Hormonal Contraceptive Use and Risk of Attempted and Completed Suicide: a Systematic Review and Narrative Synthesis
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Hormonal Contraceptive Use and Risk of Attempted and Completed Suicide: a Systematic Review and Narrative Synthesis Sonali Amarasekera 1 & Raquel Catalao 2 & Emma Molyneaux 2 & Daniela C. Fuhr 1 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Despite its widespread use, there is conflicting evidence on the association between hormonal contraception and the risk of suicide among women. This review seeks to identify, appraise and synthesize all studies on the association between hormonal contraceptive use and attempted or completed suicide. A systematic review was performed in accordance with PRISMA guidelines. Relevant citations were identified from three bibliographic databases (MEDLINE, EMBASE, and PsycInfo). Cross-sectional, cohort and case control studies were included. Quality of studies was assessed with validated tools, and a narrative synthesis was conducted to summarize study findings. Nine studies reporting on six samples (n = 683,198) were included. Three studies reported data for the association between hormonal contraceptive use and suicide attempts, and five studies reported data on completed suicides. Both protective and adverse associations between hormonal contraception and risk of suicide were identified. The evidence of the association was weakened by low to moderate methodological quality of studies. Our review found there was substantial variability in the relationships reported between hormonal contraceptive use and suicide risk. Going forward, researchers investigating this topic are encouraged to use population-based samples to take efforts to control for important confounding variables. Additional research is also needed to investigate the effects of more recent hormonal contraceptive methods on suicide risk. Keywords Hormonal contraception . Oral contraceptives . Suicide . Suicide attempt . Systematic review
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11126-02009815-5) contains supplementary material, which is available to authorized users.
* Daniela C. Fuhr [email protected] Extended author information available on the last page of the article
Psychiatric Quarterly
Background Today, more than 100 million women worldwide use hormonal contraception [1]. Since their introduction more than fifty years ago [1], hormonal contraceptives have provided women with an opportunity to exercise control over their health and well-being by avoiding unintended pregnancies [2]. Hormonal contraceptives relieve menstrual cramps, heavy bleeding, endometriosis, acne, and protect against ovarian and endometrial cancers [2, 3]. There are both benefits and risks involved with hormonal contraceptive use. Studies have detected an increased risk of venous thromboembolism [4], cardiovascular events such as myocardial infarctions [4] and breast cancer [5] among hormonal contraceptive users, although there is some uncertainty about the validity of these findings [2]. There are several different types of hormonal contraceptives
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