Abstract
Women with severe mental illness are at increased risk of suicide in the perinatal period, and these suicides are often preceded by self-harm, but little is known about self-harm and its correlates in this population. This study aimed to investigate the prevalence of suicidal ideation and self-harm, and its correlates, in women with psychotic disorders and bipolar disorder during pregnancy. Historical cohort study using de-identified secondary mental healthcare records linked with national maternity data. Women pregnant from 2007 to 2011, with ICD-10 diagnoses of schizophrenia and related disorders, bipolar disorder or other affective psychoses were identified. Data were extracted from structured fields, natural language processing applications and free text. Logistic regression was used to examine the correlates of self-harm in pregnancy. Of 420 women, 103 (24.5 %) had a record of suicidal ideation during the first index pregnancy, with self-harm recorded in 33 (7.9 %). Self-harm was independently associated with younger age (adjusted odds ratio (aOR) 0.91, 95 % CI 0.85–0.98), self-harm in the previous 2 years (aOR 2.55; 1.05–6.50) and smoking (aOR 3.64; 1.30–10.19). A higher prevalence of self-harm was observed in women with non-affective psychosis, those who discontinued or switched medication and in women on no medication at the start of pregnancy, but these findings were not statistically significant in multivariable analyses. Suicidal thoughts and self-harm occur in a significant proportion of pregnant women with severe mental illness, particularly younger women and those with a history of self-harm; these women need particularly close monitoring for suicidality.
Highlights
The perinatal period is generally a time of both lower suicide risk (Appleby 1991; Marzuk et al 1997) and lower self-harm risk (Appleby and Turnbull 1995; Weiss 1999), but for women with severe mental disorders (SMI), the risk of suicide is increased up to 70-fold in women admitted for postpartum psychiatric disorders (Appleby et al 1998)
Compared with the postnatal period, women who die by suicide during pregnancy are reported more likely to have a diagnosis of schizophrenia/related disorders or of bipolar disorder and less likely to have a diagnosis of depression (Khalifeh et al 2016)
Little is known about the prevalence and risk factors of self-harm in pregnant women with severe mental disorders even though self-harm in pregnancy is potentially harmful to the viability of the pregnancy in addition to being a potential risk factor for suicide
Summary
The perinatal period is generally a time of both lower suicide risk (Appleby 1991; Marzuk et al 1997) and lower self-harm risk (Appleby and Turnbull 1995; Weiss 1999), but for women with severe mental disorders (SMI), the risk of suicide is increased up to 70-fold in women admitted for postpartum psychiatric disorders (Appleby et al 1998). Compared with the postnatal period, women who die by suicide during pregnancy are reported more likely to have a diagnosis of schizophrenia/related disorders or of bipolar disorder and less likely to have a diagnosis of depression (Khalifeh et al 2016). Little is known about the prevalence and risk factors of self-harm in pregnant women with severe mental disorders even though self-harm in pregnancy is potentially harmful to the viability of the pregnancy in addition to being a potential risk factor for suicide. In pregnancy, a recent study (Zhong et al 2015) showed younger age and depression diagnoses were risk factors for suicidal behaviour-related hospitalisations in pregnant women but did not look at other mental health diagnoses. Illness severity and relapse have been associated with discontinuation of medication in one small study in women with bipolar disorder (Viguera et al 2007), but associations with risk of self-harm remain under-investigated
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