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Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data

Holly Hope Orcid Logo, Matthias Pierce Orcid Logo, Cemre Su Osam, Catharine Morgan, Ann John Orcid Logo, Kathryn M. Abel

The British Journal of Psychiatry, Pages: 1 - 7

Swansea University Author: Ann John Orcid Logo

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DOI (Published version): 10.1192/bjp.2022.31

Abstract

BackgroundPerinatal self-harm is of concern but poorly understood.AimsTo determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome.MethodThis was a retrospective cohort study of 2 666 088 women aged 15–...

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Published in: The British Journal of Psychiatry
ISSN: 0007-1250 1472-1465
Published: Royal College of Psychiatrists 2022
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa59644
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Abstract: BackgroundPerinatal self-harm is of concern but poorly understood.AimsTo determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome.MethodThis was a retrospective cohort study of 2 666 088 women aged 15–45 years from the 1 January 1990 to 31 December 2017 linked to 1 102 040 pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register. We identified self-harm events and mental illness (depression/anxiety/addiction/affective/non-affective psychosis/eating/personality disorders) from clinical records and grouped women's age into 5-year bands. They calculated the rate of self-harm during discrete non-perinatal, pregnant and postpartum periods. We used a gap-time, stratified Cox model to manage multiple self-harm events, and calculated the unadjusted and adjusted hazard ratios (adjHR) of self-harm associated with pregnancy and the postpartum compared with non-perinatal periods. Pre-planned interactions tested if risk varied by mental illness, age and birth outcome.ResultsThe analysis included 57 791 self-harm events and 14 712 319 person-years of follow-up. The risk of self-harm shrank in pregnancy (2.07 v. 4.01 events/1000 person-years, adjHR = 0.53, 95% CI 0.49–0.58) for all women except for 15- to 19-year-olds (adjHR = 0.95, 95% CI 0.84–1.07) and the risk reduced most for women with mental illness (adjHR = 0.40, 95% CI 0.36–0.44). Postpartum, self-harm risk peaked at 6–12 months (adjHR = 1.08, 95% CI 1.02–1.15), at-risk groups included young women and women with a pregnancy loss or termination.ConclusionsMaternity and perinatal mental health services are valuable. Family planning services might have psychological benefit, particularly for young women.
Keywords: Self-harm, perinatal psychiatry, epidemiology, primary care, suicide
College: Swansea University Medical School
Start Page: 1
End Page: 7