@article{ref1,
title="Menopausal hormone therapy and suicide in a national sample of midlife and older women veterans",
journal="Medical care",
year="2021",
author="Byers, Amy L. and Seal, Karen H. and Self, Kyle J. and Jasuja, Guneet K. and Li, Yixia and Gibson, Carolyn J.",
volume="59",
number="",
pages="S70-S76",
abstract="BACKGROUND: Among midlife and older women, menopause symptoms and menopausal hormone therapy have been linked to mental health disorders and other comorbidities related  to suicide. However, the role of hormone therapy as a prognostic factor of suicide  risk is largely unknown. <br><br>OBJECTIVES: To examine associations between menopausal  hormone therapy, suicide attempts, and suicide among midlife and older women  Veterans. RESEARCH DESIGN: In this longitudinal analysis of national Veterans Health  Administration data from women Veterans aged 50 years and above, we used Fine-Gray  proportional hazards models to examine associations between menopausal hormone  therapy (prescribed in 2012-2013) and incident suicide attempts and suicide (index  date-2016). MEASURES: Menopausal hormone therapy and psychoactive medications from  pharmacy records; suicide attempts and suicide from national suicide data  repositories; demographic variables, medical and psychiatric diagnoses, and  substance use disorders from electronic medical record data and International  Classification Diagnoses-9-CM codes. <br><br>RESULTS: In this national sample of 291,709  women Veterans (mean age 60.47, SD 9.81), 6% were prescribed menopausal hormone  therapy at baseline. Over an average of 4.5 years, 2673 had an incident suicide  attempt (93%) or death by suicide (7%). Adjusting for age, race, and medical  diagnoses, menopausal hormone therapy was associated with increased risk of suicide  attempt (hazard ratio 1.41; 95% confidence interval, 1.22-1.64) and over 2-fold  increased risk of death by suicide (hazard ratio 2.47; 95% confidence interval,  1.58-3.87). Associations with death by suicide remained significant after accounting  for psychiatric comorbidity and psychoactive medications. <br><br>CONCLUSIONS: Menopausal  hormone therapy may be an important indicator of suicide risk among midlife and  older women.<p /> <p>Language: en</p>",
language="en",
issn="0025-7079",
doi="10.1097/MLR.0000000000001433",
url="http://dx.doi.org/10.1097/MLR.0000000000001433"
}