A PSYCHOLOGICAL INVESTIGATION OF SUICIDAL IDEATION AND BEHAVIOUR IN MOTHERS DURING THE PERINATAL PERIOD

Abstract

Background: Suicide is a leading direct cause of death in women during pregnancy and the first postpartum year (i.e., the perinatal period) in the UK and Ireland. To prevent suicide in the perinatal period, better identification and support of mothers experiencing suicidal thoughts and behaviour are essential. The first aim of this thesis was to develop a better understanding of the psychological factors that underpin the development and maintenance of suicidal ideation and behaviour in mothers during the perinatal period. The second aim was to identify how mothers who were experiencing suicidal ideation and behaviour could be better supported. Methods: Four studies were conducted. In the first, a systematic review, quantitative research was summarised and appraised that investigated psychological and psychosocial factors associated with suicidal ideation and behaviour in pregnant and postpartum mothers. The second involved interviewing mothers who had experienced suicidal thoughts during the perinatal period and used grounded theory to outline what made a woman think about suicide and/or engage in suicidal behaviour during the perinatal period. The third, a subsequent qualitative study, used reflexive thematic analysis to investigate perinatal mental health professionals’ experiences and perceptions of working with suicidal mothers. The fourth study, a Q-methodology, elicited priorities for a psychological intervention aimed at reducing suicidal ideation and behaviour during the perinatal period, from the perspectives of both mothers and professionals. Findings: The systematic review included 32 psychological and psychosocial risk factors for suicide outcomes during the perinatal period. As the review findings could not provide explanations of how suicidal ideation is triggered, maintained or why some mothers act on their suicidal thoughts, a grounded theory model was developed. The model outlined the theorised process of the psychological factors that might culminate in mothers experiencing suicidal thoughts and then making a suicide attempt. To complement this model, perinatal mental health professionals provided insights into factors that they believed contributed to, and how best to reduce, perinatal suicidal ideation and behaviour. Finally, both mothers and professionals provided clear priorities for a psychological intervention to reduce suicidal ideation and behaviour in perinatal mothers. Conclusions: This novel research makes important theoretical and clinical contributions to understanding the possible psychological factors underpinning suicidal ideation and behaviour during the perinatal period. The findings also provide specific and practicable ways in which mothers can be better supported during the perinatal period to prevent and reduce suicidal ideation and behaviour. The outcomes of this research can be used to inform clinical practice and policy, as well as future intervention development and research.

Date of Award	1 Aug 2024
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Anja Wittkowski (Supervisor), Daniel Pratt (Supervisor) & Dawn Edge (Supervisor)