The risk factors associated with suicidality in the perinatal period: A systematic review [preprint]

Background: The perinatal period is a public health priority due to rising maternal mortality, with suicide being a leading cause. Suicidality, including suicidal thoughts, plans, or attempts, has increased in both low- and middle-income countries (LMIC) and high-income countries. Maternal suicidality poses risks to both mothers and children. Research on maternal suicidality is fragmented, with prior reviews focused on the prevalence of suicidality. This systematic review aims to explore the complex factors contributing to perinatal suicidality. Methods: Following PRISMA guidelines, a systematic review was conducted using the SPiDER framework across PubMed, CINAHL, and Psychology and Behavioral Sciences Collection databases. Studies were included if they presented data on factors contributing to perinatal suicidality and published from 2018 onwards. Data analysis was conducted using narrative synthesis. Results: This systematic review analysed 18 studies on perinatal suicidality. Women experiencing depression were 2.16 to 16 times more likely to experience suicidality, with postnatal depression posing a higher risk. Anxiety increased the risk by 3 to 4 times, while fetal loss raised it by 2.1 to 5.2 times. Single women faced 1.53 to 5.69 times higher odds of suicidality, and those experiencing intimate partner violence (IPV) had 1.81 to 7.60 times higher odds. Childhood abuse, substance use, and socioeconomic vulnerability also contributed to increased risk. Discussion: Research on perinatal suicidality emphasizes psychosocial risk factors, while cognitive aspects remain underexplored. It is important to assess suicidality in pregnant women independently of depression, as many women with suicidal ideation (SI) do not have depression or anxiety. The transition from SI to action remains complex, requiring further research. Limitations in current studies include cross-sectional designs and suboptimal measurement tools. Conclusion: Depression, anxiety, relationship status, IPV and socioeconomic status are risk factors for perinatal suicidality. Further research is needed to explore the transition from SI to action, improving screening tools, evaluating screening effectiveness during pregnancy, and exploring risk factors for specific groups such as women with a diagnosis of HIV. KEYWORDS: Pregnancy, Perinatal, Postpartum, Suicide, Suicidal ideation, Suicidal behaviours, Risk factors, Predictors