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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, Volume: 221, Issue: 4, Pages: 621 - 627

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
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URI: https://cronfa.swan.ac.uk/Record/cronfa59644
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spelling 2022-10-18T15:54:31.5443072 v2 59644 2022-03-16 Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2022-03-16 MEDS 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. Journal Article The British Journal of Psychiatry 221 4 621 627 Royal College of Psychiatrists 0007-1250 1472-1465 Self-harm, perinatal psychiatry, epidemiology, primary care, suicide 1 10 2022 2022-10-01 10.1192/bjp.2022.31 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University 2022-10-18T15:54:31.5443072 2022-03-16T15:10:36.7907042 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Holly Hope 0000-0002-4834-6719 1 Matthias Pierce 0000-0003-2182-0369 2 Cemre Su Osam 3 Catharine Morgan 4 Ann John 0000-0002-5657-6995 5 Kathryn M. Abel 6 59644__24708__492c1da1ccf640cda3fa7ccf37cc6522.pdf 59644_VoR.pdf 2022-07-22T10:31:14.8401509 Output 524605 application/pdf Version of Record true © The Author(s), 2022. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence true eng https://creativecommons.org/licenses/by/4.0/
title Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data
spellingShingle Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data
Ann John
title_short Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data
title_full Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data
title_fullStr Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data
title_full_unstemmed Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data
title_sort Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data
author_id_str_mv ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Ann John
author2 Holly Hope
Matthias Pierce
Cemre Su Osam
Catharine Morgan
Ann John
Kathryn M. Abel
format Journal article
container_title The British Journal of Psychiatry
container_volume 221
container_issue 4
container_start_page 621
publishDate 2022
institution Swansea University
issn 0007-1250
1472-1465
doi_str_mv 10.1192/bjp.2022.31
publisher Royal College of Psychiatrists
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description 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.
published_date 2022-10-01T14:13:49Z
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