Hormonal contraception and suicide: a new dimension of risk

摘要

Women have a higher lifetime prevalence of mood or anxiety disorders than men,1,2 with sex and gender differences within psychiatric diagnoses and course of psychiatric illness more broadly well documented.3In a recent review, Christine Kuehner identified a wide range of potential reasons for this sex divide.4 These included; the influence of sex hormones; women’s blunted hypothalamic–pituitary–adrenal axis response to stress; girls’ and women’s lower self-esteem and higher tendency for body shame and rumination; higher rates of interpersonal stressors; and experience of violence, and childhood sexual abuse.4 With such a broad range of potential implicating risk factors, there has been a drive for research to focus and analyse some of these areas.In a recent study in the American Journal of Psychiatry , Skovlund and colleagues provide an elegant and eye-opening report of their finding that hormonal contraception use doubles the risk of suicide attempt, and triples the risk of suicide.5The study utilised a nationwide registry in Denmark to identify 475 802 women, with a mean follow-up of 8.3 years: 54% of the cohort used hormonal contraception at some point during the study period. Patients with a known history of psychiatric diagnoses, including previous suicide attempts or prescription of antidepressants, were excluded from analysis, and patients were censored temporarily during …