Relationships among suicidality, depression, anxiety, and stress during the prenatal period

• In Event: Prenatal stress exposure among Black American women: Implications for maternal and child health outcomes

Abstract

Major depressive disorder (MDD) is a leading source of health burden and national mortality data indicate that suicide rates are increasing among young women, particularly racial/ethnic minority women. Moreover, the estimated global prevalence of MDD during the perinatal period is approximately 12%. Co-occurring and anxiety overall stress exposure confer substantial risk, but less is known about the interrelationships between these factors in populations that experience exposure to multiple chronic stressors. The aim of the present study was to examine the relationships between these factors during the prenatal period within a sample Black American women living in low-resourced, urban environments..

Data from this study were drawn from the Nutrition And Pregnancy Study (NAPS), a longitudinal study of pregnant Black American women living in Chicago. Analyses were conducted using two time points during pregnancy. We hypothesized that the presence of suicidality would be associated with higher scores on Perceived Stress Scale (PSS), Everyday Discrimination (EDS), the Edinburgh Postnatal Depression Scale (EPDS), and State-Trait Anxiety Inventory (STAI) at baseline and follow-up. Baseline analyses proceeded in two steps. First, we used a structural equation model (SEM) to examine the effects of the PSS, EDS, and STAI on Time 1 and Time 2 EPDS scores. Second, we used multigroup SEM to examine whether suicidality moderated these relationships with Wald tests for parameter equality.

Within the sample (N=148), 20 participants reported suicidality by the second trimester. Partial support was found for hypotheses in multivariate analyses. The SEM demonstrated good model fit (RMSEA = .05, SRMR = .07, CFI = .93, TLI = .92). EPDS scores were related to perceived stress (Time 1: B = .66, p < .001; Time 2: B = .48 p < .01) and anxiety (Time 1: B = .20, p < .05; Time 2: B = -.42 p < .001). Moderation models revealed that some of these relationships differed for suicidal participants. Discrimination was associated with higher EPDS scores at Time 1 (B = .15, p < .001; Time 2: B = .48 p < .01; Wald = 5.68, p < .05) only among suicidal participants. The effects of perceived stress on EPDS scores at Time 2 were stronger for suicidal participants (Wald = 4.03, p < .05). Additionally, anxiety was associated with a somewhat greater decline in EPDS score over time for participants who reported suicidal ideation (B = -.07, p < .01) than non-suicidal participants (B = -.03, p < .05), though this was not statistically significant.

Findings indicate that women reporting suicidality during pregnancy experience higher risk in some areas but not all. Although suicidal participants reported higher scores on most areas, they also experienced greater improvement in others. In particular, depressive symptoms were more likely to decline. The presence of suicidality may indicate a greater sensitivity to environmental stressors but this population may be highly responsive to intervention as well.

Authors

• Johnny Berona, University of Chicago
  Presenting Author

• Rimma Ilyumzhinova, University of Chicago
  Non-Presenting Author

• Anna Wiktoria Sroka, University of Chicago
  Non-Presenting Author

• Katharine Ross, University of Chicago
  Non-Presenting Author

• Kimberley Mbayiwa, University of Chicago
  Non-Presenting Author

• Willa Meyer, University of Chicago
  Non-Presenting Author

• Alison E. Hipwell, University of Pittsburgh
  Non-Presenting Author

• Kate Keenan, University of Chicago
  Non-Presenting Author