More Than a Walking Diagnosis: Identity and the Long Aftermath of Perinatal Suicidal Behaviour

Suicide ranks among the leading causes of maternal death in high income countries, and Australian population-based evidence shows that the risk persists for years after childbirth. Researchers have rarely examined the years after a perinatal suicidal crisis. We asked how women experienced diagnosis and misdiagnosis, what the crisis left behind, and how women and their families rebuilt afterwards. Forty-three people took part in interviews, a practitioner survey and five lived-experience co-design sessions; those sessions also shaped the study. With those groups, we defined perinatal suicidal behaviour as an umbrella term for suicidal ideation, planning, suicide attempts and self-harm during pregnancy or in the three years after birth. We used reflexive thematic analysis within a critical realist orientation. We constructed three themes: the long search for understanding; the long shadow of what the crisis left; and transformation rather than recovery. Many participants waited years for an explanation. When clinicians gave a diagnosis that fitted and offered validation with it, women could understand what had happened and enter a care pathway. An incorrect or dismissive label, most often borderline personality disorder, fragmented their self-understanding; participants said the label changed how clinicians engaged with them. One mother linked a refused assessment to her later suicide attempt. The second theme traced effects on parenting, relationships, healthcare engagement, employment and identity that persisted for years, while follow-up care lasted weeks. The third theme described participants’ rejection of recovery language. They described instead a self they had built, with growth held alongside grief.