Correlation

A new report projects more than 1.6 million deaths due to drugs, alcohol, and suicide among people living in the United States during next decade (2016 to 2025). That would represent a 60% increase compared to the previous decade (2006 to 2015), which saw 1 million people die from drugs, alcohol, and suicide in the United States.
“These estimates may actually be conservative, as the rapid rise of heroin, fentanyl, and carfentanil use are pushing the numbers higher and faster, where deaths over the next decade could actually double to 2 million by the year 2025,” John Auerbach, president and CEO of Trust for America’s Health (TFAH), said during a media briefing today.
“With the rise in deaths from drug overdoses, alcohol-induced causes, and suicide, it’s not surprising that life expectancy in the country decreased in 2015 for the first time in 2 decades,” said Auerbach said.
The report, Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy, was released today by TFAH and Well Being Trust. It is based on an analysis of data from the Centers for Disease Control and Prevention conducted by the Berkeley Research Group.

Is not causation: the risk for hormonal contraception would need be around 1enfold or greater to speculate this is causal.

The risk for suicide attempt varied by type of hormonal contraception. Relative risk estimates were 1.91 (95% confidence interval [CI], 1.79 – 2.03) for oral combined products, 2.29 (95% CI, 1.77 – 2.95) for oral progestin-only products, 2.58 (95% CI, 2.06 – 3.22) for vaginal ring, and 3.28 (95% CI, 2.08 – 5.16) for the patch.
The association between hormonal contraceptive use and a first suicide attempt peaked after 2 months of use; a decreasing trend was noted after 1 year of use.
“The decrease in risk estimates for suicide attempt after 1 year of use was probably due to out-selection of women who develop adverse mood reactions after initiation of hormonal contraception,” the researchers write.

The question from the paper (after carefully discussing confounding variables such as indication for prescribing contraceptives, co occurring depression and serious mental illness) relates to the size of this effect. From a population point of view it is small: from the individual and family view it is great.

The base rate of suicide is about 10 per 100 000, or 100 per million. The rate in women in NZ is generally half that, or 50 per million.

Assuming that the demonstrated associations are causal, the absolute increase in events due to use of hormonal contraception in our study population of previously mentally healthy women would be 1,400 additional first suicide attempts and 12 additional suicides per 1 million person-years. More awareness of possible mood implications from exogenous female sex hormones is warranted. Considering the severity of these little-recognized potential side effects of hormonal contraceptives, health professionals and women starting hormonal contraceptives should be informed about them.

For the families effected, the low odds are meaningless. They are grieving. For that reason, we should warn young women: these pills could increase our risk of sucide by about 20%/