title: The prevalence and correlates of self-harm in pregnant women with psychotic disorder and bipolar disorder.
abstract: Women with severe mental illness are at increased risk of suicide in the perinatal period, and these suicides are often preceded by self-harm, but little is known about self-harm and its correlates in this population. This study aimed to investigate the prevalence of suicidal ideation and self-harm, and its correlates, in women with psychotic disorders and bipolar disorder during pregnancy. Historical cohort study using de-identified secondary mental healthcare records linked with national maternity data. Women pregnant from 2007 to 2011, with ICD-10 diagnoses of schizophrenia and related disorders, bipolar disorder or other affective psychoses were identified. Data were extracted from structured fields, natural language processing applications and free text. Logistic regression was used to examine the correlates of self-harm in pregnancy. Of 420 women, 103 (24.5 %) had a record of suicidal ideation during the first index pregnancy, with self-harm recorded in 33 (7.9 %). Self-harm was independently associated with younger age (adjusted odds ratio (aOR) 0.91, 95 % CI 0.85-0.98), self-harm in the previous 2 years (aOR 2.55; 1.05-6.50) and smoking (aOR 3.64; 1.30-10.19). A higher prevalence of self-harm was observed in women with non-affective psychosis, those who discontinued or switched medication and in women on no medication at the start of pregnancy, but these findings were not statistically significant in multivariable analyses. Suicidal thoughts and self-harm occur in a significant proportion of pregnant women with severe mental illness, particularly younger women and those with a history of self-harm; these women need particularly close monitoring for suicidality.
authors.affiliation: Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. clare.l.taylor@kcl.ac.uk.|Section of Women's Mental Health, PO31 Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK. clare.l.taylor@kcl.ac.uk.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Taylor
authors.affiliation: Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Leontien M
authors.initials: LM
authors.lastname: van Ravesteyn
authors.affiliation: Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.|Department of Child & Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Mijke P Lambregtse
authors.initials: MP
authors.lastname: van denBerg
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stewart
authors.affiliation: Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Howard
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015995:Prevalence; D011618:Psychotic Disorders / Q000523:psychology*; D016728:Self-Injurious Behavior / Q000453:epidemiology*
keywords: Bipolar disorder; Pregnancy; Psychosis; Self-harm