Temporal associations of suicidal ideation within perinatal depressive symptom networks: A cross-lagged network analysis of over 90,000 Chinese women

AI Summary

Suicidal ideation demonstrated the strongest predictive influence across perinatal depressive symptom networks, particularly from late pregnancy to the postpartum period.
The strongest symptom connection was between suicidal ideation and sadness, with edge weights consistently the largest across all networks.
High network stability and large sample size support findings and highlight need for systematic screening and targeted interventions across perinatal stages.

J Affect Disord. 2026 Jun 22:122161. doi: 10.1016/j.jad.2026.122161. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal suicide is a leading cause of postpartum death. Suicidal ideation in perinatal depression is associated with significant risks to maternal, infant, and family well-being. While previous studies have explored trajectories of perinatal suicidal ideation, the dynamic relationships between symptoms remain unclear.

OBJECTIVE: To examine the predictive role of suicidal ideation within the perinatal depression symptom network across different stages of the perinatal period, using cross-lagged network analysis.

METHODS: Data were obtained from a population-based perinatal depression screening program in Shenzhen, China (June 2020-May 2022). Among 144,887 women with at least one EPDS screening record, 91,123 contributed data from at least two survey time points; after excluding 694 women who delivered before 32 gestational weeks, 90,429 were included in the final analysis. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Cross-lagged networks were estimated using the ‘glmnet’ and ‘qgraph’ packages in R, with missing data imputed via the mice package.

RESULTS: Suicidal ideation (EPDS Item 10) demonstrated the strongest predictive influence (out-expected influence) across all three cross-lagged networks. In the T3 → T4 network (late pregnancy to postpartum), suicidal ideation showed the highest out-expected influence (0.193), predicting symptoms including sadness (E8), tearfulness (E9), guilt (E3), and sleep disturbance (E7). The strongest edge across all networks was between suicidal ideation and sadness, with edge weights ranging from 0.1164 to 0.1820. Stability analyses indicated high robustness (CS-coefficients >0.75).

CONCLUSION: Suicidal ideation plays a central and sustained predictive role in the evolution of perinatal depressive symptoms, particularly from late pregnancy to postpartum. Systematic monitoring of suicidal ideation and targeted interventions across perinatal stages are essential to mitigate the progression of depressive symptoms.

REGISTRATION: Not registered.

PMID:42331043 | DOI:10.1016/j.jad.2026.122161

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