The Lancet (Psychiatry), as usual in scientific journals, allows comments on articles published in the form of letters to the director, which must be sent within 4 weeks of publication. This is the correspondence I had with them.
- January 1, 2020 [Emilio J Alegre del Rey]:
- January 2, 2020 (9:36h GMT) [speedy Lancet]:
Manuscript reference number: thelancetpsych-D-20-00001 [I was the first in 2020 :)]
Title: Abortion and suicide
Dear Mr. Alegre-del-Rey,
Thank you for your recent submission to The Lancet Psychiatry. We have now had time to consider your manuscript. Your point about completed suicides was raised during the peer review process. The authors made it very clear, as you state, that they were looking at non-fatal suicide and gave their reasons. We found these satisfactory. We therefore do not think your letter adds sufficiently to the published article and have decided not to publish it. Although this decision has not been a positive one, I thank you for your interest in the journal and hope it does not deter you from considering us again in the future.
Yours sincerely,
Joan Marsh MA PhD Deputy Editor
- January 2, 2020 (13:49 GMT) [Emilio J Alegre del Rey]:
Dear Mrs. Joan,
Thank you very much for your quick review. However, I think that precisely because it is an issue that you considered in the peer-review, it could be debatable, and it would be an exercise in scientific transparency to give voice to other opinions. In addition, although it is true that the authors do not hide that their research is restricted to failed suicide attempts, this restriction is not taken into account when issuing their categorical conclusions, and this also seems remarkable and debatable.
Yours,
Emilio Alegre
- End of correspondence. Today is January 10, 2020.
- January 1, 2020 [Emilio J Alegre del Rey]:
Abortion and suicide
In the article by Steinberg et al. on abortion and suicide (1), the
exposure of previous literature omitted relevant evidence, as the study by
Gissler et al., which showed, with data from the Finnish registry, a
significant difference between suicides (consummated) in the first year after
pregnancy in women who have aborted versus those who have given birth to their
children (31.9 vs. 5.0 per 100,000 pregnancies; p<0 .001="" br="">
The new investigation focused only on failed attempts. It was explained based on the design of the analyses, which compares the suicide events before vs. after the abortion, and obviously would be impossible for fatal suicide as an event. However, the methodology should be subordinate to what is intended to be measured.
The new investigation focused only on failed attempts. It was explained based on the design of the analyses, which compares the suicide events before vs. after the abortion, and obviously would be impossible for fatal suicide as an event. However, the methodology should be subordinate to what is intended to be measured.
The annual incidence of attempted suicide found by Steinberg et al. in
women who aborted was 8.63 per thousand; the fatal suicides in the Finnish
study were 0.32 per thousand, a ratio of 1 to 27. This is similar to the
recorded fatality rate of suicide attempts in women (1 in 30) (3). It
highlights the problem of referring to non-fatal attempts: consummated suicides
are only a small part of suicide attempts (3%). Exclusively measuring nonfatal
ones could be diluting the effect and masking the trouble about fatalities.
The article presents the results of two study designs: a cohort study and a
descriptive before/after study. The cohort study is very interesting in adjustment
for covariates. However, the control group is simply made up of women who had
not an abortion, most of whom obviously were not even pregnant. This makes the
studied group different from the control not only in the fact of abortion, but
also in the fact of pregnancy. The results show a high association (OR 2.46)
between failed autolytic attempt and a pregnancy that ended in abortion, after
adjustment for numerous risk factors such as contact with psychiatric services,
psychiatric medication, comorbidities, parental mental health, and
socioeconomic status. It shows a female population with high autolytic risk
and, at the same time, with high risk of unwanted pregnancy and abortion.
The descriptive before/after study shows that this population at high risk
of failed autolysis had it before and after pregnancy and abortion, but that
does not rule out an increase in fatal attempts. In the conclusion, the
relationship between abortion and suicide is denied, forgetting the important
limitation that this research was only concerned with non-fatal attempts.
References
1. Steinberg JR, Laursen TM, Adler NE, Gasse C, Agerbo
E, Munk-Olsen T. The association between first abortion and first-time
non-fatal suicide attempt: a longitudinal cohort study of Danish population
registries. Lancet Psychiatry. 2019;6(12):1031-8.
2. Gissler M, Berg C, Bouvier-Colle MH, Buekens P.
Injury deaths, suicides and homicides associated with pregnancy, Finland
1987-2000. Eur J Public Health. 2005;15(5):459-63.
3. Conner A, Azrael D, Miller M. Suicide Case-Fatality
Rates in the United States, 2007 to 2014: A Nationwide Population-Based
Study. Ann Intern Med. 2019 Dec 3.
Manuscript reference number: thelancetpsych-D-20-00001 [I was the first in 2020 :)]
Title: Abortion and suicide
Dear Mr. Alegre-del-Rey,
Thank you for your recent submission to The Lancet Psychiatry. We have now had time to consider your manuscript. Your point about completed suicides was raised during the peer review process. The authors made it very clear, as you state, that they were looking at non-fatal suicide and gave their reasons. We found these satisfactory. We therefore do not think your letter adds sufficiently to the published article and have decided not to publish it. Although this decision has not been a positive one, I thank you for your interest in the journal and hope it does not deter you from considering us again in the future.
Yours sincerely,
Joan Marsh MA PhD Deputy Editor
- January 2, 2020 (13:49 GMT) [Emilio J Alegre del Rey]:
Dear Mrs. Joan,
Thank you very much for your quick review. However, I think that precisely because it is an issue that you considered in the peer-review, it could be debatable, and it would be an exercise in scientific transparency to give voice to other opinions. In addition, although it is true that the authors do not hide that their research is restricted to failed suicide attempts, this restriction is not taken into account when issuing their categorical conclusions, and this also seems remarkable and debatable.
Yours,
Emilio Alegre
- End of correspondence. Today is January 10, 2020.
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