Citation

Hirakawa H, Ishii N. Lancet Psychiatry 2020; 7(3): 236-237.

Affiliation

Department of Neuropsychiatry, Faculty of Medicine, Oita University, Oita 879-5593, Japan.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/S2215-0366(19)30519-X

PMID

32087804

Abstract

We read with interest the Article by Julia Steinberg and colleagues in The Lancet Psychiatry,1 in which the authors examined the risk of first suicide attempt before and after abortion, adjusting for age, calendar year, socioeconomic status, history of childbirth, mental health, parental mental health, and physical health. The authors concluded that women who had abortions had a higher risk of non-fatal suicide attempts compared with women who did not have an abortion. Furthermore, they also concluded that heightened suicide attempts are not caused by abortion, but by differences in other risk factors related to suicide attempts. As a suggestion, we think that the authors should pay more attention to bipolar disorder.

Bipolar disorder is characterised by fluctuations in mood state and energy, whereby patients experience recurrent manic or hypomanic episodes and depression.2 Hypersexuality during manic and hypomanic episodes is associated with sexual risk behaviour (eg, unprotected sex, unplanned pregnancies, abortions, and sexually transmitted infections).3, 4 In women who have bipolar disorder, fluctuations in sex-related hormones are associated with an increased risk of affective dysregulation in response to reproductive events across their lifespan.5 Additionally, the incidence of suicide attempt in patients with bipolar disorder is high, and about a third to a half of patients with bipolar disorder attempt suicide at least once in their lifetime.2
Therefore, some of the women included in this study who had abortions and who had suicide attempts might have bipolar disorder. However, the prescription data the authors used to assess the patients' history of mental health did not include the term mood stabiliser, which is the main medication prescribed for bipolar disorder ...

Language: en