Pathways, Contexts, and Voices of Shame and Compassion: A Grounded Theory of the Evolution of Perinatal Suicidality

By Laura J. Biggs, Bonnie Jephcott, Kim Vanderwiel, Imogen Melgaard, Shannon Bott, Mitzi Paderes, Julie Borninkhof, and Melanie Birks

Published 23 March 2023

Context

Suicide is one of the leading causes of maternal deaths in Australia and other high-income countries. Several factors have been identified as contributing to suicide risk in perinatal women, including the presence or history of mental health disorders or being exposed to domestic violence.

Women are often in frequent contact with health workers during the perinatal period. Literature has examined the experiences and symptoms of women experiencing suicidality (suicidal thoughts) during the perinatal period. However, limited research explores how health staff can identify these warning signs to provide support.

Research and findings

The research approach used a grounded theory methodology of which was determined by a diverse research team as the most fitting approach. Data was collected via anonymous online surveys, telephone interviews and video interviews.

Participants were required to be women aged 18 years or older who had been pregnant in the previous five years and had experienced suicidal thoughts post pregnancy. Mental health professionals conducted the interviews and provided support where required. A total of 139 women participated in the research study including 119 women completing a testimonial and 20 women participating in an interview.

Researchers aimed to map the experiences of women in a format that mirrored a story to capture human experience. To achieve this, the researchers mapped the experiences of women using the research methodology of grounded theory. This theory allowed researchers to explore perinatal women’s experiences of suicidal thoughts against a ‘pathway through shame’ of which included analysis of factors such as experiences of shame, unmet expectations, disappearing self, psychological isolation, and feeling like a burden or not belonging. The findings indicate the complexity of perinatal suicide which are influenced by social, cultural, and biological factors.

Implications

The research points to the pathway of informed, compassionate care to support perinatal women experiencing feelings of shame, other emotions and suicidal thought patterns. Findings suggest the importance of providing compassionate, person-centred health care for all perinatal women.