Henrik Lysell

Recent research suggests that having a newborn child is associated with substantially reduced risk for maternal suicide. We studied postpartum suicides in a national cohort of mothers and the role of mental disorder, self-harm and delivery related factors. We used a nested case-control design with data from Swedish registries. The cohort consisted of all women given birth in Sweden 1974–2009. Mothers who died by suicide during follow-up were considered cases (n = 1,786) and risk of suicide was estimated with proximity to delivery as the explanatory variable. In a second step, association between suicide during the first year following delivery (n = 145) and mental disorder, self-harm and delivery related variables risk factors were analyzed. The first postpartum year was associated with a lower risk of suicide, compared to later (RR 0.80, 95%CI 0.66–0.96), which was unaltered after adjustment for socio-economic status and history of self-harm (aRR 0.82, 95%CI 0.68–0.99). Compared to living mothers, suicide victims of the postpartum year more often had affective disorders (aRR 133.94, 95%CI 45.93–390.61), psychotic disorders (aRR 83.69, 95%CI 36.99–189.31) and history of self-harm (aRR 47.56, 95%CI 18.24–124.02). The aRR of stillbirth was 2.66 (95%CI 0.63–11.30). We found only a weak negative association between childbirth during the preceding year and suicide, when using mothers as controls. A severe mental disorder after delivery and a history of self-harm was strongly associated with increased risk of suicide in the postpartum year and may inform the clinical assessment postpartum.

To study possible psychiatric and criminological risk factors of intimate partner femicide (IPF) as well as the bereaved offspring's psychiatric morbidity and premature death. We conducted a nested case-control study, based on Swedish national registries, including all perpetrators of IPF. We computed risk estimates relative to matched population controls, which were compared to those of non-IPF homicide offenders. Exposed children were matched to population controls and followed longitudinally up to 37 years. Offspring outcomes were psychiatric and substance use disorders (according to ICD) self-harm; violent crime; suicide; and premature, all-cause death. We identified 261 male IPF perpetrators and 494 bereaved children from 1973 through 2009. Multivariable logistic regression suggested that major mental disorder (adjusted odds ratio [OR] = 5.9; 95% CI, 3.3-10.6) and violent crime convictions (adjusted OR = 4.4; 95% CI, 2.7-7.2) were independent risk factors of IPF, but substance use disorders were not (aOR = 0.4; 95% CI, 0.2-1.0). Children exposed to IPF before age 18 years had elevated risks of major mental disorder (adjusted hazard ratio [HR] = 5.7; 95% Cl, 3.0-10.6), substance use disorders (adjusted HR = 5.8; 95% CI, 2.8-11.9) and self-harm (adjusted HR = 5.7; 95% CI, 3.0-11.1). Offspring 18 years or older at the IPF had an increased risk of completed suicide (adjusted HR = 4.3; 95% CI, 1.3-14.5). Previous major mental disorder and violent behavior were strong independent risk factors for IPF. Bereavement caused by IPF had significant associations with the offspring's future life, especially for those below 18 years of age at exposure. Our findings demonstrate the need of direct support to the exposed offspring by health care providers and social services.

From The Journal of Clinical Psychiatry: