by Nicolette Molina, PhD Candidate, Clinical Psychology
When people think about the postpartum period, they often picture joy, bonding, and new beginnings. For many people, that is part of the experience. Yet the months after childbirth can also bring exhaustion, isolation, financial strain, shifting identity, and emotional pain difficult to name out loud. For some, this distress becomes life-threatening. In 2022, mental health conditions accounted for more than one-quarter of pregnancy-related deaths, and nearly half of those mental health-related deaths were suicides (Centers for Disease Control and Prevention 2026). These numbers make clear that postpartum mental health can introduce private struggles or individual clinical issues. It is also a public health issue shaped by the conditions surrounding people before, during, and after childbirth.
My research begins from that tension: What do we miss when we study postpartum suicide risk as if it lives only inside an individual person?
With support from the Center for the Study of Women in Society, I developed a program of work examining self-injurious thoughts and behaviors during the postpartum period. This phrase refers to a broad range of experiences, including thoughts of hurting oneself, thoughts of dying, suicide-related thoughts, and behaviors such as planning or communicating intent to attempt suicide. These experiences are often studied through individual risk factors, such as depression or sleep problems. These factors matter and they do not unfold in isolation.
Pregnancy and postpartum are deeply embodied experiences, and they are also social and political experiences. A person’s mental health during this period may be shaped by access to health care, paid leave, childcare, stable housing, family support, financial security, racism, immigration policy, reproductive health policy, and fears about how systems may respond if they say, “I am not okay.” My work asks how we can better understand postpartum suicide risk when we take those contexts seriously.
This project grew into three related studies. The first was theoretical. In that paper, my coauthors and I proposed a reproductive sociopolitical framework for understanding self-injurious thoughts and behaviors. We argued that reproductive transitions, including puberty, menstruation, pregnancy, postpartum, and menopause, are not only biological events. They are also shaped by medicine, education, policy, stigma, and systems of power. This framework shifts the question from “Who is at risk?” to “When, and under what conditions, does risk emerge?”
The second study focused on socioeconomic context. Rather than treating socioeconomic status as a single number, we examined income, education, debt, financial stress, social support, and perceived social standing. Taken together, these factors revealed more complex combinations of socioeconomic characteristics, including participants with moderate material resources but substantial financial stress. Participants in lower and middle socioeconomic groups were more likely to report self-injurious thoughts postpartum than those in the most advantaged group. Emotion dysregulation was associated with higher risk across groups, while mindfulness appeared more relevant among participants with fewer socioeconomic resources. This suggests coping skills may matter more under greater external stress, though they cannot replace health care, housing, childcare, safety, or economic security (Molina et al. 2026).
The third study examined psychological and socioecological factors together. I tested whether postpartum self-injurious thoughts and behaviors were associated with rumination, emotion dysregulation, sleep quality, mindfulness, and feelings about parenting. Rumination, or repetitive negative thinking, emerged as the strongest psychological factor. Clinically, this makes sense. Postpartum distress may become especially painful when someone feels trapped in cycles of worry, shame, or perceived failure without enough rest, support, or space to recover. I also tested whether chronic stress and neighborhood disadvantage, measured through geocoded addresses, changed these associations. In this sample, I found limited evidence that these broader structural indicators shaped risk directly or changed psychological associations. I do not interpret this to mean context does not matter. Instead, I see it as a measurement lesson. Some structural indicators may be too broad or distant to capture how power and privilege shape postpartum distress day to day. More proximal indicators, such as personal financial strain, may better reflect how structural inequities are lived.
Taken together, these studies changed how I think about postpartum suicide risk. They clarified that distress is patterned by the environments in which people are trying to survive. Self-injurious thoughts may be connected to rumination or emotion dysregulation, but those processes may also be shaped by the resources, stressors, supports, and social conditions surrounding people during pregnancy and postpartum. CSWS support helped me move from a single dissertation idea toward a broader program of research on reproductive mental health, social inequity, and self-injurious thoughts and behaviors. My hope is that this work contributes to a larger shift in the field away from asking only what is wrong within a person, and toward asking what conditions make suffering more likely, what resources make survival more possible, and what systems need to change so postpartum people can move from surviving to thriving.
—Nicolette Molina received a 2025 CSWS Graduate Student Research Grant for this project.
References:
Centers for Disease Control and Prevention. 2026. “Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees.” Maternal Mortality Prevention. Last modified April 20, 2026. https://www.cdc.gov/maternal-mortality/php/data-research/mmrc/.
Molina, Nicolette C., Madeleine Bruce, Parisa R. Kaliush, Eric Matsunaga, Elisabeth Conradt, and Sheila E. Crowell. 2026. “Postpartum Self-Injurious Thoughts Vary by Socioeconomic Status: The Moderating Effects of Mindfulness and Emotion Dysregulation.” Journal of Affective Disorders 407 (August): 121756. https://doi.org/10.1016/j.jad.2026.121756.