Self-Harm and Suicidal Ideation in Pregnancy: the Impact of Education on Knowledge, Confidence and Documentation Related to Screening and Follow-Up to Question Ten-Positive on the Edinburgh Postnatal Depression Scale.

BACKGROUND:Suicide in the peripartum is a leading cause of death in Australia. Appropriate screening and response to self-harm and suicidality during antenatal appointments is key to reducing the risk of suicide. AIM:The study explores the knowledge, confidence and behavioural changes resulting from an educational intervention for midwives in assessing and making appropriate referrals based on self-harm and suicide risks in antenatal women, as screened by question ten of the Edinburgh Postnatal Depression Scale (EPDS) eliciting thoughts of self-harm in the previous 7 days. MATERIALS AND METHODS:Educational workshops aimed at improving midwives' confidence and capabilities in conducting suicide risk assessments, developing safety plans and understanding referral pathways were completed. Changes to medical documentation in relation to risk assessment and follow-up actions were reviewed pre- and post- the education sessions. RESULTS:Midwives' (N = 115) self-reported knowledge and confidence increased from pre- to post-education. Pre-intervention, 86 (5.87%) antenatal women answered question ten positively on the EPDS. Medical documentation revealed that more midwives were able to screen for the frequency and persistence of suicidal thoughts following the training. CONCLUSION:While education enhanced knowledge and confidence as well as resulted in improvements to some risk assessment practices, further systemic and organisational support may be necessary to achieve consistent and comprehensive risk assessments and adherence to recommended follow-up actions in clinical practice. The study underscores the critical role of continuous training for midwives in self-harm/suicide assessment, particularly given the significant maternal mortality associated with suicide.