For a long time, when we talked about a young mother, we had in mind the image of a woman nestled in happiness. The image has deteriorated since the media coverage of postpartum and particularly perinatal depression. It fades even further with the publication on Wednesday of an Inserm report drawn up with Public Health France showing that suicide has become the leading cause of death among women who gave birth less than a year ago.
This national survey measured the causes of 272 maternal deaths that occurred from the start of pregnancies to one year after childbirth, between 2016 and 2018. Among them, 45 women ended their lives in the year following childbirth. What are the risk factors and above all how can these suicides be avoided? We asked the question to psychiatrists and the study coordinator.
Postpartum depression
Among the 45 women who ended their lives, half suffered from postpartum depression. A pathology that must be differentiated from baby blues, simple sadness and transient irritability, often occurring between the second and fifth day after childbirth. “If the symptoms of baby blues last more than two weeks or intensify, you have to wonder if it is not postpartum depression,” underlines Julie Joly, psychiatrist specializing in perinatal care at the hospital. Saint-Antoine APHP Paris.
Perinatal depression is characterized by sadness, loss of desire, doubts about one’s maternal skills, difficulty interacting with one’s baby, impulse phobia – the fear of harming one’s child -, eating and sleeping disorders.
It would affect 17% of women according to a Public Health France survey published in 2023 and there are risk factors. “Primiparity (first pregnancy), young age, unwanted pregnancies, psychiatric history, history of postpartum depression, abuse and mistreatment suffered by the mother in her childhood and situations of economic precariousness are all factors risk,” lists the psychiatrist.
Pre-existing psychiatric illnesses
“We cannot correlate suicide and postpartum depression,” insists Romain Dugravier, psychiatrist at the Center for Perinatal Psychopathology at GHU Paris Psychiatry and Neurosciences. And for good reason, according to the study, only half of the women who committed suicide had developed this pathology. The others had psychiatric illnesses pre-existing the pregnancy.
Among these 53% of women who had a psychiatric history, 33% suffered from depression, 13% from a history of suicidal acts associated with a depressive disorder or a personality disorder, 9% from a bipolar disorder, 7% history of scarification in adolescence isolated or associated with suicidal acts and 7% eating disorders.
“It’s complicated to make generalizations from suicides,” says Catherine Deneux Tharaux, research director at Inserm and coordinator of the study. But there are vulnerability factors to psychological disorders and postpartum depression. » Among the women who ended their lives, 29% presented social vulnerability and 16% lived alone. Women whose first child was also more affected.
A stigma that is still too strong
“If these suicides happen, it is probably because there are errors in screening and support,” believes Romain Dugravier. There were prior indicators of vulnerability that could not be directly addressed. » In 46% of women with mental disorders who took their own lives, their history was not known to the obstetric team.
The stigma around mental illness is not for nothing. “Women may be reluctant to talk about their psychiatric history even though they would easily talk about it if it was diabetes or hypertension,” considers the research director. Same story with postpartum depression. “The fact of not feeling any joy with your baby when you expect to be at the height of happiness, it is very guilty for women who will have difficulty opening up about it to their loved ones or to professionals », continues Catherine Deneux-Tharaux.
A lack of healthcare structures
Women who do not speak, but also health professionals who do not ask questions. “Professionals, whether midwives, obstetricians, pediatricians, did not dare to address these questions because they did not know what to do with them, or because they are not comfortable with these questions, or because they have no one to whom to refer them,” analyzes the psychiatrist for his part. A question of training, therefore, but also of the structure of care.
“There is no standard on the number of psychologists or psychiatrists who should be present in maternity wards so it depends on local cultures. In some maternity wards, there is no psychologist. » Romain Dugravier hopes that the new epidemiological data from the Inserm study will raise awareness and make it possible to impose a minimum level of care.
A lack of training for caregivers
“We must raise awareness among all front-line professionals in the perinatal field, pediatricians, midwives, childcare workers, obstetricians,” considers the psychiatrist. Julie Joly gives courses in perinatal psychopathology to midwives and nurses. In particular, it encourages them to use the EPDS scale. “There are several items and depending on the score, we will be more or less vigilant in knowing whether or not there is postpartum depression,” explains the psychiatrist.
But these professionals should not be the only ones to be trained. “The peak of suicide is four or five months after giving birth, it is a time when women are far from the obstetric team,” underlines the research director. The people who can sound the alarm are therefore more likely to be relatives, colleagues, nursery staff or the pediatrician.
Solutions and slow evolution
Things are changing little by little. “Even if I have a bias due to my specialization, I receive a lot of young mothers in consultation who talk to me about their very dark, even suicidal ideas,” testifies psychiatrist Romain Dugravier. Before, it was something I heard very little about. »
Because solutions exist. “When we identify a woman with risk factors, in maternity wards, we do joint follow-up with the obstetrician,” explains psychiatrist Julie Joly. We offer support from a psychologist or psychiatrist but also workshops on parenting to anticipate what could happen. »
Our Mental Health file
Postpartum depression is most often treated with psychotherapy combined with antidepressant treatment. In this area, research is progressing. A new drug, Zurzuvae, has just been put on the market in the United States. It could treat perinatal depression in two weeks.
If you are experiencing suicidal thoughts or are close to someone who is, you can call the national Suffering and Suicide Prevention number on 31 14 (free and confidential listening 24/7).