{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T10:53:36Z","timestamp":1774608816281,"version":"3.50.1"},"reference-count":25,"publisher":"Royal College of Psychiatrists","issue":"4","license":[{"start":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T00:00:00Z","timestamp":1646092800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["GA682741"],"award-info":[{"award-number":["GA682741"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["National institute of Health Research"],"award-info":[{"award-number":["National institute of Health Research"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec id=\"S0007125022000319_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Perinatal self-harm is of concern but poorly understood.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125022000319_sec_a2\"><jats:title>Aims<\/jats:title><jats:p>To determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125022000319_sec_a3\" sec-type=\"methods\"><jats:title>Method<\/jats:title><jats:p>This was a retrospective cohort study of 2 666 088 women aged 15\u201345 years from the 1 January 1990 to 31 December 2017 linked to 1 102 040 pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register. We identified self-harm events and mental illness (depression\/anxiety\/addiction\/affective\/non-affective psychosis\/eating\/personality disorders) from clinical records and grouped women's age into 5-year bands. They calculated the rate of self-harm during discrete non-perinatal, pregnant and postpartum periods. We used a gap-time, stratified Cox model to manage multiple self-harm events, and calculated the unadjusted and adjusted hazard ratios (adjHR) of self-harm associated with pregnancy and the postpartum compared with non-perinatal periods. Pre-planned interactions tested if risk varied by mental illness, age and birth outcome.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125022000319_sec_a4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>The analysis included 57 791 self-harm events and 14 712 319 person-years of follow-up. The risk of self-harm shrank in pregnancy (2.07 <jats:italic>v.<\/jats:italic> 4.01 events\/1000 person-years, adjHR = 0.53, 95% CI 0.49\u20130.58) for all women except for 15- to 19-year-olds (adjHR = 0.95, 95% CI 0.84\u20131.07) and the risk reduced most for women with mental illness (adjHR = 0.40, 95% CI 0.36\u20130.44). Postpartum, self-harm risk peaked at 6\u201312 months (adjHR = 1.08, 95% CI 1.02\u20131.15), at-risk groups included young women and women with a pregnancy loss or termination.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125022000319_sec_a5\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Maternity and perinatal mental health services are valuable. Family planning services might have psychological benefit, particularly for young women.<\/jats:p><\/jats:sec>","DOI":"10.1192\/bjp.2022.31","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T08:19:26Z","timestamp":1646122766000},"page":"621-627","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":6,"title":["Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data"],"prefix":"10.1192","volume":"221","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4834-6719","authenticated-orcid":false,"given":"Holly","family":"Hope","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2182-0369","authenticated-orcid":false,"given":"Matthias","family":"Pierce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cemre Su","family":"Osam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catharine","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5657-6995","authenticated-orcid":false,"given":"Ann","family":"John","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn M.","family":"Abel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"170","published-online":{"date-parts":[[2022,3,1]]},"reference":[{"key":"S0007125022000319_ref18","volume-title":"Progress in Brain Research","volume":"133","author":"Carter","year":"2001"},{"key":"S0007125022000319_ref6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4351"},{"key":"S0007125022000319_ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s00737-016-0636-2"},{"key":"S0007125022000319_ref11","unstructured":"11 National Institute for Health and Care Excellence. Self-Harm in over 8s: Long-Term Management. Clinical Guideline [CG133]. NICE, 2011."},{"key":"S0007125022000319_ref10","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4811"},{"key":"S0007125022000319_ref19","unstructured":"19 Social Care Institute for Excellence. Sexual, Reproductive and Mental Health e-Learning Course. Social Care Institute for Excellence, 2011 (https:\/\/www.scie.org.uk\/e-learning\/sexual-health)."},{"key":"S0007125022000319_ref24","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.109.072637"},{"key":"S0007125022000319_ref8","doi-asserted-by":"publisher","DOI":"10.1192\/apt.bp.108.006635"},{"key":"S0007125022000319_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.02.056"},{"key":"S0007125022000319_ref20","article-title":"Midwife-led continuity models versus other models of care for childbearing women","volume":"4","author":"Sandall","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"S0007125022000319_ref25","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12059"},{"key":"S0007125022000319_ref17","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-016-0753-5"},{"key":"S0007125022000319_ref2","unstructured":"2 Knight, M , Bunch, K , Tuffnell, D , Jayakody, H , Shakespeare, J , Kotnis, R , Saving Lives, Improving Mothers\u2019 Care Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014\u201316. National Perinatal Epidemiology Unit, University of Oxford, 2018."},{"key":"S0007125022000319_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.03.037"},{"key":"S0007125022000319_ref23","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2016.3478"},{"key":"S0007125022000319_ref4","first-page":"19r12773","article-title":"The prevalence and correlates of self-harm in the perinatal period: a systematic review","volume":"81","author":"Ayre","year":"2020","journal-title":"J Clin Psychiatry"},{"key":"S0007125022000319_ref3","unstructured":"3 Knight, M , Bunch, K , Tuffnell, D , Shakespeare, J , Kotnis, R , Kenyon, S , Saving Lives, Improving Mother's Care Report: Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015\u201317. National Perinatal Epidemiology Unit, University of Oxford, 2019."},{"key":"S0007125022000319_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.03.040"},{"key":"S0007125022000319_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(19)30059-3"},{"key":"S0007125022000319_ref22","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp18X700277"},{"key":"S0007125022000319_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.08.016"},{"key":"S0007125022000319_ref21","doi-asserted-by":"publisher","DOI":"10.1176\/appi.prcp.20210027"},{"key":"S0007125022000319_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"S0007125022000319_ref12","volume-title":"Code list: res59: Self-harm","author":"Morgan","year":"2017"},{"key":"S0007125022000319_ref1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.162.2.297"}],"container-title":["The British Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007125022000319","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T11:26:31Z","timestamp":1664191591000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007125022000319\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,1]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["S0007125022000319"],"URL":"https:\/\/doi.org\/10.1192\/bjp.2022.31","relation":{},"ISSN":["0007-1250","1472-1465"],"issn-type":[{"value":"0007-1250","type":"print"},{"value":"1472-1465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,1]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}