Abstract
Self-harm in pregnancy or the year after birth ('perinatal self-harm') is clinically important, yet prevalence rates, temporal trends and risk factors are unclear. A cohort study of 679 881 mothers (1 172 191 pregnancies) was conducted using Danish population register data-linkage. Hospital treatment for self-harm during pregnancy and the postnatal period (12 months after live delivery) were primary outcomes. Prevalence rates 1997-2015, in women with and without psychiatric history, were calculated. Cox regression was used to identify risk factors. Prevalence rates of self-harm were, in pregnancy, 32.2 (95% CI 28.9-35.4)/100 000 deliveries and, postnatally, 63.3 (95% CI 58.8-67.9)/100 000 deliveries. Prevalence rates of perinatal self-harm in women without a psychiatric history remained stable but declined among women with a psychiatric history. Risk factors for perinatal self-harm: younger age, non-Danish birth, prior self-harm, psychiatric history and parental psychiatric history. Additional risk factors for postnatal self-harm: multiparity and preterm birth. Of psychiatric conditions, personality disorder was most strongly associated with pregnancy self-harm (aHR 3.15, 95% CI 1.68-5.89); psychosis was most strongly associated with postnatal self-harm (aHR 6.36, 95% CI 4.30-9.41). For psychiatric disorders, aHRs were higher postnatally, particularly for psychotic and mood disorders. Perinatal self-harm is more common in women with pre-existing psychiatric history and declined between 1997 and 2015, although not among women without pre-existing history. Our results suggest it may be a consequence of adversity and psychopathology, so preventative intervention research should consider both social and psychological determinants among women with and without psychiatric history.
Highlights
Self-harm in pregnancy or the year after birth (‘perinatal self-harm’) is clinically important, yet prevalence rates, temporal trends and risk factors are unclear
During follow-up, we identified 377 women with records of self-harm during pregnancy and 742 women in the postnatal period
Women with a psychiatric history had a substantially higher prevalence of self-harm in both pregnancy and the postnatal period: 83.7 v. 19.5 per 100 000 liveborn deliveries in pregnancy and 174.6 v. 35.0 per 100 000 liveborn deliveries in the postnatal period
Summary
Self-harm in pregnancy or the year after birth (‘perinatal self-harm’) is clinically important, yet prevalence rates, temporal trends and risk factors are unclear. Prevalence rates of perinatal self-harm in women without a psychiatric history remained stable but declined among women with a psychiatric history. Perinatal self-harm is more common in women with pre-existing psychiatric history and declined between 1997 and 2015, not among women without pre-existing history. Self-harm during pregnancy and/or the first postnatal year (‘perinatal self-harm’) often precedes maternal suicide (Knight et al, 2015), which remains a leading cause of maternal death in high-income countries (Goldman-Mellor & Margerison, 2019; Knight et al, 2015, 2018; Metz et al, 2016; Thornton, Schmied, Dennis, Barnett, & Dahlen, 2013). A recent large US general population registry study reported the prevalence of acts of self-harm in the year preceding or following birth doubled between 2012 and 2017, describing this as a potential public health crisis (Admon et al, 2021)
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