Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland.
Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
Eur J Epidemiol. 2024 Sep;39(9):1013-1022. doi: 10.1007/s10654-024-01155-z. Epub 2024 Sep 3.
Evidence regarding the role of hormonal contraception (HC) as a risk factor for attempted suicide is inconclusive. Thus, this study aimed to assess the associations of use of different types of systemic HC with the risk of attempted suicide in women aged 15-49 years. Data on a population-based cohort (n = 587,823) of HC users and non-users in 2017 was derived from national registers in Finland. In a nested case-control design we examined the risk of attempted suicide in relation to current HC use (past six months) via multivariable conditional logistic regression models. During the follow-up (from 2018 to 2019) there were 1.174,346 million person-years of which 818 cases of suicide attempts were observed (incidence rate: 0.70 per 1000 person-years). Use of HC, especially combined hormonal contraceptives, was not associated with a higher risk of attempted suicide compared to non-use (OR 0.68, 95% CI 0.45-1.02) after controlling for marital status, socioeconomic status, education, chronic diseases, recent delivery, recent psychiatric hospitalizations, and current use of psychotropic medications. In women without psychiatric history, current HC use (OR 0.73, 95% CI 0.58-0.91), especially ethinylestradiol-containing preparations (OR 0.54, 95% CI 0.40-0.73), was associated with a lower risk of attempted suicide. After adjusting for recent psychiatric hospitalizations and use of psychotropic medications, current use of progestin-only preparations was not associated with attempted suicide. In conclusion, current HC use was not associated with an increased risk of attempted suicide in fertile-aged women.
关于激素避孕（HC）作为自杀未遂风险因素的证据尚无定论。因此，本研究旨在评估不同类型的全身用 HC 与 15-49 岁女性自杀未遂风险的关联。2017 年，我们从芬兰国家登记处获得了一项基于人群的 HC 使用者和非使用者队列（n=587823）的数据。通过多变量条件逻辑回归模型，我们在嵌套病例对照设计中研究了与当前 HC 使用（过去六个月）相关的自杀未遂风险。在随访期间（2018 年至 2019 年），有 1.174346 亿人年，观察到 818 例自杀未遂（发生率：0.70/1000 人年）。在控制婚姻状况、社会经济地位、教育、慢性疾病、近期分娩、近期精神病院住院和当前使用精神药物后，与非使用者相比，HC 使用，特别是复方激素避孕药的使用与自杀未遂的风险增加无关（OR 0.68，95%CI 0.45-1.02）。在没有精神病史的女性中，当前 HC 使用（OR 0.73，95%CI 0.58-0.91），特别是含乙炔雌二醇的制剂（OR 0.54，95%CI 0.40-0.73）与自杀未遂的风险降低相关。在调整近期精神病院住院和使用精神药物后，当前使用孕激素仅制剂与自杀未遂无关。总之，在生育年龄的女性中，当前的 HC 使用与自杀未遂风险增加无关。
