Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China.
JAMA Netw Open. 2024 Jan 2;7(1):e2350897. doi: 10.1001/jamanetworkopen.2023.50897.
Suicidal ideation is common among women with perinatal depression (PND). However, prospective data are limited on the risk, particularly long-term risk, of suicidal behavior (suicide attempt and completed suicide) among women with perinatal depression.
To examine the association between PND and risk of short- and long-term suicidal behavior.
DESIGN, SETTING, AND PARTICIPANTS: A nationwide population-matched cohort study was conducted in Sweden including 86 551 women with PND from 2001 to 2017 and 865 510 unaffected women individually matched on age and calendar year at delivery. Sibling comparison was used to account for familial confounding. Data were analyzed from January 2022 to November 2023.
PND was identified through depression diagnosis or filled prescriptions of antidepressants from pregnancy to 1 year post partum in registers.
All women were followed up for the first event of suicidal behavior recorded in registers. Hazard ratios (HR) of suicidal behavior were estimated using time-to-event analysis.
Women with PND (86 551 participants) received a diagnosis at a mean (SD) age of 30.67 (5.23) years. During a median (IQR) follow-up of 6.91 (3.62-10.88) years, 3604 events of suicidal behavior (incidence rate [IR], 5.62 per 1000 person-years) were identified among women with PND and 6445 (IR, 1.01 per 1000 person-years) among population-unaffected women. Women with PND had an elevated risk of suicidal behavior when compared with matched unaffected women (HR, 3.15; 95% CI, 2.97-3.35). Comparable, albeit somewhat attenuated, associations were yielded when comparing PND women with their PND-free sisters (HR, 2.75; 95% CI, 2.10-3.61). In the population-matched cohort, the association was greater for postnatal depression and among women without a history of psychiatric disorders. The excess risk was pronounced during the first year after diagnosis (HR, 7.20; 95% CI, 6.07-8.54), yet remained statistically significant during 5 to 18 years of follow-up (HR, 2.34; 95% CI, 2.12-2.57).
In this nationwide cohort study, women with PND were at an increased risk of suicidal behavior, particularly within the first year after diagnosis with persistent risk elevations throughout the 18 years of follow-up, highlighting the need for vigilant clinical monitoring of this vulnerable group.
围产期抑郁症（PND）患者常有自杀意念。然而，关于患有围产期抑郁症的女性自杀行为（自杀企图和完成自杀）的风险，尤其是长期风险，前瞻性数据有限。
研究 PND 与短期和长期自杀行为风险之间的关联。
设计、设置和参与者：这是一项全国性的人群匹配队列研究，在瑞典进行，纳入了 2001 年至 2017 年期间 86551 名患有 PND 的女性，以及 865510 名年龄和分娩年份与 PND 女性相匹配的未受影响的女性。使用同胞比较来解释家族性混杂。数据于 2022 年 1 月至 2023 年 11 月进行分析。
通过在登记处中怀孕至产后 1 年期间的抑郁诊断或填写抗抑郁药处方来识别 PND。
所有女性都通过登记处记录的首次自杀行为事件进行随访。使用生存分析估计自杀行为的风险比（HR）。
患有 PND（86551 名参与者）的女性平均（SD）年龄为 30.67（5.23）岁。在中位（IQR）随访 6.91（3.62-10.88）年期间，86551 名 PND 女性中有 3604 例自杀行为事件（发生率[IR]，每 1000 人年 5.62 例），6445 例（IR，每 1000 人年 1.01 例）在未受影响的人群中。与匹配的未受影响的女性相比，患有 PND 的女性自杀行为的风险增加（HR，3.15；95%CI，2.97-3.35）。当比较 PND 女性与 PND 阴性的姐妹时，也得出了类似的、但略有减弱的关联（HR，2.75；95%CI，2.10-3.61）。在人群匹配队列中，产后抑郁症和无精神疾病史的女性的相关性更大。在诊断后第一年的风险增加显著（HR，7.20；95%CI，6.07-8.54），但在随访 5 至 18 年内仍具有统计学意义（HR，2.34；95%CI，2.12-2.57）。
在这项全国性队列研究中，患有 PND 的女性自杀行为的风险增加，尤其是在诊断后的第一年，在 18 年的随访期间持续存在风险升高，这凸显了需要对这一弱势群体进行警惕的临床监测。
