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Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data
Holly Hope1, Matthias Pierce1, Cemre Su Osam1
1Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK.
Summary
Perinatal self-harm risk decreases during pregnancy for most women, but increases postpartum, especially for young women and those with pregnancy loss. Mental illness significantly reduces pregnancy self-harm risk.
Area of Science:
- Reproductive Health
- Mental Health
- Public Health
Background:
- Perinatal self-harm is a significant concern but remains poorly understood.
- Understanding temporal changes in self-harm risk during and after pregnancy is crucial for targeted interventions.
Purpose of the Study:
- To investigate changes in women's self-harm risk during pregnancy and the first postpartum year.
- To examine how mental illness, age, and birth outcomes influence self-harm risk in the perinatal period.
Main Methods:
- Retrospective cohort study of over 2.6 million women (aged 15-45) using linked electronic health records.
- Analysis of self-harm events and mental illnesses (e.g., depression, anxiety, psychosis) over distinct non-perinatal, pregnant, and postpartum periods.
- Utilized a gap-time, stratified Cox model to assess adjusted hazard ratios (adjHR) for self-harm risk.
Main Results:
- Self-harm risk significantly decreased during pregnancy (adjHR=0.53), most notably in women with mental illness (adjHR=0.40).
- Risk reduction in pregnancy was not observed in 15- to 19-year-olds (adjHR=0.95).
- Postpartum self-harm risk peaked at 6-12 months (adjHR=1.08), with elevated risk for young women and those experiencing pregnancy loss or termination.
Conclusions:
- Maternity and perinatal mental health services are vital for supporting women.
- Family planning services may offer psychological benefits, particularly for younger women, potentially mitigating self-harm risk.
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