Research does not prove that birth control pills reduce the risk of suicide

An article on The Sun’s website is headlined: “Taking the pill could ‘save your life’ as fewer women attempt suicide, experts say”.

This headline is not an accurate representation of the (as yet unpublished) research cited in the article, which reports on a study examining possible links between hormonal contraceptives and suicide, and does not claim a causal relationship between the two.

Although the phrase “save your life” appears in the headline as if said by an expert, the article itself does not specifically attribute the phrase to anyone. dr Elena Toffol, the study’s lead researcher, told Full Fact the headline was an exaggeration of the results and not a quote from her.

Correlation is not causation

The study, submitted to the European Psychiatric Association but not yet published, used data from more than half a million women in Finland aged 15 to 49 to compare suicide attempt rates among those using hormonal contraceptives with those who who did not.

The study’s definition of hormonal contraception applied not only to the birth control pill, as The Sun’s headline suggests, but also to other birth control methods, including the implant and the intrauterine system (IUS).

She found 344 cases of attempted suicide in women who filled a prescription for hormonal contraceptives in 2017 and 474 cases of attempted suicide in women who didn’t. It therefore concluded that in Finland, women who did not use hormonal contraceptives were 37% more likely than women who did to attempt suicide over the following two years.

While this study found an association between hormonal contraceptive prescriptions and lower suicide attempts, it does not show that the birth control pill is responsible for reducing the risk of suicide, or that it “saves lives” by lowering the suicide attempt rate among women , as The Sun suggests.

It was not intended to prove a causal relationship between birth control pills and a lower risk of suicide. In a presentation at the European Congress of Psychiatry, Dr. Instead, Toffol said she set out to review previous data suggesting that hormonal birth control was plausibly associated with a higher risk of suicide. dr Toffol told Full Fact that her data instead indicated that use of hormonal contraceptives does not appear to be associated with an increased likelihood of attempting suicide.

When attempting to determine whether a factor caused a particular result, it is important to consider all other factors that may affect the results. dr Toffol confirmed that the study controlled for a number of risk factors, including psychiatric history, marital status, socioeconomic status, education, chronic illness and use of psychiatric drugs.

She said analysis of the study showed that hormonal contraceptives were not associated with an increased risk of suicide attempts in women with a psychiatric history and were associated with a lower risk in women with no history of suicide attempts.

However, it was not established whether contraceptive use was the reason for the lower risk of suicide.

Study not yet published

As the research has not yet been fully published, it is difficult to fully appreciate its methodological qualities and limitations.

However, a potential issue affecting the interpretation of the results is the categorization of contraceptive users and non-users in the study. dr Toffol told Full Fact that the non-user control group included women who were not prescribed hormonal birth control in 2017 or who were prescribed hormonal birth control but had not taken it.

However, this means that some of the control group of non-users may have been using contraceptives before 2017, which may obscure the link between contraceptive use and suicide risk. Some previous large studies looking at the link between hormonal contraceptives and suicide analyzed data over a much longer period of time.

dr Toffol told Full Fact that this is because “information about filled prescriptions for hormonal contraceptives was not available in Finland before 2017.”

The study compared the suicide rate between women who filled a prescription for birth control and those who didn’t, but it’s unclear whether all of these women who filled a prescription continued to use birth control, used it correctly, or for how long they used it for.

dr However, Toffol also said the study covered a wider age range than previous studies.

Professor Andrea Fiorillo, Editor-in-Chief of the journal European Psychiatry, said: “This remarkable finding deserves careful evaluation and needs to be replicated in different cohorts of women and controlled for the impact of multiple psychosocial stressors such as economic upheaval, social insecurity and insecurity due to the COVID pandemic . The clinical implications of the study are evident and may help destigmatize hormonal contraceptive use.”

Image courtesy of the Reproductive Health Supplies Coalition

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