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Self-harm in women with postpartum mental disorders

Published online by Cambridge University Press:  12 July 2019

Benedicte Marie Johannsen ,
Janne Tidselbak Larsen ,
Thomas Munk Laursen ,
Karyn Ayre ,
Louise M. Howard ,
Samantha Meltzer-Brody ,
Bodil Hammer Bech  and
Trine Munk-Olsen Open the ORCID record for Trine Munk-Olsen [Opens in a new window]
Benedicte Marie Johannsen*
Affiliation:
National Center for Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210Aarhus, Denmark
Janne Tidselbak Larsen
Affiliation:
National Center for Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210Aarhus, Denmark CIRRAU, Centre for Integrated Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210Aarhus, Denmark
Thomas Munk Laursen
Affiliation:
National Center for Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210Aarhus, Denmark CIRRAU, Centre for Integrated Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210Aarhus, Denmark
Karyn Ayre
Affiliation:
Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Louise M. Howard
Affiliation:
Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Samantha Meltzer-Brody
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
Bodil Hammer Bech
Affiliation:
Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark
Trine Munk-Olsen
Affiliation:
National Center for Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210Aarhus, Denmark
*
Author for correspondence: Benedicte Marie Johannsen, E-mail: bjohannsen@econ.au.dk
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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.

Keywords

Epidemiologypostpartum depressionpostpartum mental disordersself-harmsuicidewomen's mental health
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 9 , July 2020 , pp. 1563 - 1569
Copyright
Copyright © Cambridge University Press 2019

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