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Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data
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Matthias Pierce ,
Cemre Su Osam,
Catharine Morgan,
Ann John ,
Kathryn M. Abel
The British Journal of Psychiatry, Volume: 221, Issue: 4, Pages: 621 - 627
Swansea University Author:
Ann John
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© The Author(s), 2022. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence
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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–...
| Published in: | The British Journal of Psychiatry |
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| ISSN: | 0007-1250 1472-1465 |
| Published: |
Royal College of Psychiatrists
2022
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| Online Access: |
Check full text
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa59644 |
| 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. |
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| Keywords: |
Self-harm, perinatal psychiatry, epidemiology, primary care, suicide |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Issue: |
4 |
| Start Page: |
621 |
| End Page: |
627 |