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The Prevalence and Correlates of Self-Harm in the Perinatal Period: A Systematic Review
Karyn Ayre1,2, Hannah G Gordon3, Rina Dutta4
1Section of Women's Mental Health, Health Service and Population Research Department, PO31 Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK, SE5 8AF. karyn.k.ayre@kcl.ac.uk.
Insights
Perinatal self-harm is rare but linked to adverse outcomes. It is more common in women with serious mental illness (SMI), though research on this group is limited.
Area of Science:
- Reproductive Health
- Mental Health
- Public Health
Background:
- Self-harm during pregnancy and the postpartum year (perinatal self-harm) requires further investigation.
- Understanding prevalence and correlates is crucial for maternal and infant well-being.
Purpose of the Study:
- To systematically review and meta-analyze the prevalence and correlates of perinatal self-harm.
- To identify risk factors and outcomes associated with self-harm in this population.
Main Methods:
- A comprehensive search of six databases was conducted up to October 31, 2018.
- Inclusion criteria focused on peer-reviewed articles with data on prevalence and correlates, excluding abortion-related studies and case reports.
- Two reviewers independently screened, extracted data, and appraised the quality of 39 included studies.
Main Results:
- Prevalence of self-harm during pregnancy ranged from 0%-2.39% (median 0.0004%), and during the postpartum year from 0%-2.41% (median 0.17%).
- In women with serious mental illness (SMI), prevalence was higher: 0%-23.78% during pregnancy (median 2.16%) and 0%-21.9% postpartum (median 7.97%).
- Key correlates included mental disorder, substance misuse, younger age, unmarried status, obstetric/neonatal complications, history of self-harm, and fetal/infant loss.
Conclusions:
- Perinatal self-harm is uncommon but associated with adverse obstetric and neonatal outcomes.
- Self-harm is more prevalent in women with SMI, but evidence on correlates and outcomes in this group is limited.
- Further research is needed on perinatal self-harm, especially in women with SMI, to improve care and outcomes.
Objective:
To perform a systematic review and meta-analysis on research on prevalence and correlates of self-harm in pregnancy and the postpartum year ("perinatal self-harm").
Data Sources:
Six databases (EMBASE, MEDLINE, PsycINFO, Maternity and Infant Care Database, CINAHL, Cochrane Controlled Register of Trials) were searched from inception through October 31, 2018.
Study Selection:
Inclusion criteria were (1) peer-reviewed articles with (2) data available for estimating prevalence and correlates. Exclusion criteria were (1) studies of women seeking abortion and (2) letters, editorials, or case reports/series.
Data Extraction:
Two reviewers independently screened all articles, extracted data, and appraised quality.
Results:
Of 3,913 articles screened, 39 (reporting 19,191,431 pregnancies) were included. Prevalence ranges were as follows: self-harm during pregnancy (14 studies): 0%-2.39% (median = 0.0004%; interquartile range [IQR], 0.0002%-0.18%); self-harm during postpartum year (10 studies): 0%-2.41% (median = 0.17%; IQR, 0.04%-1.05%); self-harm during pregnancy in women with serious mental illness (SMI) (6 studies): 0%-23.78% (median = 2.16%; IQR, 0.26%-7.9%); self-harm during postpartum year in women with SMI (7 studies): 0%-21.9% (median = 7.97%; IQR, 0%-18%). Key correlates of self-harm during pregnancy and the postpartum year include mental disorder, substance misuse, younger age, being unmarried, and obstetric and neonatal complications. Additionally, a history of self-harm and fetal/infant loss were associated with postpartum self-harm. There were limited data on correlates of perinatal self-harm in women with SMI.
Conclusions:
Perinatal self-harm appears to be rare but is associated with adverse obstetric and neonatal outcomes. However, it is common in women with SMI, though there is limited evidence regarding correlates and outcomes in this population. More research into the prevalence, correlates, and outcomes of perinatal self-harm, particularly in women with SMI, is needed.
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