Suicidal Thoughts During Pregnancy Aren’t Talked About—Meghan Markle’s Story Is Changing That

Trigger warning: This post contains discussion of suicidal thoughts and maternal mortality.

Of the many revelations of the jaw-dropping CBS interview between Oprah and Meghan Markle and Prince Harry, perhaps the most powerful moment was when Markle revealed her private and devastating struggle with suicidal thoughts during pregnancy while she was living and working in the monarchy.

Markle calmly described a day during her first pregnancy in 2019 when, after years of dealing with intense pressure, racism, and lack of support, she finally opened up to her husband about having suicidal thoughts. “I knew that if I didn't say it, that I would do it. I just didn't want to be alive anymore,” Markle told Oprah. She went on to say that that night she put on a smile and a beautiful sequined gown to make a public appearance, saying she chose to go to the event because she was scared of what might have happened had she stayed home alone. She talked openly about her desire to end her own life as a result of the lack of protection she received and the scrutiny of the British media.

Most women are not in Markle's situation. She made it clear that her mental health issues during her pregnancy as a working royal stemmed from racist media coverage, lack of support, and what she described as a “character assassination.” But Markle is certainly not the only woman to experience an acute mental health crisis during pregnancy—and her candor and honesty is opening the door for an essential and necessary conversation about the unique struggle of suicidal thoughts during pregnancy.

The stigma of suicidal thoughts during pregnancy

We’ve become more accustomed to hearing about pregnant people’s battles with infertility, the trauma of miscarriage and stillbirth, as well as the growing mental health crisis caused by postpartum depression, but conversations about suicidal thoughts during pregnancy are still shrouded in stigma.

Suicidal thoughts during pregnancy are actually not uncommon, according to Helena Vissing, Psy.D., PMH-C, a psychologist and certified perinatal mental health professional, who says that 10% to 20% of her patients report this symptom. According to a study published in JAMA Psychiatry in November 2020, these thoughts aren’t only common but rising at an alarming rate. Researchers found that between 2006 and 2017 thoughts of self-harm and suicide in the year before and after giving birth had nearly tripled among pregnant people. The increases among Black women, and those with existing mental health conditions were even greater.

One of the reasons Vissing thinks suicidal thoughts surrounding pregnancy aren’t as openly discussed as, say, infertility is because there’s an added layer of stigma. “When you are pregnant you ‘should’ be happy. It’s a ‘joyous’ time, so people think, Why can’t I just be happy?” Vissing says. Additional pressure comes from our increased knowledge and awareness that a pregnant person’s mental health directly impacts the health of the fetus. “We have so much focus on how children’s development starts before birth,” Vissing says. Pregnant people are told to worry about maintaining a calm and unanxious status throughout their pregnancy, so when they do experience mental health issues, it compounds when they worry about anxiety and depression hurting the baby.

Another layer of stigma comes from the unspoken double tragedy of a potential suicide—Vissing says this contributes to the pregnant person struggling to vocalize their “dark stuff.” “It’s so scary for us to even go there because, worst-case scenario, that’s a tragedy not just for that person but another life involved,” she says.

Markle’s story gave viewers a glimpse into the lack of support she says she received from the system meant to be providing a safety net. She says she reached out to both the Firm and the H.R. department within the monarchy and to specific family members for help but did not ultimately receive it. She (sort of) joked about not being able to Uber to the hospital from the palace. But that lack of validation she experienced can be disastrous for people struggling with suicide who finally decide to reach out; as Markle pointed out during the interview, it takes an incredible amount of courage to ask for help—to then be told no is devastating.

Vissing says it’s important for others to understand the struggle in the pregnant person’s mind. “It sounds a bit extreme but the logic of it is when you feel so bad about yourself, you feel you are the worst possible person, the worst possible parent,” she says. “It’s intense shame.”

You don’t have to have a history of depression to experience these thoughts

In a 2019 study published in the Journal of Affective Disorders, researchers found that women with depression were 13 times more likely to report suicidal ideations. However, you don’t have to have preexisting depression or anxiety to have suicidal thoughts, Vissing says—a third of the women with suicidal thoughts during pregnancy in the 2019 study did not report clinically significant depressive symptoms.

Depression during pregnancy can take wildly different forms for each individual. The core element, Vissing says, is a “deep sense of hopelessness.” For some, it manifests as “intense anger, irritability, and rage.” Trauma can make matters worse, whether from intimate partner abuse, childhood events, medical abuse, or sexual abuse.

Pregnant people can also experience “intrusive thoughts,” meaning passing thoughts such as “What would happen if I killed myself?” that don’t necessarily signify intent or major mental health disorders. “Intrusive thoughts are very common in pregnancy. It can be very scary and uncomfortable,” Vissing says, encouraging those with potential mental health disorders and those with fleeting intrusive thoughts alike to pursue help. “There’s no reason not to—there’s no issue too small.” Therapists can help with strategies and education surrounding intrusive thoughts to train people to recognize them and address them quickly.

A broken system for women of color struggling with mental health in pregnancy

Mental health conditions are one of the leading causes of maternal death during the postpartum period. Pregnant non-Hispanic Black women are more than three times more likely to die due to pregnancy complications than white or Hispanic women, the CDC reports, disparities that Vissing calls “staggering and deeply concerning.”

“It’s easy for me to say, ‘Reach out to your provider,’ but they know the system is not supporting them,” Vissing says. “We can’t put it all on the individual and see it as an individual’s responsibility. Pregnant moms are really angry and frustrated and have good reasons to be.”

The solution starts with better support for pregnant people. Vissing challenges pregnant people’s friends, family, and neighbors to go there when it comes to asking the tough questions about mental health during pregnancy. It could be a lifesaving conversation at a time when everyone else, including ob-gyns, may be focusing more on the baby’s health and development, she explains. Don’t be afraid that you could “plant the idea” or make it worse, a serious barrier to these conversations, she says. “We need to get over that. The opposite is true.” If you’re not sure how to broach the topic, Vissing suggests saying something like: “I know this is heavy stuff, but it’s important and I really care.”

Medication like antidepressants and talk therapy can be powerful long-term tools for pregnant people who are struggling. But if you are having suicidal thoughts, call the national suicide hotline or tell a health care provider to get immediate help. If you aren’t comfortable with your provider or need help finding a new one, Motherfigure offers a database of providers that specialize in maternal mental health among other resources for pregnant people.

“The good news is this is treatable and preventable,” Vissing says. “We can reach those people and give them hope and connect with them—it is through the connections with others that they will come out of that state.”

Originally Appeared on Glamour