Contents lists available at ScienceDirect Mental Health & Prevention journal homepage: www.elsevier.com/locate/mhp Suicidal ideation in the perinatal period: A systematic review Avril O'Connor a , Sadie Geraghty b,c, ⁎ , Dr Gemma Doleman c , Annemarie De Leo c a Joondalup Health Campus, Perth, Western Australia, Australia b Charles Darwin University, Darwin, Northern Territory, Nursing & Midwifery, Australia c Edith Cowan University, Perth, Western Australia, Australia ABSTRACT Objective: To examine literature surrounding suicidal ideation and suicidality in the perinatal period. Design: Systematic Literature Review of published 15 research studies. Findings: There is a scarcity of prospective studies conducted in suicidal ideation during the perinatal period. More research is needed to ensure childbearing women at risk of suicidal ideation during pregnancy receive the appropriate care and maternity services required to support them throughout this period. Key conclusions: Midwives play an important role in screening women for possible emotional distress and mood disorders during pregnancy. Therefore, midwives need to have knowledge of risk factors so vulnerable women are monitored and supportive maternity services can be implemented if indicated. Implications for practice: Suicidal ideation can have serious consequences for the women and the product if left untreated. Screening for suicidal ideation, antenatal and postnatal depression is imperative. Women with a pre-existing mental health disorders are a particularly vulnerable population group and should be monitored closelyforsuicidalideation.Womenwhoexperienceintimatepartnerviolenceorarefromlowsocioeconomicbackgroundsalsopresentariskofsuicidalideation,all of which require complex mental-health care. 1. Introduction Suicide is one of the major contenders to the global mortality burden with approximately one million people dying annually from suicide (Turecki & Brent, 2016). Suicide represents a major public health problem, particularly during pregnancy and the postpartum period, where women are considered more vulnerable to mood dis- orders, suicidal ideation or the onset of a psychiatric illness (Orsolini et al., 2016). Contrary to the belief that pregnancy may be a protective factor against suicide, there is concern relating to the in- creased incidence of suicidal ideation in pregnant women (Gagliardi, Genovese, & Betos, 2014). Suicidal ideation is currently reported as a common complication of pregnacy (Gelaye, Kajeepeta, & Williams, 2016), and has been recognised as a predictor for suicidal attempts and completed suicide, informing the need for better under- standing of this issue during pregnancy and the postpartum period. Suicidal behaviour during the antepartum period can have long lasting adverse health outomes that extend beyond the peripartum period, effecting both maternal and neonatal wellbeing. Serious injury during the antepartum period from failed suicide attempts can also have devastating implications for the woman and fetus (Gelaye et al., 2016). Untreated depression in pregnancy can also have adverse effects on fetal development including fetal hyperativity; irregular heart rate, increased cortisol and norephinephrine levels and reduced tone, that may require neonatal admission to a special care nursery (Gentile, 2017). Women with untreated depression in pregnany are at increased risk of vaginal bleeding, miscarriage, premature birth, fetal death in utero (FDIU) and preclampsia (Larsen et al., 2015). During the postnatal period women diagnosed with depression may experience difficulty bonding with the neonate or display reduced breastfeeding initiatives (Schmidt,Seehagen,Vocks,Schneider,&Teismann,2016).It has been reported neonates of mothers diagnosed with depression are fussy, have poor maternal attachment and are observed to exhibit be- havioural problems (Dennis & Dowswell, 2013). Recent literature pro- vides evidence that children are at increased risk of developing a con- duct disorder if exposed to their mother's postnatal depression (Glasheen et al., 2013). Suicidal ideation in pregnancy is associated with a range of risk factors that contribute to a later diagnosis of post partum depression (Gavin, Tabb, Melville, Guo, & Katon, 2011). A history of anxiety, de- pression or other mental disorders, stress, smoking or lack of paternal involvement can place a woman at increased risk of suicidal ideation (Alhusen, Frohman, & Purcell, 2015). Women also diagnosed with se- vere mental disorders (such as schizophrenia or bipolar disorder) are more likely to complete suicide during pregnancy (Khalifeh, Brauer, Toulmin, & Howard, 2015). https://doi.org/10.1016/j.mhp.2018.10.002 Received 5 April 2018; Received in revised form 29 September 2018; Accepted 9 October 2018 ⁎ Corresponding author. E-mail address: sadie.geraghty@cdu.edu.au (S. Geraghty). Mental Health & Prevention 12 (2018) 67–75 Available online 11 October 2018 2212-6570/ © 2018 Elsevier GmbH. All rights reserved. T