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Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data.
The British Journal of Psychiatry ( IF 10.5 ) Pub Date : 2022-10-01 , DOI: 10.1192/bjp.2022.31
Holly Hope 1 , Matthias Pierce 1 , Cemre Su Osam 1 , Catharine Morgan 2 , Ann John 3 , Kathryn M Abel 4
Affiliation  

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.

中文翻译:

妊娠期自残风险:使用英国初级保健数据的复发事件生存分析。

背景围产期自残是一个令人担忧的问题,但人们却知之甚少。目的 确定女性在怀孕和产后第一年的自残风险是否发生变化,以及风险是否因精神疾病、年龄和出生结果而异。方法 这是一项回顾性队列研究,使用临床实践研究数据链接和妊娠登记册,对 1990 年 1 月 1 日至 2017 年 12 月 31 日期间 2 666 088 名 15-45 岁女性与 1 102 040 次妊娠及其结果相关联。我们从临床记录中确定了自残事件和精神疾病(抑郁/焦虑/成瘾/情感/非情感性精神病/饮食/人格障碍),并将女性的年龄分组为 5 年。他们计算了离散的非围产期、怀孕期和产后期间的自残率。我们使用了间隔时间,分层 Cox 模型来管理多个自伤事件,并计算与非围产期相比与妊娠和产后相关的自伤的未调整和调整风险比 (adjHR)。如果风险因精神疾病、年龄和出生结果而异,则测试预先计划的互动。结果 分析包括 57 791 起自残事件和 14 712 319 人年的随访。除了 15 至 19 岁的女性(adjHR = 0.95, 95% CI 0.84-1.07)并且对于患有精神疾病的女性,风险降低最多(adjHR = 0.40, 95% CI 0.36-0.44)。产后自伤风险在 6-12 个月时达到峰值(adjHR = 1.08, 95% CI 1.02-1.15),高危人群包括年轻女性和流产或终止妊娠的女性。结论 产科和围产期心理健康服务很有价值。计划生育服务可能对心理有益,尤其是对年轻女性。
更新日期:2022-03-01
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