Letters

Association between obstetric care and risk of suicide

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7192.1211 (Published 01 May 1999) Cite this as: BMJ 1999;318:1211

Study has methodological flaws

  1. D J Gunnell, Senior lecturer in epidemiology and public health medicine (D.J.Gunnell@Bristol.ac.uk),
  2. Andy Ness, Senior lecturer in epidemiology,
  3. Elise Whitley, Lecturer in medical statistics
  1. Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. Department of Medical Engineering, F60 Novum, Huddinge University Hospital, SE-14186 Huddinge, Sweden
  3. Department of Obstetrics and Gynaecology, Karolinska Hospital, SE-17176 Stockholm, Sweden

    EDITOR—Jacobson and Bygdeman present intriguing data suggesting that the risk of suicide is influenced by birth trauma; they argue that this may explain recent increases in suicide among adolescents.1 However, deficiencies in the design and analysis of this case-control study should be addressed before the findings are accepted or possible mechanisms are considered.

    The significant findings in Jacobson and Bygdeman's paper are confined to a subgroup of men who committed suicide using violent methods, were born and died in the catchment area of Stockholm's forensic medicine department, and had siblings whose birth records were available. The 175 males for whom the significant associations were found probably represent 25% of all suicides. The authors' suggestion that the association is restricted to violent suicides might be tested by presenting separate risk estimates for violent and non-violent suicides. Furthermore, there is overlap in the cases included in this analysis and those included in a previous study which reported highly significant associations …

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