Hormonal Contraceptive Use and Risk of Attempted and Completed Suicide: a Systematic Review and Narrative Synthesis.

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.