Open Access Short Communication

Evoking Solutions to Maternal Self-Harm and Mortality

John R Holmberg*

The University of Denver, Graduate School of Professional Psychology, United States

Corresponding Author

Received Date:June 06, 2023;  Published Date:July 14, 2023


The arts evoke many emotions. Can a controversial film evoke an important conversation about parenthood and mental health or contribute to a public health crisis already affecting one in five expectant or new parents [1]?

Media and Perinatal Mental Health

Dramatic depictions of death by suicide are common in film [2]. In the 2021 theatrical release and recent release to streaming services, A Mouth Full of Air, Amanda Seyfried plays Julie, a blissful and creative new mom who is progressively besieged by postpartum depression [3]. The film’s trailer suggests a story of a struggling mom, supported by a loving husband and family, finding her way to recovery. The trailer’s first audible line is “You made it,” reinforcing the suggestion of a happy ending. The emotionally soothing voiceover shares a metaphor, “Sometimes the stars (i.e., for casting wishes, reasons for living) are blocked by the clouds (i.e., symptoms); but, even if you don’t see them, they’re always there (i.e., supports, recovery, joy).” By contrast, the film’s finale a devastating suicide. The even more evocative ending to the novel depicts simultaneous matricide and suicide [4].

While Postpartum Depression is the best known, researchers see it as one of a cluster of mental health conditions with birthrelated prevalence spikes referred to as Perinatal Mental Health Disorders or PMHDs [5]. PMHDs affect around 20% of pregnant and postpartum women4, with an even higher prevalence for mothers of color and among those parenting in poverty [6]. Mental disorders account for 11% of maternal mortality (e.g., suicide or overdose) and are presumed 100% preventable [7]. Unaddressed, these disorders result in high societal costs [8] and the impact on children is decades-long burdens such as developmental problems and psychopathology [9].

More than 60 films have included characters with a PMHD [10,11]. A PMHD afflicted father was recently portrayed for the first time in Daddy Blues [12,13], an acknowledgment that both parents have increased risk of developing a PMHD [11]. For those personally touched by birth related trauma or mental health difficulties, A Mouth Full of Air’s depiction of persistent desperation, self-harm, and death are likely to be “triggering” or result in a flood of painful thoughts, memories and emotions. It may be especially difficult in our culture, which mostly sweeps mental health issues behind the mythical white picket fence we associate with parenthood.

Two Critical Priorities

1. Media creators have responsibility to include crisis service resources when characters are, by common sense, likely to evoke or incite viewers’ thoughts of self-harm, suicide or harm to others. When depicting teen suicide in 13 Reasons Why10 Netflix had actors break from character to inform the audience of the show’s triggering content. Crisis-line resources were frequently displayed. While a sensible start, this approach alone is inadequate to mitigate the risk; the series release still resulted in increased prevalence of teen suicide attempts and deaths [14].

2. Make perinatal mental health screening universal and prioritize funding for treatment and resources. Evidence shows benefit from “screening” or asking mothers (and likely fathers) about the degree to which she/he recently experienced symptoms [15]. Obstetric, pediatric, and primary care visits provide points for screening. Effective treatments are available, and many include the father/partner and the baby [16]. Needed are ongoing, coordinated public health investments to ensure professionals are trained to screen parents and ensure links to treatments. A paucity of perinatally trained clinicians needs to be addressed [17,18]. The current patch-quilt of limited resources and services is, for everyone, falling short on this clear and addressable problem. If you or someone you know is struggling with a PMAD, self-harm, or suicidal thoughts please help them link to local professional support and/or national crisis services.



Conflict of Interest

The author declares that there is no conflict of interest.

  1. Shorey S, Yin Ing Chee C, Debby Ng E, Huak Chan Y, Wai San Tam W, et al. (2018) Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. J Psychiatr Res 104: 235-248.
  2. Niederkrotenthaler T (2021) Media and Suicide.
  3. Koppelman A (2021) A Mouth Full of Air (2021) Sony Pictures.
  4. Leung Y (2021) The ending of A Mouthful of Air: How similar is it to the book?
  5. Wagner Moyer S, Kinser PA (2021) A comprehensive conceptual framework to guide clinical practice and research about mental health during the perinatal period. J Perinat Neonatal Nurs 35(1): 46-56.
  6. Huggins B, Jones C, Adeyinka O, Ofomata A, Drake C, et al. (2020) Racial disparities in perinatal mental health. Psychiatric Annals 50(11): 489-493.
  7. Trost SL, Beauregard JL, Smoots AN, Ko JY, Haight SC, et al. (2021) Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008–17. Health Aff (Millwood) 40(10): 1551-1559.
  8. Luca DL, Garlow N, Staatz C, Margiotta C, Zivin K (2019) Societal costs of untreated perinatal mood and anxiety disorders in the United States. Cambridge (MA), Mathematica Policy Research.
  9. Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O (2019) Consequences of maternal postpartum depression: a systematic review of maternal and infant outcomes. Womens Health (Lond) 15: 1745506519844044.
  10. International Movie Database (n.d.).
  11. Shergill P (2021) Daddy Blues. Jabbie Studios.
  12. Fisher SD, Cobo J, Figueiredo B, Fletcher R, Garfield CF, et al. (2021) Expanding the international conversation with fathers’ mental health: Toward an era of inclusion in perinatal research and practice. Arch Womens Ment Health 24(5): 841-848.
  13. International Movie Database (n.d.). 13 Reasons Why.
  14. Bridge JA, Greenhouse JB, Ruch D, Stevens J, Ackerman J, et al. (2020) Association between the release of Netflix’s 13 Reasons Why and suicide rates in the United States: An interrupted time series analysis. J Am Acad Child Adolesc Psychiatry 59(2): 236-243.
  15. Reilly N, Kingston D, Loxton D, Talcevska K, Austin MP (2020) A narrative review of studies addressing the clinical effectiveness of perinatal depression screening programs. Women Birth 33(1): 51-59.
  16. Griffen A, McIntyre L, Zahlaway Belsito J, Burkhard J, Davis W, et al. (2021) Perinatal mental health care in the United States: An overview of policies and programs. Health Aff (Millwood) 40(10): 1543-1550.
  17. Moore JE, McLemore MR, Glenn N, Zivin K (2021) Policy opportunities to improve prevention, diagnosis, and treatment of perinatal mental health conditions. Health Aff (Millwood) 40(10): 1534-1542.
  18. Colorado Health Institute (2020) Preparing the path: A needs assessment of Colorado’s infant and early childhood mental health workforce.
Signup for Newsletter
Scroll to Top