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Association of Hormonal Contraception With Suicide Attempts and Suicides.
Am J Psychiatry 2018; 175(4):336-342AJ

Abstract

OBJECTIVE

The purpose of this study was to assess the relative risk of suicide attempt and suicide in users of hormonal contraception.

METHOD

The authors assessed associations between hormonal contraceptive use and suicide attempt and suicide in a nationwide prospective cohort study of all women in Denmark who had no psychiatric diagnoses, antidepressant use, or hormonal contraceptive use before age 15 and who turned 15 during the study period, which extended from 1996 through 2013. Nationwide registers provided individually updated information about use of hormonal contraception, suicide attempt, suicide, and potential confounding variables. Psychiatric diagnoses or antidepressant use during the study period were considered potential mediators between hormonal contraceptive use and risk of suicide attempt. Adjusted hazard ratios for suicide attempt and suicide were estimated for users of hormonal contraception as compared with those who never used hormonal contraception.

RESULTS

Among nearly half a million women followed on average for 8.3 years (3.9 million person-years) with a mean age of 21 years, 6,999 first suicide attempts and 71 suicides were identified. Compared with women who never used hormonal contraceptives, the relative risk among current and recent users was 1.97 (95% CI=1.85-2.10) for suicide attempt and 3.08 (95% CI=1.34-7.08) for suicide. Risk estimates for suicide attempt were 1.91 (95% CI=1.79-2.03) for oral combined products, 2.29 (95% CI=1.77-2.95) for oral progestin-only products, 2.58 (95% CI=2.06-3.22) for vaginal ring, and 3.28 (95% CI=2.08-5.16) for patch. The association between hormonal contraceptive use and a first suicide attempt peaked after 2 months of use.

CONCLUSIONS

Use of hormonal contraception was positively associated with subsequent suicide attempt and suicide. Adolescent women experienced the highest relative risk.

Authors+Show Affiliations

From the Department of Gynecology and the Psychiatric Center Copenhagen, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; the Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen; and the Center for Statistical Science, Peking University, Beijing.From the Department of Gynecology and the Psychiatric Center Copenhagen, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; the Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen; and the Center for Statistical Science, Peking University, Beijing.From the Department of Gynecology and the Psychiatric Center Copenhagen, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; the Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen; and the Center for Statistical Science, Peking University, Beijing.From the Department of Gynecology and the Psychiatric Center Copenhagen, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; the Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen; and the Center for Statistical Science, Peking University, Beijing.From the Department of Gynecology and the Psychiatric Center Copenhagen, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; the Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen; and the Center for Statistical Science, Peking University, Beijing.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29145752

Citation

Skovlund, Charlotte Wessel, et al. "Association of Hormonal Contraception With Suicide Attempts and Suicides." The American Journal of Psychiatry, vol. 175, no. 4, 2018, pp. 336-342.
Skovlund CW, Mørch LS, Kessing LV, et al. Association of Hormonal Contraception With Suicide Attempts and Suicides. Am J Psychiatry. 2018;175(4):336-342.
Skovlund, C. W., Mørch, L. S., Kessing, L. V., Lange, T., & Lidegaard, Ø. (2018). Association of Hormonal Contraception With Suicide Attempts and Suicides. The American Journal of Psychiatry, 175(4), pp. 336-342. doi:10.1176/appi.ajp.2017.17060616.
Skovlund CW, et al. Association of Hormonal Contraception With Suicide Attempts and Suicides. Am J Psychiatry. 2018 04 1;175(4):336-342. PubMed PMID: 29145752.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Hormonal Contraception With Suicide Attempts and Suicides. AU - Skovlund,Charlotte Wessel, AU - Mørch,Lina Steinrud, AU - Kessing,Lars Vedel, AU - Lange,Theis, AU - Lidegaard,Øjvind, Y1 - 2017/11/17/ PY - 2017/11/18/pubmed PY - 2019/4/6/medline PY - 2017/11/18/entrez KW - Adolescents KW - Combined Oral Contraceptive Pill KW - Depression KW - Hormonal Contraception KW - Suicide KW - Suicide Attempt SP - 336 EP - 342 JF - The American journal of psychiatry JO - Am J Psychiatry VL - 175 IS - 4 N2 - OBJECTIVE: The purpose of this study was to assess the relative risk of suicide attempt and suicide in users of hormonal contraception. METHOD: The authors assessed associations between hormonal contraceptive use and suicide attempt and suicide in a nationwide prospective cohort study of all women in Denmark who had no psychiatric diagnoses, antidepressant use, or hormonal contraceptive use before age 15 and who turned 15 during the study period, which extended from 1996 through 2013. Nationwide registers provided individually updated information about use of hormonal contraception, suicide attempt, suicide, and potential confounding variables. Psychiatric diagnoses or antidepressant use during the study period were considered potential mediators between hormonal contraceptive use and risk of suicide attempt. Adjusted hazard ratios for suicide attempt and suicide were estimated for users of hormonal contraception as compared with those who never used hormonal contraception. RESULTS: Among nearly half a million women followed on average for 8.3 years (3.9 million person-years) with a mean age of 21 years, 6,999 first suicide attempts and 71 suicides were identified. Compared with women who never used hormonal contraceptives, the relative risk among current and recent users was 1.97 (95% CI=1.85-2.10) for suicide attempt and 3.08 (95% CI=1.34-7.08) for suicide. Risk estimates for suicide attempt were 1.91 (95% CI=1.79-2.03) for oral combined products, 2.29 (95% CI=1.77-2.95) for oral progestin-only products, 2.58 (95% CI=2.06-3.22) for vaginal ring, and 3.28 (95% CI=2.08-5.16) for patch. The association between hormonal contraceptive use and a first suicide attempt peaked after 2 months of use. CONCLUSIONS: Use of hormonal contraception was positively associated with subsequent suicide attempt and suicide. Adolescent women experienced the highest relative risk. SN - 1535-7228 UR - https://www.unboundmedicine.com/medline/citation/29145752/Association_of_Hormonal_Contraception_With_Suicide_Attempts_and_Suicides_ L2 - https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2017.17060616?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -