Perinatal Mental Health, Postpartum Psychosis, Suicide Risk

Screening for perinatal depression and suicidal ideation

Mood disorders during the perinatal period have a high incidence among young mothers due to a lack of social and family support, stigmatization, and immature emotional coping mechanisms.

Maternal suicide remains one of the leading causes of indirect maternal mortality during the first year after childbirth.

Clinical follow-up should include screening for depressive and anxiety symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and the PHQ-9 questionnaire, distinguishing transient postpartum sadness (“maternity blues”) from a major depressive episode.

It is imperative to actively investigate a history of non-suicidal self-injury, chronic hopelessness, and structured death ideation, implementing protective measures and urgent psychiatric referral at the first sign of self-destructive behavior.

Pharmacological Intervention, Psychotherapy, and Psychiatric Emergency Care

The management of perinatal psychiatric disorders involves balancing the risks associated with medications against the documented neurobiological damage caused by untreated depression.

Individual psychotherapy (cognitive-behavioral and interpersonal) is the first-line treatment for mild or moderate cases; in cases of severe symptoms or life-threatening risk, selective serotonin reuptake inhibitors (SSRIs) are indicated, with a preference for sertraline due to its low transplacental transfer and minimal excretion in breast milk.

On the other hand, postpartum psychosis is a medical emergency characterized by delusions, hallucinations, extreme mood lability, and a risk of infanticide or suicide; this condition requires immediate psychiatric hospitalization, monitored separation from the newborn, a secure environment, and pharmacological therapy with antipsychotics and mood stabilizers under continuous clinical supervision.