Benedicte Marie Johannsen1, Janne Tidselbak Larsen1,2, Thomas Munk Laursen1,2, Karyn Ayre3, Louise M Howard3, Samantha Meltzer-Brody4, Bodil Hammer Bech5, Trine Munk-Olsen1. 1. National Center for Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210Aarhus, Denmark. 2. CIRRAU, Centre for Integrated Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210Aarhus, Denmark. 3. Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 4. Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA. 5. Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark.
Abstract
BACKGROUND: Women suffering from first onset postpartum mental disorders (PPMD) have a highly elevated risk of suicide. The current study aimed to: (1) describe the risk of self-harm among women with PPMD and (2) investigate the extent to which self-harm is associated with later suicide. METHODS: We conducted a register-based cohort study linking national Danish registers. This identified women with any recorded first inpatient or outpatient contact to a psychiatric facility within 90 days after giving birth to their first child. The main outcome of interest was defined as the first hospital-registered episode of self-harm. Our cohort consisted of 1 202 292 women representing 24 053 543 person-years at risk. RESULTS: Among 1554 women with severe first onset PPMD, 64 had a first-ever hospital record of self-harm. Women with PPMD had a hazard ratio (HR) for self-harm of 6.2 (95% CI 4.9-8.0), compared to mothers without mental disorders; but self-harm risk was lower in PPMD women compared to mothers with non-PPMD [HR: 10.1, (95% CI 9.6-10.5)] and childless women with mental disorders [HR: 9.3 (95% CI 8.9-9.7)]. Women with PPMD and records of self-harm had a significantly greater risk for later suicide compared with all other groups of women in the cohort. CONCLUSIONS: Women with PPMD had a high risk of self-harm, although lower than risks observed in other psychiatric patients. However, PPMD women who had self-harmed constituted a vulnerable group at significantly increased risk of later suicide.
BACKGROUND:Women suffering from first onset postpartum mental disorders (PPMD) have a highly elevated risk of suicide. The current study aimed to: (1) describe the risk of self-harm among women with PPMD and (2) investigate the extent to which self-harm is associated with later suicide. METHODS: We conducted a register-based cohort study linking national Danish registers. This identified women with any recorded first inpatient or outpatient contact to a psychiatric facility within 90 days after giving birth to their first child. The main outcome of interest was defined as the first hospital-registered episode of self-harm. Our cohort consisted of 1 202 292 women representing 24 053 543 person-years at risk. RESULTS: Among 1554 women with severe first onset PPMD, 64 had a first-ever hospital record of self-harm. Women with PPMD had a hazard ratio (HR) for self-harm of 6.2 (95% CI 4.9-8.0), compared to mothers without mental disorders; but self-harm risk was lower in PPMD women compared to mothers with non-PPMD [HR: 10.1, (95% CI 9.6-10.5)] and childless women with mental disorders [HR: 9.3 (95% CI 8.9-9.7)]. Women with PPMD and records of self-harm had a significantly greater risk for later suicide compared with all other groups of women in the cohort. CONCLUSIONS:Women with PPMD had a high risk of self-harm, although lower than risks observed in other psychiatricpatients. However, PPMD women who had self-harmed constituted a vulnerable group at significantly increased risk of later suicide.