lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Suicide and Self-Harm in Women with Mental Disorders During Pregnancy and the Year after Birth

23 Pages Posted: 20 Oct 2020

See all articles by Karyn Ayre

Karyn Ayre

King's College London - Section of Women's Mental Health

Rina Dutta

University of London - Academic Department of Psychological Medicine

Andre Bittar

University of London - Academic Department of Psychological Medicine

Megan Pritchard

University of London - Academic Department of Psychological Medicine; Government of the United Kingdom - South London and Maudsley NHS Foundation Trust

Louise Howard

King's College London - Section of Women's Mental Health

More...

Abstract

Background: Despite the strong links between mental disorder, self-harm and suicide, there is little prospective data on risk factors for later suicide in women who experience perinatal mental disorders. We aimed to examine later suicide in a cohort of women in contact with a mental healthcare provider perinatally and whether self-harm increased suicide risk.

Methods: Via data-linkage, de-identified service-user electronic healthcare records, national hospital episode statistics and mortality data generated a clinical cohort of women who gave birth in hospital and were in contact with a mental healthcare provider in London, UK, perinatally. Using Natural Language Processing and structured field extraction, we identified clinical, socio-demographic characteristics, self-harm, and suicide.

Outcomes: Among 5204 women, crude rate of suicide 9·69/100 000 person-years (95% CI 3·64 - 25·82) within one year of delivery; 27·56 (15·26 - 49·77) within two, and 55·12 (36·29 - 83·71) during total follow up time (39,912·9 person-years). Characteristics of women who did and did not die by suicide were similar apart from illness severity indicators, which were more common in women who died by suicide. In a Cox regression model, lifetime self-harm was not associated with later suicide. Suicides occurred most frequently in the second year after delivery, most commonly by violent means. Suicides beyond two years were most commonly by poisoning.

Interpretation: This study provides support for the extension of perinatal mental healthcare to two years post-delivery, particularly for women with severe mental disorders.

Funding : The National Institute for Health Research, King's College London Biomedical Research Council, Health Foundation, Academy of Medical Sciences.

Declaration of Interests: None.

Ethics Approval Statement: CRIS has pre-existing ethical approval via the Oxfordshire Research Ethics Committee C (ref 18/SC/0372). The use of HES data is included in the CRIS REC approval and the BRC also have approval through the Health Research Authority’s support under Section 251 of the NHS Act 2006 (Ref: ECC 3- 04(f)/2011). Linkage between CRIS and ONS Mortality data is approved via the Health Research Authority’s support under Section 251 of the NHS Act 2006. Individual CRIS projects require ethical approval from the CRIS Oversight Committee (approval 16-069), which is chaired by a service-user and member of the SLAM BRC Stakeholder Participation theme.

Keywords: perinatal, Suicide, self-harm, Mental disorders

Suggested Citation

Ayre, Karyn and Dutta, Rina and Bittar, Andre and Pritchard, Megan and Howard, Louise, Suicide and Self-Harm in Women with Mental Disorders During Pregnancy and the Year after Birth. Available at SSRN: https://ssrn.com/abstract=3687375 or http://dx.doi.org/10.2139/ssrn.3687375

Karyn Ayre (Contact Author)

King's College London - Section of Women's Mental Health ( email )

London
United Kingdom

Rina Dutta

University of London - Academic Department of Psychological Medicine ( email )

United Kingdom

Andre Bittar

University of London - Academic Department of Psychological Medicine ( email )

United Kingdom

Megan Pritchard

University of London - Academic Department of Psychological Medicine

United Kingdom

Government of the United Kingdom - South London and Maudsley NHS Foundation Trust

Monks Orchard Road
Beckenham, BR3 3BX
United Kingdom

Louise Howard

King's College London - Section of Women's Mental Health ( email )

London
United Kingdom

Click here to go to TheLancet.com

Paper statistics

Abstract Views
192
Downloads
25
PlumX Metrics