Evoking Solutions to Maternal Self-Harm and Mortality

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]?

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.

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.

None.

The author declares that there is no conflict of interest.

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