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

Papers

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 traumatic birth and obstetric procedures in relation to suicide by violent means in offspring as adults.
Design: Prospective case-control study.
Setting: Stockholm, Sweden.
Subjects: 242 adults who committed suicide by violent means from 1978 to 1995, and who were born in one of seven hospitals in Stockholm during 1945-80, matched with 403 biological siblings born during the same period and at the same group of hospitals.
Main outcome measures: Adverse and beneficial perinatal factors expressed as relative risks (odds ratios) and 95% confidence intervals, derived from logistic regression of cases matched with their siblings.
Results: For multiple birth trauma the estimated relative risks of offspring subsequently committing suicide by violent means were 4.9 (95% confidence interval 1.8 to 13) for men and 1.04 (0.2 to 4.6) for women. In mothers who received multiple opiate treatment during delivery, the estimated relative risk of offspring subsequently committing suicide was equal for both sexes (0.26, 0.09 to 0.69).
Conclusion: Minimising pain and discomfort to the infant during birth seems to be of importance in reducing the risk of committing suicide by violent means as an adult.

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

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© BMJ 1998
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