Abstract
We used national Swedish registry data to investigate the nature of the association between pregnancy and decreased risk for suicide attempt (SA). Analyses included pregnant individuals aged 18–35, biological fathers, and matched controls born 1975–1995. Data were available for between 366,125 and 2,129,244 females (depending on the model) and 359,622 males. We evaluated risk for SA as a function of pregnancy status using three methods designed to strengthen causal inference: a matched cohort design, co-relative analyses, and within-individual analyses. In within-individual analyses, we also examined potential moderators of the pregnancy-SA association, and we conducted separate analyses in the unborn children’s biological fathers. Across all analyses, pregnancy was associated with a lower risk of SA (ORs = 0.15–0.30). Moderation analyses indicated that the potentially protective effect of pregnancy was stronger in unmarried individuals, those with prior registration for externalizing or internalizing disorders, and younger individuals. Decreased SA risk was also observed during the postpartum period (ORs = 0.16–0.31) and in biological fathers (ORs = 0.67–0.82). These findings suggest that risk for non-fatal SA is substantially lower during pregnancy in expectant mothers and fathers, and the association between pregnancy and reduced SA risk may be causal.
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Data availability
The Swedish registry data are not publicly available. However, we are willing to share the code related to the present project. Please contact Dr. Henrik Ohlsson (henrik.ohlsson@med.lu.se) for any questions related to the analyses.
References
Servin-Barthet, C. et al. The transition to motherhood: Linking hormones, brain and behaviour. Nat. Rev. Neurosci. 24(10), 605–619. https://doi.org/10.1038/s41583-023-00733-6 (2023).
Brandon, A. R., Pitts, S., Denton, W. H., Stringer, C. A. & Evans, H. M. A history of the theory of prenatal attachment. J Prenat Perinat Psychol Health APPPAH 23(4), 201–222 (2009).
Gioia, M. C. et al. The relationship between maternal-fetus attachment and perceived parental bonds in pregnant women: Considering a possible mediating role of psychological distress. Front Psychol. 13, 1095030. https://doi.org/10.3389/fpsyg.2022.1095030 (2022).
Rosa, KMda et al. Maternal-fetal attachment and perceived parental bonds of pregnant women. Early Hum. Dev. 154, 105310. https://doi.org/10.1016/j.earlhumdev.2021.105310 (2021).
Edwards, A. C. et al. Protective effects of pregnancy on alcohol use disorder risk. Am. J. Psychiatry. 176(2), 138. https://doi.org/10.1176/appi.ajp.2018.18050632 (2018).
Pinto, E., Barros, H. & dos Santos Silva, I. Dietary intake and nutritional adequacy prior to conception and during pregnancy: A follow-up study in the north of Portugal. Public Health Nutr. 12(7), 922–931. https://doi.org/10.1017/S1368980008003595 (2009).
Harrison, P. A. & Sidebottom, A. C. Alcohol and drug use before and during pregnancy: An examination of use patterns and predictors of cessation. Matern. Child Health J. 13(3), 386–394. https://doi.org/10.1007/s10995-008-0355-z (2009).
Kendler, K. S., Ohlsson, H., Svikis, D. S., Sundquist, K. & Sundquist, J. The protective effect of pregnancy on risk for drug abuse: A population, co-relative, co-spouse, and within-individual analysis. Am. J. Psychiatry. 174(10), 954. https://doi.org/10.1176/appi.ajp.2017.16091006 (2017).
Román-Gálvez, M. R. et al. Caffeine intake throughout pregnancy, and factors associated with non-compliance with recommendations: A cohort study. Nutrients 14(24), 5384. https://doi.org/10.3390/nu14245384 (2022).
Appleby, L. Suicide during pregnancy and in the first postnatal year. BMJ 302(6769), 137–140. https://doi.org/10.1136/bmj.302.6769.137 (1991).
Marzuk, P. M. et al. Lower risk of suicide during pregnancy. Am J Psychiatry. 154(1), 122–123. https://doi.org/10.1176/ajp.154.1.122 (1997).
Lindahl, V., Pearson, J. L. & Colpe, L. Prevalence of suicidality during pregnancy and the postpartum. Arch. Womens Ment. Health 8(2), 77–87. https://doi.org/10.1007/s00737-005-0080-1 (2005).
Gissler, M., Berg, C., Bouvier-Colle, M. H. & Buekens, P. Injury deaths, suicides and homicides associated with pregnancy, Finland 1987–2000. Eur. J. Public Health 15(5), 459–463. https://doi.org/10.1093/eurpub/cki042 (2005).
Khalifeh, H., Hunt, I. M., Appleby, L. & Howard, L. M. Suicide in perinatal and non-perinatal women in contact with psychiatric services: 15 year findings from a UK national inquiry. Lancet Psychiatry 3(3), 233–242. https://doi.org/10.1016/S2215-0366(16)00003-1 (2016).
Ayre, K., Gordon, H. G., Dutta, R., Hodsoll, J. & Howard, L. M. The prevalence and correlates of self-harm in the perinatal period: A systematic review. J. Clin. Psychiatry 81(1), 15343. https://doi.org/10.4088/JCP.19r12773 (2019).
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based injury statistics query and reporting system (WISQARS). Published online 2022. Accessed January 8, 2025. www.wisqars.cdc.gov
Kendell, R. E. Suicide in pregnancy and the puerperium. BMJ 302(6769), 126–127 (1991).
Linehan, M. M., Goodstein, J. L., Nielsen, S. L. & Chiles, J. A. Reasons for staying alive when you are thinking of killing yourself: The reasons for living inventory. J. Consult. Clin. Psychol. 51(2), 276–286 (1983).
Klonsky, E. D. & May, A. M. The three-step theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. Int. J. Cogn. Ther. 8(2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114 (2015).
Joiner, T. Why people die by suicide (Harvard University Press, Cambridge, 2005).
Van Orden, K. A. et al. The interpersonal theory of suicide. Psychol. Rev. 117(2), 575–600. https://doi.org/10.1037/a0018697 (2010).
O’Connor, R. C. Towards an integrated motivational-volitional model of suicidal behaviour. In International handbook of suicide prevention: Research, policy and practice 181–198 (2011).
Xie, F. et al. Association between physical activity and infertility: A comprehensive systematic review and meta-analysis. J. Transl. Med. 20, 237. https://doi.org/10.1186/s12967-022-03426-3 (2022).
Grasdalsmoen, M., Eriksen, H. R., Lønning, K. J. & Sivertsen, B. Physical exercise, mental health problems, and suicide attempts in university students. BMC Psychiatry 20, 175. https://doi.org/10.1186/s12888-020-02583-3 (2020).
Arnone, D. et al. Risk of suicidal behavior in patients with major depression and bipolar disorder—A systematic review and meta-analysis of registry-based studies. Neurosci. Biobehav. Rev. 159, 105594. https://doi.org/10.1016/j.neubiorev.2024.105594 (2024).
Liao, T. et al. Preconception depression reduces fertility: A couple-based prospective preconception cohort. Hum. Reprod. Open 2024(3), hoae032. https://doi.org/10.1093/hropen/hoae032 (2024).
White, M. A., Wilson, M. E., Elander, G. & Persson, B. The Swedish family: Transition to parenthood. Scand. J. Caring Sci. 13(3), 171–176 (1999).
Wilson, M. E. et al. Family dynamics, parental-fetal attachment and infant temperament. J. Adv. Nurs. 31(1), 204–210. https://doi.org/10.1046/j.1365-2648.2000.01245.x (2000).
Lorensen, M., Wilson, M. E. & White, M. A. Norwegian families: Transition to parenthood. Health Care Women Int. 25(4), 334–348. https://doi.org/10.1080/07399330490278394 (2004).
Cnattingius, S. et al. The Swedish medical birth register during five decades: Documentation of the content and quality of the register. Eur. J. Epidemiol. 38(1), 109–120. https://doi.org/10.1007/s10654-022-00947-5 (2023).
Ekbom, A. The Swedish multi-generation register. In Methods in biobanking (ed. Dillner, J.) 215–220 (Humana Press, 2011). https://doi.org/10.1007/978-1-59745-423-0_10.
Ludvigsson, J. F. et al. Registers of the Swedish total population and their use in medical research. Eur. J. Epidemiol. 31(2), 125–136. https://doi.org/10.1007/s10654-016-0117-y (2016).
Edwards, A. C. et al. On the genetic and environmental relationship between suicide attempt and death by suicide. Am. J. Psychiatry. https://doi.org/10.1176/appi.ajp.2020.20121705 (2021).
Björkenstam, C., Kosidou, K., Björkenstam, E. Childhood adversity and risk of suicide: cohort study of 548 721 adolescents and young adults in Sweden. Published online April 19. https://doi.org/10.1136/bmj.j1334 (2017).
Chen, Q. et al. Predicting suicide attempt or suicide death following a visit to psychiatric specialty care: A machine learning study using Swedish national registry data. PLoS Med. 17(11), e1003416. https://doi.org/10.1371/journal.pmed.1003416 (2020).
Bittár, N. H., Falkstedt, D. & Wallin, A. S. How intelligence and emotional control are related to suicidal behavior across the life course—A register-based study with 38-year follow-up. Psychol. Med. 50(13), 2265–2271. https://doi.org/10.1017/S0033291719002423 (2020).
Kendler, K. S., Ohlsson, H., Sundquist, J. & Sundquist, K. Family genetic risk scores and the genetic architecture of major affective and psychotic disorders in a Swedish national sample. JAMA Psychiat. 78(7), 7. https://doi.org/10.1001/jamapsychiatry.2021.0336 (2021).
Kendler, K. S. et al. Genetic liability to suicide attempt, suicide death, and psychiatric and substance use disorders on the risk for suicide attempt and suicide death: A Swedish national study. Psychol. Med. 53(4), 1639–1648. https://doi.org/10.1017/S0033291721003354 (2023).
Stuart, E. A. Matching methods for causal inference: A review and a look forward. Stat. Sci. 25(1), 1–21. https://doi.org/10.1214/09-STS313 (2010).
D’Onofrio, B. M., Lahey, B. B., Turkheimer, E. & Lichtenstein, P. Critical need for family-based, quasi-experimental designs in integrating genetic and social science research. Am. J. Public Health. 103(Suppl 1), Suppl 1. https://doi.org/10.2105/AJPH.2013.301252 (2013).
Maclure, M. & Mittleman, M. A. Should we use a case-crossover design?. Annu. Rev. Public Health 21, 193–221. https://doi.org/10.1146/annurev.publhealth.21.1.193 (2000).
Lahey, B. B. & D’Onofrio, B. M. All in the family: Comparing siblings to test causal hypotheses regarding environmental influences on behavior. Curr. Dir. Psychol. Sci. 19(5), 5. https://doi.org/10.1177/0963721410383977 (2010).
Kendler, K. S., Ohlsson, H., Sundquist, K. & Sundquist, J. The causal nature of the association between neighborhood deprivation and drug abuse: A prospective national Swedish co-relative control study. Psychol. Med. 44(12), 2537. https://doi.org/10.1017/S0033291713003048 (2014).
Sharma, R., Biedenharn, K. R., Fedor, J. M. & Agarwal, A. Lifestyle factors and reproductive health: Taking control of your fertility. Reprod. Biol. Endocrinol. 11, 66. https://doi.org/10.1186/1477-7827-11-66 (2013).
Kendler, K. S. & Gardner, C. O. Interpretation of interactions: Guide for the perplexed. Br. J. Psychiatry 197(3), 170–171. https://doi.org/10.1192/bjp.bp.110.081331 (2010).
Franklin, J. C. et al. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol. Bull. 143(2), 187–232. https://doi.org/10.1037/bul0000084 (2017).
Gili, M. et al. Mental disorders as risk factors for suicidal behavior in young people: A meta-analysis and systematic review of longitudinal studies. J. Affect. Disord. 245, 152–162. https://doi.org/10.1016/j.jad.2018.10.115 (2019).
Stephenson, M., Prom-Wormley, E., Lannoy, S. & Edwards, A. C. The temporal relationship between marriage and risk for suicidal ideation. J. Affect. Disord. 343, 129–135. https://doi.org/10.1016/j.jad.2023.10.007 (2023).
Beghi, M. & Rosenbaum, J. F. Risk factors for fatal and nonfatal repetition of suicide attempt: A critical appraisal. Curr. Opin. Psychiatry 23(4), 349–355. https://doi.org/10.1097/YCO.0b013e32833ad783 (2010).
Lannoy, S. et al. Examining common and distinct contributions to the etiology of suicide attempt and reattempt. J. Psychopathol. Clin. Sci. 132(2), 165–172. https://doi.org/10.1037/abn0000802 (2023).
Nelson, H. D. et al. Associations of unintended pregnancy with maternal and infant health outcomes: A systematic review and meta-analysis. JAMA 328(17), 1714–1729. https://doi.org/10.1001/jama.2022.19097 (2022).
Bearak, J. et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: Estimates from a comprehensive model for 1990–2019. Lancet Glob. Health. 8(9), e1152–e1161. https://doi.org/10.1016/S2214-109X(20)30315-6 (2020).
Muskens, L. et al. The association of unplanned pregnancy with perinatal depression: A longitudinal cohort study. Arch. Womens Ment. Health. 25(3), 611. https://doi.org/10.1007/s00737-022-01225-9 (2022).
Hellerstedt, W. L. et al. Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies. Am. J. Public Health. 88(4), 663–666. https://doi.org/10.2105/ajph.88.4.663 (1998).
Durkheim, E. Suicide: A study in sociology (Snowball Publishing, California, 2012).
Funding
This study was supported by the National Institutes of Health (R01MH129356 to Alexis C. Edwards and K99AA030611 to Severine Lannoy) and the Swedish Research Council (2022–00812 to Kristina Sundquist).
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MS and SL contributed equally: They wrote the main manuscript text and prepared figures. HO, MS, SL, and AE designed the study aims and analytic approaches. HO conducted the analyses, while JS and KS ensured data access. All authors participated in the results interpretation and in editing and writing of the manuscript.
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Stephenson, M., Lannoy, S., Ohlsson, H. et al. The protective effect of pregnancy on risk for suicide attempt in a Swedish national cohort. Sci Rep (2026). https://doi.org/10.1038/s41598-026-49192-w
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DOI: https://doi.org/10.1038/s41598-026-49192-w


