Use of hormonal contraceptives and antidepressants and risks of suicidal behavior and accidents among women with premenstrual disorders: a nationwide cohort study

Table 4 Associations of use of hormonal contraceptives and antidepressants with subsequent risk of suicidal behavior among women with premenstrual disorders (PMDs), stratified by psychiatric comorbidities

	Events	Between-individual analysis	Within-individual analysis
	N (IR)	IRR (95% CIs)^a	IRR (95% CIs)^b
Hormonal contraceptives
*Without psychiatric comorbidities*
No use	161 (1.5)	Ref	Ref
Use	24 (1.6)	0.70 (0.40–1.24)	0.40 (0.24–0.69)
*With psychiatric comorbidities*
No use	648 (47.9)	Ref	Ref
Use	99 (52.9)	0.77 (0.39–1.50)	0.74 (0.56–0.98)
*P for interaction*		0.830	0.043
Antidepressants
*Without psychiatric comorbidities*
No use	91 (0.9)	Ref	Ref
Use	94 (3.8)	4.66 (3.29–6.62)	2.76 (1.95–3.93)
*With psychiatric comorbidities*
No use	289 (30.2)	Ref	Ref
Use	458 (78.7)	2.78 (1.89–4.09)	1.79 (1.48–2.16)
*P for interaction*		0.048	0.030

CI, confidence interval; IR, crude incidence rate per 1 000 person-years; IRR, incidence rate ratio; N, number
^aUse of hormonal contraceptives and antidepressants were mutually adjusted for and the analysis was accounted for non-independence of follow-ups contributed by a same individual using robust sandwich estimator of variance. Estimates were also adjusted for age at follow-up, educational level (primary school, high school, or college and beyond), country of birth (Sweden or other), region of residency (south, middle, or north of Sweden), and psychiatric comorbidities (yes or no)
^bUse of hormonal contraceptives and antidepressants were mutually adjusted for and the analysis was conditioned on each individual. Estimates were also adjusted for age at follow-up and psychiatric comorbidities (yes or no)

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