Abstract
Introduction: Despite self-harm being increasingly prevalent among childbearing-age women, little is known about the prevalence and correlates during pregnancy and the year after birth (“the perinatal period”). I hypothesised that among women known psychiatric disorders, perinatal self-harm would be independently associated with younger age and pre-conception self-harm. Finally, there is little prospective data on the extent to which perinatal self-harm is associated with suicide.Methods: Study 1: a systematic review on the prevalence and correlates of perinatal self-harm. Study 2: a Danish general population cohort study using linked registry, prospectively-collected, data. Study 3: a cohort study of women in contact with a secondary mental healthcare provider in South London, UK, using data-linkage of electronic mental healthcare records and mortality databases.
Results: Study 1: A heterogenous body of literature suggested perinatal self-harm was rare among the general population but relatively common among women with known psychiatric disorders: median 2.16% (IQR 0.26─7.9) in pregnancy; median 7.97% (IQR 0─18) postnatally. Due to limitations in the ascertainment of self-harm, most studies likely under-estimated prevalence. There was little evidence on the correlates of perinatal self-harm among women with known psychiatric disorders. Study 2: Perinatal self-harm was five times more common in women with a psychiatric history than without. Prevalence among women with a psychiatric history declined 1997─2015 but remained stable among women without. Risk-factors were younger age; maternal birth outside Denmark; mental disorder; pre-conception self-harm and parental psychiatric history. Multiparity and premature birth were postnatal-specific risk-factors. Personality disorder was most strongly associated with pregnancy self-harm; psychotic disorders most strongly with postnatal self-harm. Study 3: Using a novel outcome measure, I estimated the prevalence of pregnancy self-harm to be 15.3% (95% CI 14.3–16.3) and postnatal self-harm to be 19.7% (95% CI 18.6–20.8), among a cohort of women in contact with secondary mental healthcare. I confirmed my hypotheses that younger age and pre-conception self-harm are independent risk factors for both pregnancy and postnatal self-harm. There was no statistically significant association between perinatal self-harm andsuicide, however the confidence intervals around the adjusted hazard ratio for suicide within two years of childbirth contained the possibility of an elevated risk (aHR 3.97, 95% CI 0.66–23.85, p=0.13).
Conclusions: Perinatal self-harm is a marker of psychosocial, psychiatric and obstetric vulnerability. In general and clinical populations, younger women with a prior history of self-harm are at risk. Perinatal self-harm may be a marker of increased suicide risk that extends beyond the commonly-accepted paradigm of the perinatal period as lasting up to one year postnatal.
| Date of Award | 1 Mar 2022 |
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| Original language | English |
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| Supervisor | Rina Dutta (Supervisor) & Louise Howard (Supervisor) |