-term consequences for women's health. During this period, major biological and psychosocial changes occur that can increase vulnerability to depression, anxiety, and other psychiatric conditions. Despite previous research, knowledge has been limited, especially regarding how different psychiatric diagnoses develop before, during, and after pregnancy.

In a new study, researchers have used data from Swedish registers covering all women who gave birth in Sweden between 2003 and 2019 – a total of nearly 1.8 million pregnancies.

The study, published in the journal Molecular Psychiatry, shows that mental ill health has increased over time during this period, especially before pregnancy. During pregnancy itself, the number of new diagnoses decreases, but after childbirth, the risk increases again, especially for depression and psychosis.

We can see that the risk of depression is about 20 percent higher during weeks 5 to 15 after childbirth, compared to the year before pregnancy. For psychosis, the risk is up to seven times higher during the first 20 weeks after childbirth."

Emma Bränn, study's first author, researcher, Institute of Environmental Medicine, Karolinska Institutet

When national guidelines for screening pregnant women for depression were introduced in 2020, it opened up the possibility of detecting mental illness earlier. By comparing women who gave birth before and after 2020, the researchers saw that the peak of depression diagnoses occurred earlier after childbirth in women who gave birth after the guidelines were introduced.

"We don't see that more people are being diagnosed, but screening could mean that women are identified earlier and don't have to suffer as long before they can get the support and help they need," says Emma Bränn.

The study also shows that the risk of other psychiatric diagnoses, such as anxiety, stress-related conditions, and substance abuse, is lower during pregnancy and after childbirth compared to before. The researchers believe that this may be due to biological changes, lifestyle changes, and increased contact with healthcare during pregnancy.

Another study from the same research group has investigated the risk of suicide in connection with pregnancy and childbirth. In the study, published in Nature Human Behaviour, researchers found that mothers were less likely to attempt suicide during and after pregnancy compared to fathers. This is the opposite of what researchers usually observe in the general population, where women tend to have higher rates of suicide attempts than men. For fathers, the risk decreased in the first ten weeks after childbirth, only to increase again.

"Our results suggest that both mothers and fathers are less likely to attempt suicide immediately after having a child, especially mothers," says first author Yihui Yang, PhD student at the Institute of Environmental Medicine, Karolinska Institutet. She continues:

"Although suicide attempts during and after pregnancy are rare, they can have devastating consequences and are often preventable. It is therefore important that healthcare providers conduct regular check-ups during and after pregnancy to identify parents who are struggling and offer support to prevent suicide."

The study in Molecular Psychiatry was funded in part by the Uppsala Medical Faculty Foundation, while both studies were funded by Karolinska Institutet, Forte, and the Swedish Research Council.