Background. Albeit preventable, suicide is a leading cause of death worldwide, affecting thousands of people every year. To prevent suicide, we need to understand and identify its risk factors that can be changed. Children whose mothers suffer from mental health disorders face a higher risk of suicidal behavior during their life. Thus, treating mothers’ mental health is important. Psychotropic medications (like antidepressants, anxiolytics, and antipsychotics) are effective treatments, but they may adversely affect children’s development and increase risks of suicidal behavior when used during pregnancy. In this context, clinical decision making is complex during pregnancy and need to balance different risks. First, the risk for mothers (including of suicide) when stopping psychotropic medication. Second, the risk for the children exposed to untreated maternal mental disorders. Third, the risk for the child to suffer long-term consequences due to the exposure to psychotropic mediations in utero. So far, only one study has explored this topic. Thus, more research is needed to confirm findings in other populations.
Aims and Hypotheses. This project aims to answer two main questions. First, does a mother’s use of mental health medications during pregnancy affect her child’s risk of suicidal behavior later in time? We hypothesize that using these medications may increase this risk. Second, does the stopping of mental health medication initiated before pregnancy affect the mother’s risk of suicidal behavior (both during and after pregnancy) and later child’s suicidal risk? We hypothesize that stopping these medications could further increase the risk of suicidal behavior among both children and their mothers.
Sample, Measures and Procedures. We will use registers data from 1.7 million individuals born after 1997 and representative of the entire Danish population. Suicidal behavior will be defined as hospital contact for a suicide attempt or death by suicide, whichever happened first. Psychotropic medications will be defined as prescriptions of antidepressants, anxiolytics, and antipsychotics. We will consider further covariates, such as child sex, birth order, birth period, maternal and paternal mental health, and family socioeconomic status. For the two aims, we will use advanced statistical methods that mimic the conditions of clinical trials as if randomization had occurred. It will allow us to infer the causal effects of taking (or stopping) these medication on maternal and child suicidal behavior risk.
Potential impact and Next steps. This study will provide the most reliable evidence to date on this topic. It has therefore important implications for the refinement of clinical guidelines. It will help doctors and patients to make informed decisions about whether or not to use psychotropic medications during pregnancy, but also about whether or not discontinue treatments initiated before pregnancy. Ultimately, this research aims to reduce the risk of suicide by improving mental health care for both mothers and their children, benefitting individuals, families, and society as a whole.
