848: Can demographic characteristics identify women with self-harm ideation during pregnancy?

Abstract

Objective: Because endorsement of thoughts of self-harm can be an antecedent to suicide, identification of self- harm ideation can enable targeted intervention efforts. Our objective was to identify whether maternal characteristics could accurately predict which women report self-harm ideation during pregnancy. Study Design: This secondary analysis of a prospective cohort included nulliparous women recruited across 8 centers in the United States. Women were screened twice during pregnancy with an Edinburgh Postpartum Depression Scale (EPDS) (between 6-14 weeks and 22-30 weeks gestation) and categorized according to whether they reported, at either EPDS screen, at least sometime when the “thought of harming myself has occurred”. Maternal sociodemographic characteristics and medical history were compared between women who did and did not endorse self-harm ideation in bivariable and multivariable analyses. An ROC curve was generated and AUC estimated to assess the predictive capacity of the model to identify self-harm ideation. Results: Of the 10,038 women included in the original study, 8,817 completed both EPDS screens. Of these women, 470 (5.3%) endorsed self-harm ideation at least once: 306 (3.5%) at the first EPDS screen and 249 (2.8%) at the second screen. Compared with women who did not endorse self-harm ideation, women who did endorse self-harm ideation were younger, and more likely to self-identify as a racial/ethnic minority, utilize government-funded insurance, have a lower household income, and use tobacco or drugs (Table). They were less likely to have completed advanced education, a partner/significant other, and intentionally conceived. Including all of these sociodemographic and medical factors into a regression still only yielded fair prediction of self-harm ideation (AUC 0.718). Conclusion: Over one in twenty nulliparous pregnant women endorse self-harm ideation at some point during their pregnancy. As sociodemographic and medical characteristics alone did not enable accurate identification, universal assessment for self-harm ideation during pregnancy remains an important aspect of antenatal care. [Figure presented]