RESUMO
Background: Suicide is a leading cause of death for perinatal women. It is estimated that up to 50% of women with mental health issues during pregnancy and/or after birth are not identified, despite regular contact with healthcare services. Screening items are one way in which perinatal women needing support could be identified. However, research examining the content validity and acceptability of suicide-related screening items with perinatal women is limited. Aims: This study sought to: (i) assess the acceptability and content validity of 16 suicide-related items that have been administered and/or validated in perinatal populations; and (ii) explore the potential barriers and facilitators that may affect how women respond to these items when administered during pregnancy and after birth. Methods: Twenty-one cognitive and semi-structured interviews were conducted with pregnant and postnatal women in the UK. The sample included women who had experienced self-reported mental health problems and/or suicidality during the perinatal period, and those who had not. Interviews were transcribed verbatim, and a coding framework based on the Theoretical Framework of Acceptability was applied to explore the data using deductive and inductive approaches. Results: Findings indicated that the acceptability and content validity of suicide-related items were largely unacceptable to perinatal women in their current form. Women found terms such as 'better off dead' or 'killing myself' uncomfortable. Most women preferred the phrase 'ending your life' as this felt less confronting. Comprehensibility was also problematic. Many women did not interpret 'harming myself' to include suicidality, nor did they feel that abstract language such as 'leave this world' was direct enough in relation to suicide. Stigma, fear, and shame was central to non-disclosure. Response options and recall periods further affected the content validity of items, which created additional barriers for identifying those needing support. Conclusions: Existing suicide-related screening items may not be acceptable to perinatal women. Maternity practitioners and researchers should consider the phrasing, clarity, context, and framing of screening items when discussing suicidality with perinatal women to ensure potential barriers are not being reinforced. The development of specific suicidality screening measures that are acceptable, appropriate, and relevant to perinatal women are warranted.
RESUMO
BACKGROUND: Suicide is a leading cause of death for perinatal women. Identifying women at risk of suicide is critical. Research on the validity and/or reliability of measures assessing suicidality in perinatal women is limited. This review sought to: (1) identify; and (2) evaluate the psychometric properties of suicidality measures validated in perinatal populations. METHODS: Nine electronic databases were systematically searched from inception to January 2022. Additional articles were identified through citation tracking. Study quality was assessed using an adapted tool, and the psychometric properties of measures were reviewed and presented using a narrative synthesis. RESULTS: A total of 208 studies were included. Thirty-five studies reported psychometric data on ten suicidality measures. Fifteen studies reported both validity and reliability data, 12 reported more than one type of validity, seven validated more than one measure and four only reported reliability. Nearly all measures primarily screened for depression, with an item or subscale assessing suicidal ideation and/or behaviours. Three measures were specifically developed for perinatal women, but only two were validated in more than one study. The Postpartum Depression Screening Scale (PDSS), suicidal thoughts subscale, was validated most frequently. LIMITATIONS: Methodological differences and variability between the measures (e.g., suicidality construct assessed, number of items and administration) precluded direct comparisons. CONCLUSION: Further validation of suicidality measures is needed in perinatal women. Screening for perinatal suicidality often occurs in the context of depression. The development of a standalone measure specifically assessing suicidality in perinatal women may be warranted, particularly for use in maternity care settings.
