Self-harm in pregnancy and the postnatal year: Prevalence and risk factors

Karyn Ayre*, Xiaoqin Liu, Louise M. Howard, Rina Dutta, Trine Munk-Olsen


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Background Self-harm in pregnancy or the year after birth ('perinatal self-harm') is clinically important, yet prevalence rates, temporal trends and risk factors are unclear. Methods A cohort study of 679 881 mothers (1 172 191 pregnancies) was conducted using Danish population register data-linkage. Hospital treatment for self-harm during pregnancy and the postnatal period (12 months after live delivery) were primary outcomes. Prevalence rates 1997-2015, in women with and without psychiatric history, were calculated. Cox regression was used to identify risk factors. Results Prevalence rates of self-harm were, in pregnancy, 32.2 (95% CI 28.9-35.4)/100 000 deliveries and, postnatally, 63.3 (95% CI 58.8-67.9)/100 000 deliveries. Prevalence rates of perinatal self-harm in women without a psychiatric history remained stable but declined among women with a psychiatric history. Risk factors for perinatal self-harm: younger age, non-Danish birth, prior self-harm, psychiatric history and parental psychiatric history. Additional risk factors for postnatal self-harm: multiparity and preterm birth. Of psychiatric conditions, personality disorder was most strongly associated with pregnancy self-harm (aHR 3.15, 95% CI 1.68-5.89); psychosis was most strongly associated with postnatal self-harm (aHR 6.36, 95% CI 4.30-9.41). For psychiatric disorders, aHRs were higher postnatally, particularly for psychotic and mood disorders. Conclusions Perinatal self-harm is more common in women with pre-existing psychiatric history and declined between 1997 and 2015, although not among women without pre-existing history. Our results suggest it may be a consequence of adversity and psychopathology, so preventative intervention research should consider both social and psychological determinants among women with and without psychiatric history.

TidsskriftPsychological Medicine
Udgave nummer7
Sider (fra-til)2895-2903
StatusUdgivet - 14. maj 2023

Bibliografisk note

Funding Information:
KA is funded by a National Institute for Health Research (NIHR) Doctoral Research Fellowship (NIHR-DRF-2016-09-042). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. XL is supported by the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 891 079. RD is funded by a Clinician Scientist Fellowship (research project e-HOST-IT) from the Health Foundation in partnership with the Academy of Medical Sciences. Professor Louise M Howard receives salary support from NIHR South London and Maudsley/King's College London Biomedical Research Council and the NIHR South London Applied Research Collaboration. She is an NIHR Senior Investigator. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. TMO is supported by the National Institute of Mental Health (NIMH) (R01MH 122869), iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research (R155-2014-1724), the Lundbeck Foundation (R313-2019-569), AUFF NOVA (AUFF-E 2016-9-25), and Fabrikant Vilhelm Pedersen og Hustrus Legat.


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