Perinatal mental health screening in Australia

Suicide and intentional self-harm are complex issues and can have multiple contributing factors. Screening for mental and psychosocial risk factors plays an important role in providing timely support, further assessment and follow-up for women. In a study of women giving birth in Western Sydney between 2006 and 2016, women reporting intimate partner violence at their first antenatal care visit were more likely to have an Edinburgh Postnatal Depression Scale (EPDS) score above 13, to have had a history of anxiety and depression, or to have had thoughts of self-harm (Dahlen et al. 2018). Further assessment is recommended for any women who report thoughts of self-harm on the EPDS, regardless of total EPDS score (Highet et al. 2023). Experiencing one or more psychosocial risk factors does not mean a person will experience suicidal behaviours, and most people experiencing psychosocial risk factors will not experience suicidal behaviours (AIHW 2023).

While most individuals with a mental health condition do not report suicidal behaviours, suicidality is more prevalent for people with a mental health condition compared to those without (AIHW 2022c). In the 2007 National Survey of Mental Health and Wellbeing, almost 3 in 4 people exhibiting suicidality (72%) reported a mental health condition in the preceding 12 months (ABS 2008). Research indicates that individuals with a diagnosed mental illness such as borderline personality disorder, psychotic disorders and severe perinatal depression are at increased risk of suicidality and intentional self-harm (Cantwell et al. 2011; Kroger et al. 2011).

Death by suicide was the leading cause of death for women in Australia aged 15–44 between 2011 and 2023 (ABS 2013, 2014, 2015, 2016a, 2016b, 2017, 2018b, 2019, 2020, 2021b, 2022, 2023, 2024). Death by suicide was one of the leading causes of maternal death in Australia, accounting for 10% of maternal deaths (20 women) between 2012 and 2021 (AIHW 2024). Maternal death is defined as the death of a woman while pregnant or within 42 days of the end of pregnancy, irrespective of the duration and outcome of the pregnancy.

Research indicates the risk of death by suicide may be even higher between 43 and 365 days after the end of pregnancy. In Queensland between 2014 and 2019, 31 of the 130 deaths during pregnancy and up to one year postpartum (24%) were by suicide of which 27 (87%) occurred after 42 days postpartum (Queensland Health 2018, 2020, 2022).

Mental health screening is a critical tool for the early identification of women at risk of suicide, and can reduce the risk of perinatal suicide if supported by strong referral pathways that connect at-risk mothers to accessible mental health care and support (Chin et al. 2022).