Birth Control Pill and Teen Suicide

The American College of Pediatricians (ACPeds) notes with interest the recent study published in the American Journal of Psychiatry (1) documenting an increased risk factor of suicide – nearly doubled (RR 2.06) for suicide attempts and more than tripled (RR 3.08) for successful suicide – among adolescent girls who use hormonal contraceptives.

This study did not determine whether the girls in the study were sexually active. While sexually active girls are more likely than virgins to be using the pill, virgins too may use the pill for non-contraceptive reasons such as painful menstrual periods. Failure to document the girls’ sexual history is an important confounding factor because sexual activity during adolescence has been established as an independent risk factor for suicide among teen girls. (2) Consequently, it is possible that the increased suicide rate is due solely to the adolescent sexual activity. Alternatively, it may be that sexual activity and hormonal contraception are independent and potentially additive, risk factors for adolescent suicide.

The authors of this study noted that the association between hormonal contraceptive use and increased suicide persisted (though to a lower degree) in older women (RR1.6), thus suggesting that the increased risk they found was not due solely to sexual activity.  Although the authors note that most girls do not use hormonal contraceptives at first sexual encounter (1), it must be recognized that first sexual encounter does not encompass all sexual activity.  The only study found comparing hormonal versus non-hormonal contraceptives (IUDs and diaphragms) showed no difference in suicide rates. (3)

While more study is needed to elucidate whether the primary cause for the increased suicide among adolescent girls is the use of hormonal contraceptives, the sexual activity itself, or both, it is important to recognize that hormonal contraceptives are associated with a much higher suicide risk. This has public policy implications, since sexual activity is associated with an increased use of hormonal contraceptives, and sexual education programs promoting their use may be placing adolescents at greater risk. Furthermore, all adolescents taking hormonal contraceptives should be under the care of a physician, and the easy availability of hormonal contraception, either over-the-counter or through electronic apps, (4) risks the lives of our adolescents.

 

References

(1) Skovlund CW, Mørch LS, Kessing V, et al., Association of hormonal contraception with suicide attempts and suicides. American Journal of Psychiatry. November 17, 2017.Accessed 12/5/2017 at https://doi.org/10.1176/appi.ajp.2017.17060616.

(2)  Hallfors DD, Waller MW, Ford CA, Halpern CT, and Brodish PH, Iritani B. “Adolescent Depression and Suicide Risk: Association with Sex and Drug Behavior. American Journal of Preventative Medicine27 (2004): 224-230.

(3) Vessey MP, Villard-Mackintosh L, McPherson K et a; Mortality among oral contraceptive users: 20- year follow up of women in a cohort study.
BMJ 1989; 299:1487-1491.

(4) American College of Pediatricians November 2017 Press Release on Nurx: Accessed 12/5/2017 at https://www.acpeds.org/uber-for-birth-control-dangerous-for-teens.

 

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