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Abstract

Background: Suicide is a leading cause of maternal death. Complex barriers affect suicidal disclosure. Maternity services are uniquely positioned to identify perinatal women requiring support. Appropriate approaches for discussing and identifying suicidality in these settings are not well understood. Screening measures offer a pragmatic solution for early identification. There is limited research exploring the psychometric properties, acceptability, content validity and utility of suicide-related screening measures with perinatal women and maternity practitioners.

Aim: This thesis research sought to gain an understanding of acceptable, appropriate, and clinically relevant approaches for identifying and discussing suicidality with pregnant and postnatal women in the context of maternity care. To address this aim, four objectives were created to determine the psychometric properties of suicidality measures, the content validity, acceptability and potential utility of suicide-related screening items, and to determine the barriers, facilitators and implications of discussing and identifying suicidality in maternity settings.

Methods: A sequential mixed-method design was used. One systematic review and three empirical studies were conducted: (i) cognitive and semi-structured interviews with pregnant and postnatal women (n = 21), data were explored using content analysis and inductive thematic analysis; (ii) semi-structured interviews with maternity practitioners (n = 15), data were explored using inductive thematic analysis; and (iii) online survey with participants who have experience and/or expertise in perinatal mental health (PMH), suicidality, and/or measurement development (n = 30), data were explored quantitatively and qualitatively in line with a Delphi consensus approach.

Results and discussion: The systematic review found limited reliability and validity evidence for suicidality measures that have been used with perinatal women. Measures need to be psychometrically robust, and acceptable to them. Many suicide-related items are unacceptable to perinatal women in their current form. This has implications for suicidal disclosure and may create and/or reinforce barriers to care. Key barriers in maternity contexts include stigma, fearing the consequences, poor continuity of care, and a lack of PMH and suicidality information. Maternity practitioners are uncomfortable administering some suicide-related items to perinatal women due to their content. Factors such as competing demands, lack of training, and overburdened services also impact their capacity and willingness to engage in suicide-related conversations. New and adapted items that are appropriate for use with perinatal women will help to overcome limitations of existing measures.

Conclusion: Findings can inform current approaches for identifying perinatal suicidality in maternity contexts and provide a basis for the preliminary development of perinatal specific suicidality measures.

Publication Type:	Thesis (Doctoral)
Subjects:	B Philosophy. Psychology. Religion > BF Psychology H Social Sciences > HQ The family. Marriage. Woman R Medicine > RT Nursing
Departments:	School of Health & Medical Sciences > Department of Nursing & Midwifery School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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