Perinatal mental health professionals’ experiences and perceptions of working with mothers who are suicidal during the perinatal period: A reflexive thematic analysis study

Background: Suicide is the leading cause of death in mothers postpartum and one of the most common causes of death during pregnancy. As mental health professionals, who work with mothers experiencing suicidal thoughts and behaviour during pregnancy and postpartum, can offer insights into the characteristics of mothers most likely to experience suicidal ideation and behaviour, how they can support these mothers and improve current practices, we aimed to explore mental health professionals’ experiences and perceptions. Method: As part of this qualitative study, semi-structured interviews were conducted face-to-face or via telephone with mental health professionals working in perinatal mental health inpatient or community services across England. Data were analysed using reflexive thematic analysis. Results: Fifteen professionals took part in this study and two main themes were developed from their interview data. The first theme, identifying the problem(s) , overarched three subthemes: 1.1) the mother’s context , 1.2) what the baby represents and what this means for the mother , and 1.3) types of suicidal ideation and attempts. These subthemes described factors that professionals assessed or deemed contributory in relation to suicidal ideation/behaviour when a mother was under their care. The second main theme, reducing suicidal ideation and behaviour , outlined how professionals understood and tried to treat the suicidal ideation/behaviour. This theme encapsulated two subthemes: 2.1) how to talk about suicide and 2.2) changing how a mother views her baby and herself . Conclusion: Professionals highlighted many factors that should be considered when responding to a mother’s risk of suicide during the perinatal period, such as the support around her, whether the pregnancy was planned and what the baby represented for the mother. Professionals’ narratives highlighted the importance of adopting a tailored approach to discussing suicidal thoughts, plans and behaviours with mothers to encourage disclosure. Our findings also identified psychological factors that professionals perceived as being linked to suicidal outcomes for mothers, such as self-efficacy and the mother-infant bond; these factors should be investigated further to establish whether mechanisms exist.