CHAPEL HILL, N.C. - Suicide is a leading cause of death in postpartum women - and it is a preventable one. It is estimated that nearly half of mothers experiencing perinatal depression are undiagnosed and are not receiving treatment. But when women are given vital mental health tools in an accessible manner, their deaths can be prevented.
New research led by psychiatrists, psychologists, and obstetrician-gynecologists at the UNC School of Medicine points to a new kind of tool, a short-term outpatient therapy that requires patients to engage in positive and meaningful activities.
As published in JAMA Psychiatry, this low-cost, evidence-based, and adaptable intervention was found to drastically reduce suicidal thoughts by 80% after just six to eight sessions.
Key Findings
- Nearly 25% of participants reported suicidal thoughts at some point during treatment.
- Suicidal thoughts decreased steadily across treatment sessions.
- Within 3 months after treatment, participants were 80% less likely to report suicidal thoughts compared to treatment onset.
Crystal Schiller, PhD
"Maternal suicide is devastating, not only for the life of the woman, but her entire family," said Crystal Schiller, PhD, an associate professor of psychiatry at the UNC School of Medicine and director of the UNC Center for Women's Mood Disorders. "It's critically important that we find treatments that work in this space, work quickly, and can be provided through a variety of means."
Diagnosing the Data
The UNC School of Medicine research drew data from a large, ongoing multisite, clinical trial called Scaling Up Maternal Mental Health Care by Increasing Access to Treatment or SUMMIT. The trial is co-led by Samantha Meltzer-Brody, MD, MPH, the Assad Meymandi Distinguished Professor of Psychiatry at the UNC School of Medicine, and its primary aim is to improve access to mental health care for pregnant women and new mothers.
SUMMIT Clinical Trial
- 1,117 pregnant (≤36 weeks) and postpartum (4-30 weeks) women with depressive symptoms living in Chapel Hill, N.C., Chicago and Toronto.
- If patients expressed suicidal ideation or suicidal thoughts over a week's time, they were address directly in the therapy session.
- If necessary, the research team would step in between BA sessions to address suicidal thoughts.
"Suicidal ideation is a marker of distress," Schiller said. "Suicide is a leading cause of death in the first year postpartum, so we always take those thoughts very seriously because it is our best way to prevent someone from taking action on them."
Schiller adds a whole range of thoughts and behaviors associated with suicidal ideation - like developing specific plans of suicide or determining when to do it - are worth flagging.
To treat depression and suicidal ideation during and after pregnancy, researchers turned to what is known as behavioral activation, a medication-free psychological treatment that often involves engaging patients in positive and meaningful activities to counter negative feelings and withdrawal. This form of therapy can take various forms, depending on the woman and the degree of their depression.
"Some people may have trouble leaving the house, getting out of bed, or reaching out to loved ones," Schiller. explained "Behavioral activation may mean getting patients to experience the reward of putting their feet on the ground to get out of bed, getting them outside to feel sunlight on their skin, or encouraging them to connect with their social circle."
The Results
Through an in-depth analysis, researchers found that the odds of acknowledging or expressing suicidal ideation decreased by 25% with each treatment session.
- By three months - or about six to eight sessions - thoughts of suicide decreased by 80%.
- Benefits were consistent regardless of whether therapy was delivered by a specialist or a nonspecialist, and whether it was provided in person or via telemedicine.
"This brief, scalable psychotherapy can reduce suicidal thoughts in one of the most vulnerable periods of a woman's life," said Parisa Kaliush, PhD, lead author and clinical fellow at the UNC Department of Psychiatry. "Importantly, this approach works across different types of clinicians and delivery methods, making it a promising tool to expand access to care worldwide."
Parisa R. Kaliush, PhD, was lead author of the study. Samantha Meltzer-Brody, MD, MPH, Crystal Schiller, PhD, and Alison Stuebe, MD, MSc, professor of maternal fetal medicine at the UNC Department of Obstetrics & Gynecology, were all co-authors on the study.
