Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data

Holly Hope; Matthias Pierce; Cemre Su Osam; Catharine Morgan; Ann John; Kathryn M Abel

doi:10.1192/bjp.2022.31

Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data

Holly Hope, Matthias Pierce, Cemre Su Osam, Catharine Morgan, Ann John, Kathryn M Abel

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Perinatal self-harm is of concern but poorly understood.

AIMS: To determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome.

METHOD: This was a retrospective cohort study of 2 666 088 women aged 15-45 years from the 1 January 1990 to 31 December 2017 linked to 1 102 040 pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register. We identified self-harm events and mental illness (depression/anxiety/addiction/affective/non-affective psychosis/eating/personality disorders) from clinical records and grouped women's age into 5-year bands. They calculated the rate of self-harm during discrete non-perinatal, pregnant and postpartum periods. We used a gap-time, stratified Cox model to manage multiple self-harm events, and calculated the unadjusted and adjusted hazard ratios (adjHR) of self-harm associated with pregnancy and the postpartum compared with non-perinatal periods. Pre-planned interactions tested if risk varied by mental illness, age and birth outcome.

RESULTS: The analysis included 57 791 self-harm events and 14 712 319 person-years of follow-up. The risk of self-harm shrank in pregnancy (2.07 v. 4.01 events/1000 person-years, adjHR = 0.53, 95% CI 0.49-0.58) for all women except for 15- to 19-year-olds (adjHR = 0.95, 95% CI 0.84-1.07) and the risk reduced most for women with mental illness (adjHR = 0.40, 95% CI 0.36-0.44). Postpartum, self-harm risk peaked at 6-12 months (adjHR = 1.08, 95% CI 1.02-1.15), at-risk groups included young women and women with a pregnancy loss or termination.

CONCLUSIONS: Maternity and perinatal mental health services are valuable. Family planning services might have psychological benefit, particularly for young women.

Original language	English
Pages (from-to)	621-627
Number of pages	7
Journal	The British journal of psychiatry : the journal of mental science
Volume	221
Issue number	4
Early online date	1 Mar 2022
DOIs	https://doi.org/10.1192/bjp.2022.31
Publication status	Published - 1 Oct 2022

Keywords

Self-harm
epidemiology
perinatal psychiatry
primary care
suicide

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10.1192/bjp.2022.31

(MCHP) : Manchester Centre for Health Psychology
Peters, S., Ulph, F., Arden Armitage, C., Borrelli, B., Bowen, A., Byrne-Davis, L., Edge, D., French, D., Hart, J., Todd, C., Skevington, S., Wearden, A., Cotterill, S., Brooks, J., Brown, L., Bull, E., Cordingley, L., Epton, T., Smith, D., Speer, S., Powell, R., Bartlett, K., Coupe, N., Shepherd, S., Dienes, K., Ghio, D., Hood, A., Lavallee, J., Rowland, C., Benton, J., Goldthorpe, J., McWilliams, L., Keyworth, C., Goulding, R., Loughran, M., Hawkes, R., Kapadi, A., Hurley, R., Leather, J., Musa, C., Angelakis, I., Reid, C., Alshammari, D., Mountain, D., Hooper, E., Gates, E., Johnson, F., Lomas, F., Kaplan, G., Cross, H., Foote, H., Long, H., Reid, H., Hamer, J., Sibasa, K., Hozhabrafkan, K., Al Abri, K., Lucas, L., Millard, L., Hulme, L., Dhanwani, M., Sonola-Jones, O., Sfakianaki, R., Broadbent, R., Crone, R., Husni, R. R., Mank, S., Booth, S., Hindmarch, S., Plant, S., Mace, S., Sidhu, T., Macintyre, V., Vidayanti, V., Peterson, J., Woof, V., El-Khani, A., Devereux-Fitzgerald, A., Chisholm, A., Sawyer, C., Hope, H., Wilkes, J., Birtwell, K., Bakur, K., Stringer, G., Mohd Faudzi, F. N. B., Checketts, M., Tang, M. Y., Coupe, N., Crook, R., Hamnett, C., Lyons, S., Longley, V., Hulme, L., Mountain, D., Talbot, H., Lucas, L., Ecob, C., Huggett, C., Hozhabrafkan, K., Hyder, S. S. & Lee, R.
1/09/10 → …
Project: Research

Cite this

@article{6f0d9785f4b84c65aa8141690f15b919,

title = "Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data",

abstract = "BACKGROUND: Perinatal self-harm is of concern but poorly understood.AIMS: To determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome.METHOD: This was a retrospective cohort study of 2 666 088 women aged 15-45 years from the 1 January 1990 to 31 December 2017 linked to 1 102 040 pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register. We identified self-harm events and mental illness (depression/anxiety/addiction/affective/non-affective psychosis/eating/personality disorders) from clinical records and grouped women's age into 5-year bands. They calculated the rate of self-harm during discrete non-perinatal, pregnant and postpartum periods. We used a gap-time, stratified Cox model to manage multiple self-harm events, and calculated the unadjusted and adjusted hazard ratios (adjHR) of self-harm associated with pregnancy and the postpartum compared with non-perinatal periods. Pre-planned interactions tested if risk varied by mental illness, age and birth outcome.RESULTS: The analysis included 57 791 self-harm events and 14 712 319 person-years of follow-up. The risk of self-harm shrank in pregnancy (2.07 v. 4.01 events/1000 person-years, adjHR = 0.53, 95% CI 0.49-0.58) for all women except for 15- to 19-year-olds (adjHR = 0.95, 95% CI 0.84-1.07) and the risk reduced most for women with mental illness (adjHR = 0.40, 95% CI 0.36-0.44). Postpartum, self-harm risk peaked at 6-12 months (adjHR = 1.08, 95% CI 1.02-1.15), at-risk groups included young women and women with a pregnancy loss or termination.CONCLUSIONS: Maternity and perinatal mental health services are valuable. Family planning services might have psychological benefit, particularly for young women.",

keywords = "Self-harm, epidemiology, perinatal psychiatry, primary care, suicide",

author = "Holly Hope and Matthias Pierce and Osam, {Cemre Su} and Catharine Morgan and Ann John and Abel, {Kathryn M}",

note = "Funding Information: This project has received funding from the European Research Council under the European Union's Horizon 2020 research and innovation programme (grant agreement No GA682741), and the National Institute for Health Research (ref: 111905). Publisher Copyright: Copyright {\textcopyright} The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.",

year = "2022",

month = oct,

day = "1",

doi = "10.1192/bjp.2022.31",

language = "English",

volume = "221",

pages = "621--627",

journal = "British Journal of Psychiatry",

issn = "0007-1250",

publisher = "Royal College of Psychiatrists",

number = "4",

}

TY - JOUR

T1 - Self-harm risk in pregnancy

T2 - recurrent-event survival analysis using UK primary care data

AU - Hope, Holly

AU - Pierce, Matthias

AU - Osam, Cemre Su

AU - Morgan, Catharine

AU - John, Ann

AU - Abel, Kathryn M

N1 - Funding Information: This project has received funding from the European Research Council under the European Union's Horizon 2020 research and innovation programme (grant agreement No GA682741), and the National Institute for Health Research (ref: 111905). Publisher Copyright: Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

PY - 2022/10/1

Y1 - 2022/10/1

N2 - BACKGROUND: Perinatal self-harm is of concern but poorly understood.AIMS: To determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome.METHOD: This was a retrospective cohort study of 2 666 088 women aged 15-45 years from the 1 January 1990 to 31 December 2017 linked to 1 102 040 pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register. We identified self-harm events and mental illness (depression/anxiety/addiction/affective/non-affective psychosis/eating/personality disorders) from clinical records and grouped women's age into 5-year bands. They calculated the rate of self-harm during discrete non-perinatal, pregnant and postpartum periods. We used a gap-time, stratified Cox model to manage multiple self-harm events, and calculated the unadjusted and adjusted hazard ratios (adjHR) of self-harm associated with pregnancy and the postpartum compared with non-perinatal periods. Pre-planned interactions tested if risk varied by mental illness, age and birth outcome.RESULTS: The analysis included 57 791 self-harm events and 14 712 319 person-years of follow-up. The risk of self-harm shrank in pregnancy (2.07 v. 4.01 events/1000 person-years, adjHR = 0.53, 95% CI 0.49-0.58) for all women except for 15- to 19-year-olds (adjHR = 0.95, 95% CI 0.84-1.07) and the risk reduced most for women with mental illness (adjHR = 0.40, 95% CI 0.36-0.44). Postpartum, self-harm risk peaked at 6-12 months (adjHR = 1.08, 95% CI 1.02-1.15), at-risk groups included young women and women with a pregnancy loss or termination.CONCLUSIONS: Maternity and perinatal mental health services are valuable. Family planning services might have psychological benefit, particularly for young women.

AB - BACKGROUND: Perinatal self-harm is of concern but poorly understood.AIMS: To determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome.METHOD: This was a retrospective cohort study of 2 666 088 women aged 15-45 years from the 1 January 1990 to 31 December 2017 linked to 1 102 040 pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register. We identified self-harm events and mental illness (depression/anxiety/addiction/affective/non-affective psychosis/eating/personality disorders) from clinical records and grouped women's age into 5-year bands. They calculated the rate of self-harm during discrete non-perinatal, pregnant and postpartum periods. We used a gap-time, stratified Cox model to manage multiple self-harm events, and calculated the unadjusted and adjusted hazard ratios (adjHR) of self-harm associated with pregnancy and the postpartum compared with non-perinatal periods. Pre-planned interactions tested if risk varied by mental illness, age and birth outcome.RESULTS: The analysis included 57 791 self-harm events and 14 712 319 person-years of follow-up. The risk of self-harm shrank in pregnancy (2.07 v. 4.01 events/1000 person-years, adjHR = 0.53, 95% CI 0.49-0.58) for all women except for 15- to 19-year-olds (adjHR = 0.95, 95% CI 0.84-1.07) and the risk reduced most for women with mental illness (adjHR = 0.40, 95% CI 0.36-0.44). Postpartum, self-harm risk peaked at 6-12 months (adjHR = 1.08, 95% CI 1.02-1.15), at-risk groups included young women and women with a pregnancy loss or termination.CONCLUSIONS: Maternity and perinatal mental health services are valuable. Family planning services might have psychological benefit, particularly for young women.

KW - Self-harm

KW - epidemiology

KW - perinatal psychiatry

KW - primary care

KW - suicide

U2 - 10.1192/bjp.2022.31

DO - 10.1192/bjp.2022.31

M3 - Article

C2 - 35227334

VL - 221

SP - 621

EP - 627

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

SN - 0007-1250

IS - 4

ER -

Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data

Abstract

Keywords

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