Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Institute of Psychiatry, Psychology & Neuroscience, Health Service and Population Research Department, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
Psychiatr Q. 2020 Dec;91(4):1075-1087. doi: 10.1007/s11126-020-09815-5.
Despite its widespread use, there is conflicting evidence on the association between hormonal contraception and the risk of suicide among women. This review seeks to identify, appraise and synthesize all studies on the association between hormonal contraceptive use and attempted or completed suicide. A systematic review was performed in accordance with PRISMA guidelines. Relevant citations were identified from three bibliographic databases (MEDLINE, EMBASE, and PsycInfo). Cross-sectional, cohort and case control studies were included. Quality of studies was assessed with validated tools, and a narrative synthesis was conducted to summarize study findings. Nine studies reporting on six samples (n = 683,198) were included. Three studies reported data for the association between hormonal contraceptive use and suicide attempts, and five studies reported data on completed suicides. Both protective and adverse associations between hormonal contraception and risk of suicide were identified. The evidence of the association was weakened by low to moderate methodological quality of studies. Our review found there was substantial variability in the relationships reported between hormonal contraceptive use and suicide risk. Going forward, researchers investigating this topic are encouraged to use population-based samples to take efforts to control for important confounding variables. Additional research is also needed to investigate the effects of more recent hormonal contraceptive methods on suicide risk.
尽管激素避孕在临床上广泛应用，但关于其与女性自杀风险之间的关系仍存在争议。本综述旨在确定、评估和综合所有关于激素避孕与自杀未遂或自杀完成之间关联的研究。按照 PRISMA 指南进行系统综述。从三个文献数据库（MEDLINE、EMBASE 和 PsycInfo）中确定相关引文。纳入了横断面、队列和病例对照研究。使用经过验证的工具评估研究质量，并进行叙述性综合以总结研究结果。纳入了 9 项研究报告的 6 个样本（n=683198）。有 3 项研究报告了激素避孕使用与自杀未遂之间关联的数据，有 5 项研究报告了与自杀完成相关的数据。激素避孕与自杀风险之间存在保护和不利关联。研究的方法学质量为低至中度，这削弱了证据的关联。我们的综述发现，激素避孕使用与自杀风险之间的关系存在很大的可变性。今后，鼓励研究该主题的研究人员使用基于人群的样本，努力控制重要的混杂变量。还需要进一步研究最近的激素避孕方法对自杀风险的影响。
