Depression and psychosis are more common in women after childbirth than before, but the risk of suicide attempts decreases. This is shown by two new studies from Karolinska Institutet. The results suggest that national guidelines for screening can help women get help earlier.
Mental ill health in connection with pregnancy and childbirth can have long-term consequences for women’s health. During this period, major biological and psychosocial changes occur that can increase vulnerability to depression, anxiety, and other psychiatric conditions. Despite previous research, knowledge has been limited, especially regarding how different psychiatric diagnoses develop before, during, and after pregnancy.
In a new study, researchers have used data from Swedish registers covering all women who gave birth in Sweden between 2003 and 2019 – a total of nearly 1.8 million pregnancies.
The study, published in the journal Molecular Psychiatry, shows that mental ill health has increased over time during this period, especially before pregnancy. During pregnancy itself, the number of new diagnoses decreases, but after childbirth, the risk increases again, especially for depression and psychosis.
“We can see that the risk of depression is about 20 percent higher during weeks 5 to 15 after childbirth, compared to the year before pregnancy. For psychosis, the risk is up to seven times higher during the first 20 weeks after childbirth,” says the study’s first author Emma Bränn, researcher, Institute of Environmental Medicine, Karolinska Institutet.
When Swedish national guidelines for screening pregnant women for depression were introduced in 2010, it opened up the possibility of detecting mental illness earlier. By comparing women who gave birth before and after 2010, the researchers saw that the peak of depression diagnoses occurred earlier after childbirth in women who gave birth after the guidelines were introduced.
“We don’t see that more people are being diagnosed, but screening could mean that women are identified earlier and don’t have to suffer as long before they can get the support and help they need,” says Emma Bränn.
Lower risk for other psychiatric diagnoses
The study also shows that the risk of other psychiatric diagnoses, such as anxiety, stress-related conditions, and substance abuse, is lower during pregnancy and after childbirth compared to before. The researchers believe that this may be due to biological changes, lifestyle changes, and increased contact with healthcare during pregnancy.
Another study from the same research group has investigated the risk of suicide in connection with pregnancy and childbirth. In the study, published in Nature Human Behaviour, researchers found that mothers were less likely to attempt suicide during and after pregnancy compared to fathers. This is the opposite of what researchers usually observe in the general population, where women tend to have higher rates of suicide attempts than men. For fathers, the risk decreased in the first ten weeks after childbirth, only to increase again.
“Our results suggest that both mothers and fathers are less likely to attempt suicide immediately after having a child, especially mothers,” says first author Yihui Yang, PhD student at the same department. She continues:
“Although suicide attempts during and after pregnancy are rare, they can have devastating consequences and are often preventable. It is therefore important that healthcare providers conduct regular check-ups during and after pregnancy to identify parents who are struggling and offer support to prevent suicide.”
Beyond the sneezing and itchy eyes, high pollen seasons are now linked to a significant increase in suicide risk. A new University of Michigan study found a 7.4% jump in deaths, suggesting the physical discomfort of allergies may trigger a deeper, more dangerous despair, an overlooked factor in suicide prevention.
The study indicates that allergies’ physiological effects, such as poor sleep and mental distress, may contribute to this increased risk.
“A small shock could have a big effect if you’re already in a vulnerable state,” said Joelle Abramowitz, associate research scientist at U-M’s Institute for Social Research. “We looked specifically at pollen from all different kinds of plants, including trees, weeds and grasses.”
The effect is incremental. Researchers divided pollen levels into four tiers and found the suicide risk rose with each group: it increased by 4.5% in the second level, 5.5% in the third and peaked at 7.4% in the fourth and highest category.
The study, funded by the American Foundation for Suicide Prevention and U-M ISR, combines daily pollen data from 186 counties of 34 metropolitan areas across the United States, with suicide data from the National Violent Death Reporting System between 2006 and 2018.
Abramowitz and co-authors Shooshan Danagoulian and Owen Fleming of Wayne State University said that while structural factors for suicide are well-researched, short-term triggers are less understood. Pollen allergies are an ideal subject for this research, considering they are an exogenous shock – meaning they are external and not caused by an individual’s mental health status.
“During our study period, there were nearly 500 000 suicides in the US,” Abramowitz said. “Based on our incremental data, we estimate that pollen may have been a contributing factor in up to 12 000 of those deaths over the period, or roughly 900 to 1200 deaths per year.”
Vulnerable populations
Published in the Journal of Health Economics, the study also found that individuals with a known mental health condition or who had received prior mental health treatment had an 8.6% higher incidence of suicide on days with the highest pollen levels. White men strongly drive the effect, but the study also found an unexpectedly high vulnerability among Black individuals.
“While our study’s data comes from the U.S., our findings likely apply globally,” Abramowitz said. “This is supported by earlier research that found similar relationships in locations like Tokyo and Denmark. Our results, therefore, provide crucial new evidence that this phenomenon is a consistent, worldwide trend.”
Public health and awareness
The focus should be on public health and education, as reducing the number of pollen-producing plants isn’t a viable option, the researchers suggest. This includes more accurate pollen forecasting and better public communication. Providing people with clear, timely information about high-pollen days allows them to take proactive steps. Additional recommendations are limiting outdoor activities, wearing a mask or having antihistamines on hand.
There is also a need for a broader approach to mental health awareness, the authors said. Health care providers, particularly those in primary care, can benefit from understanding the connection between environmental factors, such as pollen, and patient well-being. This knowledge could help them tailor care more effectively, especially for vulnerable patients, and serve as a prompt to discuss mental health and stress management during high-pollen seasons or other periods of environmental stress.
“We should be more conscious of our responsiveness to small environmental changes, such as pollen, and our mental health in general,” Abramowitz said. “Given our findings, I believe medical providers should be aware of a patient’s allergy history, as other research has also established a connection between allergies and a higher risk for suicide. I hope this research can lead to more tailored care and, ultimately, save lives.”
The authors predict that as climate change extends and intensifies the pollen season, the impact of allergies on suicide rates could more than double by the end of the century.
People who take medication for ADHD have a lower risk of suicide attempts, substance abuse, traffic accidents, and criminality than people with ADHD who do not take medication. This is shown in a new study by researchers from Karolinska Institutet and University of Southampton, published in the journal BMJ.
ADHD, which affects about 5% of children and 2.5% of adults globally, is associated with an increased risk of suicide attempts, substance abuse, accidents, and crime, among other things.
The researchers behind the study wanted to investigate whether ADHD medication reduces the risk of these outcomes by analysing Swedish national registry data between 2007 and 2020.
A total of nearly 150 000 individuals between the ages of 6 and 64 with newly diagnosed ADHD were included. The average age in the group was 17, and 41% were women. Of these, 57% started medication, with methylphenidate being the most common drug.
The researchers compared people who had started medication within three months of diagnosis with those who had not, and assessed the outcomes over two years after diagnosis.
Reduction in the risk of serious outcomes
The results showed that ADHD medication was associated with a significant reduction in the risk of several serious outcomes: suicide attempts decreased by 17%, substance abuse by 15%, traffic accidents by 12%, and criminality by 13%. The effects were even more pronounced in certain subgroups – for example, a 25% reduction in substance abuse and criminality was noted in individuals who had had recurring problems with these issues.
One possible explanation is that the medication leads to reduced impulsivity, which can reduce the risk of crime by curbing aggressive behaviour, as well as improved attention, which can reduce the risk of traffic accidents by reducing distractions,” says the study’s last author, Zheng Chang, a researcher at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet. He continues:
“These results provide evidence that ADHD medication can affect important health and societal outcomes, which should be taken into account both in clinical practice and in the public debate on drug treatment.”
The study is a collaboration between Karolinska Institutet and the University of Southampton. The study was funded by the Swedish Research Council and the Swedish Research Council for Health, Working Life and Welfare, Forte, among others. Some researchers have received fees from pharmaceutical companies, but for work outside the current study.
A new study from Karolinska Institutet shows that healthcare workers in Sweden have a higher risk of suicide compared to other occupational groups with similar professional levels. The study highlights the risks for physicians, registered nurses, and assistant nurses in particular.
The study, published in Acta Psychiatrica Scandinavica, shows that healthcare workers, especially those working in patient care, have a significantly higher risk of suicide compared to other professions with similar professional qualifications.
Registered nurses had a 61% higher risk of suicide compared to non-healthcare workers.
Physicians had a 57% higher risk, and among them, psychiatrists stood out with an almost threefold increase in risk.
”Previous studies have mostly focused on physicians and often compared them to the general population, which may have underestimated their risk due to socio-economic differences. This study compared individuals with similar professional levels, which showed that physicians have a significantly higher risk of suicide,” says first author Alicia Nevriana, postdoctoral researcher at the Institute of Environmental Medicine, Karolinska Institutet.
The study included many different occupational roles within healthcare, including administrative staff. The study also highlights that administrative staff in healthcare do not have a higher risk of suicide.
New research shows that youth who become increasingly addicted to social media, mobile phones or video games are at greater risk of suicidal thoughts, suicide attempts and emotional or behavioural issues. The study, published in JAMA, was led by researchers at Weill Cornell Medicine, Columbia University and University of California, Berkeley.
Unlike previous studies that focused on total screen time at one point in a child’s life, this study looked at how young people’s patterns of compulsive or “addictive” use changed over time. These patterns included feeling unable to stop using a device, experiencing distress when not using it or using it to escape from problems. In contrast, simply spending more time on screens at 10 years old wasn’t associated with worse suicide-related and mental health outcomes.
“For parents and educators, the discussion around mobile phones and social media has focused on limiting or banning use, but our results indicate more complex factors are involved,” said first author Dr Yunyu Xiao, assistant professor of population health sciences at Weill Cornell Medicine. “Clinical trials have shown that limiting cell phone use, for instance during school hours, was not effective in reducing the risk of suicidal behaviour or improving other aspects of mental health.”
This study could signal a paradigm shift in how the impact of screen time on youth mental health is addressed. “Testing interventions that work against other types of addiction may be one way to approach this type of social media and mobile phone use,” Dr Xiao said.
Quantity Versus Quality
Over four years, the researchers tracked nearly 4300 youths aged 9 to 10 when they first started the study. Using machine learning and data from participant interviews, the researchers characterised three addictive use trajectories for social media and mobile phone usage and two for addictive use with video games. When graphed, these trajectories depicted relative levels of addictive behaviours.
By age 14, almost one in three participants had a high addictive use trajectory for social media and one in four for mobile phones. More than 40% of the youths had a high addictive use trajectory for video games. These adolescents were significantly more likely to report suicidal thoughts or behaviours, as well as symptoms of anxiety, depression, aggression or rule-breaking.
The researchers also found that each type of digital activity showed unique patterns of association with suicide-related behaviours and mental health symptoms. For social media and mobile phones, the high and increasing addictive use trajectories were associated with a two to three times greater risk of suicidal behaviours and suicidal ideation compared with the low addictive use trajectory. The higher use trajectories were also associated with either internalising symptoms such as anxiousness and depression, or externalising symptoms, including aggressiveness or inattentiveness.
“Parents may want to pay more attention to how their kids are using their digital devices and consider having them evaluated for signs of addictive use, said co-first author Dr Yuan Meng, postdoctoral associate in population health sciences at Weill Cornell. “If an addiction is identified, limiting use of mobile phones and social media for part of the day, may potentially reinforce addictive behaviors, so seeking professional advice is essential.”
South Africa has the third highest suicide rate in Africa and Africa has higher rates of suicide than any other continent. In the wake of World Suicide Prevention Day on September 10th, clinical psychologist Vincenzo Sinisi asks what can be done to bring down suicide rates.
Africa is currently the region with the highest suicide rate worldwide, according to the World Health Organization (WHO). This is driven by a combination of factors, including poverty, unemployment, and untreated mental health issues.
South Africa, with a suicide rate of 23.5 per 100 000 people, ranks third worst on the continent. South Africa is closely followed by Lesotho and Eswatini – countries where limited access to mental health services exacerbates the issue.
Age and gender impact suicide risk. In South Africa, for instance, suicide has been rated as the fourth leading cause of death among people aged 15 to 24, reflecting the devastating mental health toll on young people. The gender disparity is stark – men are four to five times more likely to die by suicide than women. However, women tend to report twice as many suicide attempts as men, indicating a significant gap in prevention efforts targeting both genders
Why is it happening?
While suicide is a global challenge, it manifests differently across Africa due to a variety of factors – these include economic hardship, mental health stigma, and the scarcity of healthcare resources.
Mental healthcare in Africa is severely underfunded. Many African countries have an insufficient number of mental health professionals – sometimes as few as one psychiatrist per 500 000 people. This is compounded by widespread mental health stigma, which prevents many people, particularly men, from seeking help. In some African cultures, suicide is stigmatised to the extent that it is linked to supernatural beliefs, such as curses or sorcery. These deep-seated cultural beliefs often lead to underreporting of suicide cases and contribute to delayed intervention.
In addition to cultural taboos, socioeconomic stressors like unemployment, poverty, and housing insecurity further drive suicide rates across the continent. In South Africa’s townships, the levels of indebtedness and joblessness create a cycle of despair that feeds into psychological distress, ultimately increasing the risk of suicide.
In South Africa, the impact of socioeconomic instability on mental health is evident, particularly in rural and impoverished urban areas. The link between unemployment and mental health distress is well-documented, and for many, this distress leads to thoughts of suicide. In economically deprived areas, suicide prevention efforts are often undermined by poor access to healthcare and low mental health literacy. As economic hardship worsens, so does the mental health of affected populations.
What to do?
Preventing suicide in South Africa and on the African continent more broadly requires a multi-level strategy, combining grassroots initiatives with government support. Many successful interventions have originated from community-based programmes tailored to local needs and cultural contexts – there are after all large differences between countries and, for example, between urban and rural areas.
As a starting point, community involvement is crucial in creating a supportive environment for those at risk. By training community leaders, including traditional healers and faith-based leaders, to recognise signs of mental health struggles, these communities can provide immediate support. Peer support networks have also proven effective, especially in areas with limited access to formal healthcare services. Such networks empower individuals to check in on one another and provide emotional support in times of crisis.
For example, the South African Depression and Anxiety Group (SADAG) runs mental health education programmes across rural South Africa, equipping local leaders and volunteers with tools to recognise and respond to signs of suicide. These efforts are helping to reduce stigma and encourage early intervention in communities often overlooked by national healthcare systems.
While community-led efforts are invaluable, government policy is essential for creating systemic change. South Africa’s National Mental Health Policy Framework (2023-2030) aimed to integrate mental health care into the primary healthcare system. Still, its implementation has been slow, particularly in rural areas. Expanding this framework and ensuring proper funding for mental health initiatives must be a priority. (Spotlight previously reported on expert responses to the new mental health policy.)
Governments can also collaborate with NGOs and the private sector to expand mental health services.
Telehealth and digital solutions have for example emerged as potential tools for addressing mental health challenges, particularly in areas where access to mental health professionals is limited. Telehealth services enable patients in remote and underserved areas to consult with mental health experts without travelling long distances. This is especially helpful for individuals who might otherwise be unable to access support due to geographic or financial barriers. One such initiative I am involved with is TherapyRoute.com, a platform that connects people with therapists and psychologists across Africa and that maintains a database of South African community health clinics.
Such a digital approach, though promising, still faces challenges. Internet access remains inconsistent in many parts of Africa, and telehealth services must continue to evolve to ensure they are accessible to most of the population. Increasing investment in digital infrastructure will be a critical part of expanding access to mental health services.
Practical strategies
Meanwhile, there are practical things we can do now. Suicide prevention is after all not the responsibility of healthcare professionals alone – everyone can contribute.
We can all be on the lookout for the warning signs. Sudden withdrawal from social activities, mood changes, declining self-care and hygiene, and expressions of hopelessness or helplessness (e.g., “I can’t go on” or “Everyone would be better off without me”) should never be ignored.
If someone you know appears to be at risk, ask direct questions about their mental health. Don’t be afraid to ask if they are considering suicide. Studies show that directly asking about suicide can reduce the risk of an attempt by giving the person a chance to talk about their feelings.
We can also respond as a community. We can organise peer support groups where people can check in on one another. Training community leaders, traditional healers, or local volunteers to recognise suicide risk and provide mental health first aid is another effective way to support those at risk. Running community-wide campaigns to raise awareness about mental health issues and reduce stigma can help normalize seeking professional help.
Governments also have a critical role to play. They must prioritise mental health by increasing funding for prevention and treatment programmes, particularly in rural and underserved areas. The success of such programmes depends heavily on their accessibility to people from all economic backgrounds.
In South Africa, government should focus on implementing the National Mental Health Policy Framework, ensuring it reaches the rural areas that are most in need. By integrating mental healthcare into primary healthcare services, as envisaged in the policy framework, more people will have the chance to receive timely care.
Ultimately, suicide prevention requires a multi-level approach, with involvement from individuals, communities, governments, and the private sector. By recognising warning signs, reducing mental health stigma, and expanding access to care through both in-person and telehealth services, we can make meaningful strides in reducing the suicide rate across Africa.
*Sinisi is a clinical psychologist and psychoanalyst in private practice in Cape Town. He is also a faculty member of the South African Psychoanalysis Association, The South African Psychoanalytical Initiative, and the Centre for Group Analytic Studies.
People in need of help can contact SADAG on the following helplines:
0800 21 22 23 (8am to 8pm)
0800 12 13 14 (8pm to 8am)
SMS: 31393
Also see this webpage for a longer list of helplines.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
Republished from Spotlight under a Creative Commons licence.
Maternal suicide is an alarming public health issue and the second most common cause of death during the postnatal period. New research from Karolinka Institutet in Sweden shows that mothers with clinically diagnosed perinatal depression had a three times higher risk of suicidal behaviour compared to mothers without perinatal depression. The findings were published in JAMA Network Open.
Some 13–36% of maternal deaths are attributable to suicide, and the consequences are devastating to the newborn and the family. Maternal suicide is linked to a complex interplay of risk factors, including history of psychiatric disorders, socioeconomic disparities, and inadequate access to healthcare service. It is of paramount importance to identify high-risk populations for preventing maternal suicide and suicidal attempt.
Our findings suggest that women with clinically diagnosed PND are at an increased risk of suicidal behavior, particularly within one year after PND yet throughout 18 years of follow-up. This highlights the pressing need for vigilant clinically monitoring and prompt intervention for this vulnerable population to prevent such devastating outcomes, regardless of pre-pregnancy history of psychiatric disorders.
Hang Yu, PhD student
In this nationwide population-matched cohort study with a maximal follow-up of 18 years, 86 551 women with PND from 2001 to 2017 and 865 510 unaffected women individually matched on age and calendar year at delivery. Sibling comparison was employed to account for familial confounding. It was found that women with a clinical diagnosis of PND have an elevated risk of suicidal behaviour compared to population-matched women or their full sisters without PND. Attenuated yet still substantially elevated risks were observed when comparing with full sisters without PND who share partial genetic and familial environmental factors with affected women. Importantly, such excess risk was apparent among women regardless of their history of psychiatric disorders, suggesting that PND is linked to an added risk of suicidal behaviour beyond that the risk associated with psychiatric disorders occurring before the perinatal period. Moreover, the risk elevations were particularly high shortly after the PND diagnosis, and despite of the rapid decline over time, remained throughout 18 years of follow-up.
In countries which allow the practice, assisted suicide would seem to be an alternative to conventional suicide – but new research shows that this is not a simple relationship. An analysis published in Cancer Medicine reveals the trends of self-initiated deaths – including assisted suicide (AS) and conventional suicide (CS) – in Switzerland over a 20-year period, focusing on people who suffered from cancer. While cancer-related AS rose, CS fell but then stabilised – suggesting that cancer-related CS has more complex reasons behind it.
Although supporters of assisted dying state that access to AS should lead to a reduction in violent CS, the study’s findings do not confirm this assumption. The situations and motivations for cancer-associated CS seem to be clearly different from those for cancer-related AS.
In Switzerland, assisting in a suicide is not punishable as long as it does not serve selfish motives. In this analysis of data from 1999–2018, investigators found that cancer was the most often listed principal disease for AS: 3580 people with cancer died by AS, representing 41.0% of AS cases. Cancer was listed in only a small minority of CS cases (832 people, representing 3.8% of CS cases).
There was approximately a doubling of AS cases among patients with cancer every 5 years. Also, the percentage of cancer-associated AS in relationship with all cancer-associated deaths increased over time to 2.3% in 2014–2018. The numbers of cancer-associated CS showed a downward trend in 1999–2003 and were stable through 2009–2018.
“Obviously, the situations and motivations for cancer-associated CS seem to be clearly different from those for cancer-related AS,” said corresponding author Uwe Güth, MD, of the University of Basel.
Analysis of US poison centre data has shown that suspected suicidal cannabis exposures have increased 17% annually, over a period of 12 years. According to the study published in the journal JAMA Network Open, more than 92%, involved other substances in addition to cannabis, and the data cannot show a direct causal link between cannabis and suicide attempts.
Still, the findings are cause for concern, the researchers said, especially since the increase was more pronounced among children and women during and after the pandemic.
“This study adds to already ample evidence that cannabis use, particularly by younger people, has significant implications for mental health,” said study co-author Tracy Klein, a WSU associate professor of nursing. “We don’t have evidence that cannabis alone was the primary driver of a suicide attempt, but we do know that cannabis can worsen certain mental health conditions and increase impulsivity.”
The researchers found 18,698 cases of intentional, suspected suicide cannabis exposures reported to U.S. poison centers from 2009 to 2021. Of these cases, 9.6% resulted in death or major outcomes such as permeant disability. The researchers noted that while more of these exposures involved younger people, severe consequences occurred more often among people 65 and older.
U.S. poison centers take calls 24-hours a day from households and healthcare facilities to provide toxicology expertise in suspected poisoning cases. They also investigate the causes, often following up with patients and doctors to determine if patients took substances intentionally or not.
It is well known that accidental cannabis poisonings have been increasing since many states legalized cannabis. Some policies can help prevent these unintentional cases, Klein said, such as packaging guidelines so edible cannabis products are not mistaken for candy.
Intentional cannabis poisonings, on the other hand, have not been well studied, which is one of the reasons the researchers undertook this analysis, and their findings point to the need for more mental health services.
“We have a significant shortage of mental health and primary care providers in the United States,” Klein said. “We know that mental health needs not only changed but became even more acute during the COVID-19 emergency. Cannabis is one part of that.”
Other research has shown that cannabis use is associated with depression and anxiety in youth and that it may interfere with brain development as well. Recent studies have also suggested a link between suicidal ideation and cannabis use in young people. Given this evidence, it is especially important to limit youth access to cannabis, said Janessa Graves, first author and a WSU nursing associate professor.
“Children and adolescents shouldn’t be able to purchase or access cannabis,” Graves said. “We also need to educate kids and parents around the risks of cannabis. I think many people just aren’t aware the impacts cannabis can have on brain development, and on behavioural and mental health, especially in adolescents and young adults.”
Forced retirement is a major factor when it comes to physician suicides, according to a study by Dr Kristin Kim and colleagues. Physicians also neglect to discuss physical health concerns as work stressors, the authors noted, but these are still detrimental to wellbeing – especially when it renders physicians unable to work.
“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health.”
Kim et al., 2022
While physicians are known to be more likely than non-physicians to experience work-related stressors prior to suicide, the specific nature of these stressors was not known. The present study therefore aimed to better characterise job-related problems prior to physician suicide.
Using a mixed methods approach, researchers combined thematic analysis and natural language processing to develop themes representing death investigation narratives of 200 physician suicides with implicated job problems in the National Violent Death Reporting System database between 2003 and 2018.
The thematic analysis identified six overarching themes: incapacity to work due to deterioration of physical health, substance use jeopardising employment, interaction between mental health and work-related issues, relationship conflict affecting work, legal problems leading to work-related stress, and increased financial stress. Natural language processing analysis confirmed five of these themes and elucidated important subthemes.
Clinicians often neglect physical health when identifying work stressors, but poor physical health affects work performance and increases work stress, the authors said, noting that legal and psychological supports, particularly during malpractice investigations and “fit for duty” evaluations, are sorely needed.
“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health,” the researchers wrote.
First author Kristen Kim, MD, told Medpage Today that she hopes that this research will help physicians “give ourselves permission to attend to those needs … to prevent the dire consequences that we may see.”
The findings highlight the importance of bolstering systemic support for physicians experiencing job problems associated with their physical and mental health, substance use, relationships, legal matters, and finances in suicide prevention efforts.
