By Kara Zivin March 11, 2021
As Meghan Markle revealed to Oprah Winfrey in a now-viral interview that she “did not want to be alive anymore,” I listened in stunned silence to her describe her shame. Her inability to stay home alone. Her admission that “I just didn’t see a solution,” and “I thought it would have solved everything for everyone.”
That’s what I was thinking when I made a suicide attempt during pregnancy a decade ago.
Markle’s interview may have been the first time that millions of viewers worldwide learned about the depths of despair people can face during pregnancy. Although the royal circumstances contributing to Markle’s suicidal feelings are unique, her experience of having suicidal thoughts during pregnancy is all too common.
My suicide attempt and recovery led me conduct research on access to health care for women with mental health and substance use conditions during pregnancy and postpartum, including suicidal thoughts and self-harm. As a mother of a healthy fourth grade son, I aim to help women and families avoid the anguish and loneliness that both Markle and I faced.
A myth persists that pregnancy represents a blissful time in an individual’s life and hormones offer protection from mental illness. Yet data provide disturbing but little-known facts.
What I’ve learned over the years is that suicide represents a leading cause of maternal death. My research team found that rates of suicidal thoughts and self-harm among pregnant and postpartum individuals with private health insurance have steadily increased over time, with larger increases in non-Hispanic Black people. Rates in those covered by Medicaid are higher.
The financial burden of maternal mental health conditions is staggering. In the United Kingdom, depression, anxiety, and psychosis during pregnancy and up to one year after giving birth carry a long-term cost to society of £8.1 billion per year (about $11.3 billion). My collaborators and I found that the societal costs of not treating mood and anxiety disorders during and after pregnancy and during the first five years of a child’s life in the U.S. exceed $14 billion per year.
Despite these alarming statistics, no one fully knows the extent of suicidal thoughts or actions among pregnant people and new mothers. Measures of severe maternal morbidity or “near misses” focus on physical health conditions such as high blood pressure or potentially deadly blood clots, which tennis star Serena Williams developed after giving birth.
When accounting for pregnancy-related deaths, the Centers for Disease Control and Prevention exclude incidents of suicide, overdose, homicide, or accidents. So estimates indicating that 700 new mothers die per year represents a substantial undercount. State maternal mortality review committees have found that a significant proportion of maternal deaths are associated with mental health conditions and two-thirds of maternal deaths are preventable.
Early detection and treatment of mental disorders during pregnancy and after giving birth, including having suicidal thoughts, helps mothers and infants and save lives. Markle said she asked for help but didn’t get it.
She’s not alone. University of North Carolina at Chapel Hill researchers tried to quantify what they call the perinatal depression treatment cascade: a cumulative shortfall in recognition and treatment for individuals with depression during pregnancy and afterward. This model suggests that there are multiple opportunities to improve care, allocate resources, and provide treatment.
As a reproductive behavioral health researcher, not to mention someone who once experienced the feelings that Markle revealed in her interview with Oprah, I felt sad and angry that she found herself in an untenable situation and could not get treatment. I felt gratitude for her willingness to publicly acknowledge her emotional struggles during a vulnerable time in her life. And I felt relief that she and her baby both survived.
As Markle said to Oprah, “I share this because there are so many people who are afraid to voice that they need help.”
As a researcher, survivor, and mother, I share this to support those who suffer in silence — and encourage them to seek help.
Kara Zivin is a professor of psychiatry and of obstetrics and gynecology at the University of Michigan, a research scientist at the Ann Arbor VA Center for Clinical Management Research, and a senior health researcher at Mathematica. The views expressed here are the author’s and do not necessarily reflect those of her employers.
If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.