Self-Harm Ideation in Perinatal Mothers in Home Visiting Programs

Objectives To examine the prevalence and predictors of self-harm ideation during the perinatal period among mothers ( N = 9638) enrolled in a home visiting program. Methods Subjects were all mothers enrolled in a home visiting program in the United States between 2006 and 2023 who completed the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987) prenatally and/or at up to 6 months postpartum. Item 10 of the EPDS, reflecting thoughts of self-harm, was used to operationalize self-harm ideation and severity. Demographic and clinical variables were examined as predictors of self-harm ideation and change over the two time points. Results 6.8% of the sample reported self-harm ideation prenatally, with 33.8% of these mothers endorsing the two highest levels of severity. 4.0% of the sample reported self-harm ideation postnatally. Of those who reported self-harm ideation prenatally, 77.9% no longer reported it postnatally. Reporting of self-harm ideation was associated with mean EPDS scores above the established clinical cutoff (≥ 13). Younger mothers reported higher levels of ideation compared with older mothers. Conclusions for Practice A large proportion of mothers reported self-harm ideation prenatally, and younger mothers reported higher levels of ideation compared with older mothers. Given the dangers of unrecognized and untreated suicide risk in perinatal mothers, home visitors are in a unique and important position to support and link mothers to mental health services.