Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T11:03:30.997Z Has data issue: false hasContentIssue false
  • English
  • Français

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: [email protected]
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abdelraheem, M, McAloon, J and Shand, F (2019) Mediating and moderating variables in the prediction of self-harm in young people: A systematic review of prospective longitudinal studies. Journal of Affective Disorders 246, 14–28.CrossRefGoogle ScholarPubMed
Adouard, F, Glangeaud-Freudenthal, NM and Golse, B (2005) Validation of the Edinburgh postnatal depression scale (EPDS) in a sample of women with high-risk pregnancies in France. Archives of Women's Mental Health 8, 89–95.CrossRefGoogle Scholar
Appleby, L (1991) Suicide during pregnancy and in the first postnatal year. BMJ (Clinical Research Ed.) 302, 137–140.CrossRefGoogle ScholarPubMed
Appleby, L and Turnbull, G (1995) Parasuicide in the first postnatal year. Psychological Medicine 25, 1087–1090.CrossRefGoogle ScholarPubMed
Appleby, L, Mortensen, PB and Faragher, EB (1998) Suicide and other causes of mortality after post-partum psychiatric admission. The British Journal of Psychiatry: The Journal of Mental Science 173, 209–211.10.1192/bjp.173.3.209CrossRefGoogle ScholarPubMed
Cantwell, R, Clutton-Brock, T, Cooper, G, Dawson, A, Drife, J, Garrod, D, Harper, A, Hulbert, D, Lucas, S, McClure, J, Millward-Sadler, H, Neilson, J, Nelson-Piercy, C, Norman, J, O'Herlihy, C, Oates, M, Shakespeare, J, de Swiet, M, Williamson, C, Beale, V, Knight, M, Lennox, C, Miller, A, Parmar, D, Rogers, J and Springett, A (2011) Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 118(Suppl 1), 1–203.Google ScholarPubMed
Carroll, R, Metcalfe, C and Gunnell, D (2014) Hospital presenting self-harm and risk of fatal and non-fatal repetition: systematic review and meta-analysis. PloS One 9, e89944.CrossRefGoogle ScholarPubMed
Cavanagh, JT, Carson, AJ, Sharpe, M and Lawrie, SM (2003) Psychological autopsy studies of suicide: a systematic review. Psychological Medicine, 33, 395–405.CrossRefGoogle ScholarPubMed
Christiansen, E, Larsen, KJ, Agerbo, E, Bilenberg, N and Stenager, E (2013) Incidence and risk factors for suicide attempts in a general population of young people: a Danish register-based study. The Australian and New Zealand Journal of Psychiatry 47, 259–270.CrossRefGoogle Scholar
Cox, JL, Holden, JM and Sagovsky, R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry: The Journal of Mental Science 150, 782–786.CrossRefGoogle ScholarPubMed
Esscher, A, Essen, B, Innala, E, Papadopoulos, FC, Skalkidou, A, Sundstrom-Poromaa, I and Hogberg, U (2016) Suicides during pregnancy and 1 year postpartum in Sweden, 1980–2007. The British Journal of Psychiatry: The Journal of Mental Science 208, 462–469.CrossRefGoogle Scholar
Gasse, C, Danielsen, AA, Pedersen, MG, Pedersen, CB, Mors, O and Christensen, J (2018) Positive predictive value of a register-based algorithm using the Danish National Registries to identify suicidal events. Pharmacoepidemiology and Drug Safety 27, 1131–1138.CrossRefGoogle ScholarPubMed
Helweg-Larsen, K (2011) The Danish register of causes of death. Scandinavian Journal of Public Health 39(Suppl), 26–29.10.1177/1403494811399958CrossRefGoogle ScholarPubMed
Helweg-Larsen, K, Kjøller, M, Juel, K, Sundaram, V, Laursen, B, Kruse, M, Nørlev, J and Davidsen, M (2005) Selvmord I Danmark: Markant Fald I Selvmord, men Stigende Anatal Selvmordsforsøg. Hvorfor? Statens Institut for Folkesundhed. Copenhagen: Statens Institut for Folkesundhed.Google Scholar
Howard, LM, Molyneaux, E, Dennis, CL, Rochat, T, Stein, A and Milgrom, J (2014) Non-psychotic mental disorders in the perinatal period. Lancet 384, 1775–1788.10.1016/S0140-6736(14)61276-9CrossRefGoogle ScholarPubMed
Johannsen, BM, Larsen, JT, Laursen, TM, Bergink, V, Meltzer-Brody, S and Munk-Olsen, T (2016) All-cause mortality in women with severe postpartum psychiatric disorders. The American Journal of Psychiatry 173, 635–642.CrossRefGoogle ScholarPubMed
Jones, I, Chandra, PS, Dazzan, P and Howard, LM (2014) Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 384, 1789–1799.CrossRefGoogle ScholarPubMed
Khalifeh, H, Hunt, IM, Appleby, L and Howard, LM (2016) Suicide in perinatal and non-perinatal women in contact with psychiatric services: 15 year findings from a UK national inquiry. The Lancet Psychiatry 3, 233–242.10.1016/S2215-0366(16)00003-1CrossRefGoogle ScholarPubMed
Lewis, G (2001) Chapter 1: introduction and key findings. In Lewis, G (ed.), Why Mothers Die 1997–1999 Confidential Enquiry Into Maternal and Child Health. Cambridge: RCOG Press, p. 22.Google Scholar
Lindahl, V, Pearson, JL and Colpe, L (2005) Prevalence of suicidality during pregnancy and the postpartum. Archives of Women's Mental Health 8, 77–87.CrossRefGoogle ScholarPubMed
Lynge, E, Sandegaard, JL and Rebolj, M (2011) The Danish national patient register. Scandinavian Journal of Public Health 39(Suppl), 30–33.CrossRefGoogle ScholarPubMed
Lysell, H, Dahlin, M, Viktorin, A, Ljungberg, E, D'onofrio, BM, Dickman, P and Runeson, B (2018) Maternal suicide – Register based study of all suicides occurring after delivery in Sweden 1974–2009. PloS One 13, e0190133.CrossRefGoogle ScholarPubMed
Meltzer-Brody, S, Howard, LM, Bergink, V, Vigod, S, Jones, I, Munk-Olsen, T, Honikman, S and Milgrom, J (2018) Postpartum psychiatric disorders. Nature Reviews Disease Primers 4, 18022.CrossRefGoogle ScholarPubMed
Mors, O, Perto, GP and Mortensen, PB (2011) The Danish psychiatric central research register. Scandinavian Journal of Public Health 39(Suppl), 54–57.CrossRefGoogle ScholarPubMed
Munk-Olsen, T, Laursen, TM, Pedersen, CB, Mors, O and Mortensen, PB (2006) New parents and mental disorders: a population-based register study. JAMA: The Journal of the American Medical Association, 296, 2582–2589.CrossRefGoogle ScholarPubMed
Munk-Olsen, T, Jones, I and Laursen, TM (2014) Birth order and postpartum psychiatric disorders. Bipolar Disorders 16, 300–307.10.1111/bdi.12145CrossRefGoogle ScholarPubMed
Munk-Olsen, T, Maegbaek, ML, Johannsen, BM, Liu, X, Howard, LM, Di Florio, A, Bergink, V and Meltzer-Brody, S (2016) Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence. Translational Psychiatry 6, e919.10.1038/tp.2016.190CrossRefGoogle Scholar
Olfson, M, Wall, M, Wang, S, Crystal, S, Gerhard, T and Blanco, C (2017) Suicide following deliberate self-harm. The American Journal of Psychiatry 174, 765–774.CrossRefGoogle ScholarPubMed
Pedersen, CB (2011) The danish civil registration system. Scandinavian Journal of Public Health 39(Suppl), 22–25.CrossRefGoogle ScholarPubMed
Pedersen, CB, Mors, O, Bertelsen, A, Waltoft, BL, Agerbo, E, Mcgrath, JJ, Mortensen, PB and Eaton, WW (2014) A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders. JAMA Psychiatry 71, 573–581.CrossRefGoogle ScholarPubMed
Rubertsson, C, Borjesson, K, Berglund, A, Josefsson, A and Sydsjo, G (2011) The Swedish validation of Edinburgh Postnatal Depression Scale (EPDS) during pregnancy. Nordic Journal of Psychiatry 65, 414–418.CrossRefGoogle ScholarPubMed
Runeson, B, Haglund, A, Lichtenstein, P and Tidemalm, D (2016) Suicide risk after nonfatal self-harm: a national cohort study, 20002008. Journal of Clinical Psychiatry 77, 240–246.CrossRefGoogle Scholar
Taylor, CL, Van Ravesteyn, LM, Van Denberg, MP, Stewart, RJ and Howard, LM (2016) The prevalence and correlates of self-harm in pregnant women with psychotic disorder and bipolar disorder. Archives of Women's Mental Health 19, 909–915.CrossRefGoogle ScholarPubMed
Thornton, C, Schmied, V, Dennis, CL, Barnett, B and Dahlen, HG (2013) Maternal deaths in NSW (2000–2006) from nonmedical causes (suicide and trauma) in the first year following birth. BioMed Research International 2013, 623743.10.1155/2013/623743CrossRefGoogle ScholarPubMed
Wisner, KL, Sit, DK, Mcshea, MC, Rizzo, DM, Zoretich, RA, Hughes, CL, Eng, HF, Luther, JF, Wisniewski, SR, Costantino, ML, Confer, AL, Moses-Kolko, EL, Famy, CS and Hanusa, BH (2013) Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry (Chicago, Ill.) 70, 490–498.10.1001/jamapsychiatry.2013.87CrossRefGoogle ScholarPubMed
World Health Organization (1976) Klassifikation af sygdomme: Udvidet dansk-latinsk udgave af verdenssundhedsorganisationens international klassifikation af sygdomme, skader og dødsårsager. 8th revision ed.Aarhus: Danish National Board of Health.Google Scholar
World Health Organization (2016) International statistical classification of diseases and related health problems. 10th Revision.Google Scholar
Supplementary material: File

Johannsen et al. supplementary material

Appendix 1

Download Johannsen et al. supplementary material(File)
File 32.1 KB
Supplementary material: File

Johannsen et al. supplementary material

Appendix 2

Download Johannsen et al. supplementary material(File)
File 13.6 KB