In the field of abortion and mental health research, few studies have focused on suicide attempts. The study of Julia R Steinberg and colleagues in The Lancet Psychiatry is based on an impressively large, bias-free, real-world registry dataset, and is a welcome addition to the academic literature. Steinberg and colleagues correctly limit their analyses to first-time abortions and first-time suicide attempts; although this decreases external validity, it is a necessary step to establish causal effects and ensure temporal order. However, the fact that the data are based on registries also poses some limitations to the interpretation of the results; furthermore, their findings do raise an important question. The results suggest that the abortion itself was not the reason for the increased risk of suicide attempts, but that one or more unmeasured variables contributed to it. Obviously, Steinberg and colleagues could not capture what these co-occurring variables might have been. If the increased risk was not due to the abortion itself, then why was the risk higher in women who had an abortion the year before and after the abortion, relative to more than one year after the abortion?

中文翻译：

---

堕胎和自杀未遂的常见危险因素。

在堕胎和心理健康研究领域，很少有研究侧重于自杀未遂。Julia R Steinberg及其同事在《柳叶刀精神病学》中的研究基于庞大的，无偏差的真实注册表数据集，是学术文献中受欢迎的补充。斯坦伯格及其同事正确地将他们的分析限于第一次流产和第一次自杀企图。尽管这会降低外部效度，但是这是建立因果关系并确保时间顺序的必要步骤。但是，数据基于注册表的事实也对结果的解释造成了一些限制。此外，他们的发现确实提出了一个重要的问题。结果表明，堕胎本身不是自杀未遂风险增加的原因，而是一个或多个无法衡量的变量导致了自杀。显然，Steinberg及其同事无法捕获这些共同出现的变量可能是什么。