Obstetric care and proneness of offspring to suicide as adults: case-control study

BMJ 1998;317:1346-1349 ( 14 November )

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Obstetric care and proneness of offspring to suicide as adults: case-control study

Editorial by Appleby

Bertil Jacobson, professor emeritus, ^a Marc Bygdeman, professor. ^b

^a Department of Medical Engineering, F60 Novum, Huddinge University Hospital, SE-141 86 Huddinge, Sweden, ^b Department of Obstetrics and Gynaecology, Karolinska Hospital, SE-171 76 Stockholm, Sweden

Correspondence to: Professor Jacobson bertil.jacobson{at}labtek.ki.se

Objective: To investigate any long term effects of traumaticbirth and obstetric procedures in relation to suicide by violentmeans in offspring asadults.
Design: Prospective case-controlstudy.
Setting: Stockholm,Sweden.
Subjects: 242 adults who committed suicide by violentmeans from 1978 to 1995, and who were born in one of seven hospitalsin Stockholm during 1945-80, matched with 403 biological siblingsborn during the same period and at the same group ofhospitals.
Main outcome measures: Adverse and beneficial perinatal factors expressedas relative risks (odds ratios) and 95% confidence intervals,derived from logistic regression of cases matched with theirsiblings.
Results: For multiple birth trauma the estimated relativerisks of offspring subsequently committing suicide by violentmeans were 4.9 (95% confidence interval 1.8 to 13) for men and1.04 (0.2 to 4.6) for women. In mothers who received multipleopiate treatment during delivery, the estimated relative riskof offspring subsequently committing suicide was equal for bothsexes (0.26, 0.09 to 0.69).
Conclusion: Minimising pain and discomfort to the infantduring birth seems to be of importance in reducing the risk ofcommitting suicide by violent means as anadult.

Key messages

Adverse perinatal conditions are associated with an increased risk of suicide by violent means for adult men
Giving opiates to the mother during delivery was associated with a decreased risk of subsequent suicide by violent means in offspring
Similar studies of accident proneness as well as suicides by violent means are required possibly to corroborate the findings
Obstetric procedures should be chosen that reduce perinatal trauma to minimise the possible risk for subsequent adult self destructive behaviour

© BMJ 1998

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