Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Psychol Med. 2022 Jul;52(9):1710-1717. doi: 10.1017/S0033291720003475. Epub 2020 Oct 21.
Oral contraceptive use has been previously associated with an increased risk of suicidal behavior in some, but not all, samples. The use of large, representative, longitudinally-assessed samples may clarify the nature of this potential association.
We used Swedish national registries to identify women born between 1991 and 1995 ( = 216 702) and determine whether they retrieved prescriptions for oral contraceptives. We used Cox proportional hazards models to test the association between contraceptive use and first observed suicidal event (suicide attempt or death) from age 15 until the end of follow-up in 2014 (maximum age 22.4). We adjusted for covariates, including mental illness and parental history of suicide.
In a crude model, use of combination or progestin-only oral contraceptives was positively associated with suicidal behavior, with hazard ratios (HRs) of 1.73-2.78 after 1 month of use, and 1.25-1.82 after 1 year of use. Accounting for sociodemographic, parental, and psychiatric variables attenuated these associations, and risks declined with increasing duration of use: adjusted HRs ranged from 1.56 to 2.13 1 month beyond the initiation of use, and from 1.19 to 1.48 1 year after initiation of use. HRs were higher among women who ceased use during the observation period.
Young women using oral contraceptives may be at increased risk of suicidal behavior, but risk declines with increased duration of use. Analysis of former users suggests that women susceptible to depression/anxiety are more likely to cease hormonal contraceptive use. Additional studies are necessary to determine whether the observed association is attributable to a causal mechanism.
在一些但不是所有样本中，口服避孕药的使用与自杀行为的风险增加有关。使用大型、有代表性、纵向评估的样本可能会澄清这种潜在关联的性质。
我们使用瑞典国家登记处确定了 1991 年至 1995 年之间出生的女性（=216702 人），并确定她们是否获得了口服避孕药的处方。我们使用 Cox 比例风险模型来检验从 15 岁开始到 2014 年随访结束（最大年龄 22.4 岁）期间避孕药使用与首次观察到的自杀事件（自杀未遂或死亡）之间的关联。我们调整了协变量，包括精神疾病和父母自杀史。
在一个未经调整的模型中，使用复方或孕激素仅口服避孕药与自杀行为呈正相关，使用后 1 个月的危害比（HRs）为 1.73-2.78，使用 1 年后的 HRs 为 1.25-1.82。考虑到社会人口统计学、父母和精神科变量后，这些关联减弱，并且随着使用时间的增加风险降低：调整后的 HRs 在使用开始后 1 个月时范围从 1.56 到 2.13，在使用开始 1 年后从 1.19 到 1.48。在观察期间停止使用的女性中，HRs 更高。
使用口服避孕药的年轻女性可能有更高的自杀行为风险，但随着使用时间的增加风险会降低。对前使用者的分析表明，易患抑郁/焦虑的女性更有可能停止使用激素避孕药。需要进一步研究以确定观察到的关联是否归因于因果机制。
