COMMENTARY

Do Contraceptive Hormones Increase Suicide Risk?

Peter M. Yellowlees, MBBS, MD

Disclosures

March 23, 2018

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

The causes of suicide attempts and suicide are hard to investigate, but there is strong evidence for the importance of depression, which in itself has been linked with a wide range of possible hormonal abnormalities across many studies. Now a team of investigators[1] from the University of Copenhagen, Denmark, have undertaken a study to assess the relative risk of suicide attempt and suicide in users of hormonal contraception. Using national Danish registers, the investigators followed nearly half a million women with a mean age of 21 years on average for 8.3 years (3.9 million person-years). They identified 6999 first suicide attempts and 71 suicides and found that, compared with women who never used hormonal contraceptives, the relative risk among current and recent users was 1.97 for suicide attempt and 3.08 for suicide. They concluded that use of hormonal contraception was positively associated with subsequent suicide attempt and suicide, that adolescents had the highest relative risk, and that the association between hormonal contraceptive use and a first suicide attempt peaked after 2 months of use.

So, what is the clinical significance of these associations? First, there is no evidence from this study of a causative link between hormonal contraception and suicidal behavior, but it does seem that we should be screening for suicidal ideation in any woman, especially adolescents, who are starting hormonal contraceptives for the first time. Not surprisingly, this may be a stressful developmental time for such individuals, in terms of new relationships and sexual activities, and is potentially a time of increased risk for victimization and abuse, which may be the drivers of suicidal behavior, with the need for contraceptives being the potential identifying marker. More studies to examine this link between hormonal contraception and suicide are certainly needed.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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