TOPLINE:

In a Swedish study of over 2.1 million pregnancies, mothers showed lower suicide attempt rates than fathers during and after pregnancy, reversing the typical sex-specific pattern of suicide attempts seen in the general population.

METHODOLOGY:

• Researchers conducted a nationwide register-based cohort study in Sweden from 2001 to 2021 and analysed data of 2,196,276 pregnancies involving 1,236,816 mothers and 1,175,674 fathers to assess sex-specific differences in the risk for suicide attempt.
• Time periods were defined as the year before conception (preconception), the duration of pregnancy (antepartum), and the year after birth (postpartum), and analyses were week specific.
• Researchers identified suicide attempts from the National Patient Register using the International Classification of Diseases codes, and the first suicide attempt during each time period was considered the primary outcome.
• Incidence rate ratios (IRRs) were calculated by comparing antepartum and postpartum periods with corresponding weeks in the preconception period, while controlling for the country of birth, age, education level, civil status, psychiatric history, and season.

TAKEAWAY:

• During the study, researchers identified 7469 suicide attempts among mothers (IR, 1.39 per 1000 person-years) and 8338 suicide attempts among fathers (IR, 1.62 per 1000 person-years).
• Mothers showed significantly lower suicide attempt rates per 1000 person-years during pregnancy (0.74) and postpartum (0.85) than during preconception (2.69), with the lowest risk observed during the first week of postpartum (IRR, 0.14; adjusted P < .001). Fathers showed stable suicide attempt rates before childbirth, with a decreased risk observed during the first 10 weeks of postpartum (IRR, 0.69-0.91) but an increased risk observed later in the postpartum period (IRR, 1.10-1.72).
• Mothers had a lower risk for suicide attempt during and after pregnancy than fathers, with the lowest IRR observed during the first week of postpartum (0.22).
• The typically higher female suicide attempt rate observed in the general population was found to be reversed during and after pregnancy, with mothers showing a lower risk than fathers.

IN PRACTICE:

"Our results illustrate a lower risk of suicide attempt among both mothers and fathers after childbirth, supporting that childbirth may be a protective factor against suicidality among mothers. Our study also illustrates that the well-established female excess in suicide attempt in the general population is reversed during and after pregnancy," the authors wrote.

"Clinicians may take opportunities of the current scheme of maternal and child health services to identify high-risk individuals, implement suicide risk assessment and enhance suicide prevention strategies for both mothers and fathers," they added.

SOURCE:

This study was led by Yihui Yang, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. It was published online on September 25 in Nature Human Behaviour.

LIMITATIONS:

This study excluded early pregnancy terminations and potentially confounded non-suicidal self-harm or fatal suicide attempts. The analysis was limited to parents who survived, could not assess completed suicide in all periods, and may have underestimated the effect size by using a generally healthy period (preconception) at baseline. Furthermore, the results may not have generalised to individuals whose gender identity differs from their assigned sex at birth or to countries lacking Sweden's comprehensive healthcare and social welfare systems (eg, free prenatal care and paid leave).

DISCLOSURES:

This study was funded by the China Scholarship Council; Swedish Research Council; Swedish Research Council for Health, Working Life, and Welfare; and Karolinska Institutet Strategic Research Area in Epidemiology and Biostatistics. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.