Fig. 3

Summary of findings. This chart summarizes the results for our primary outcomes (namely, the first diagnosis of any depressive, anxiety or adjustment disorder, or an antidepressant medication redemption (the individual diagnostic and medication components comprising the outcomes are detailed in the respective tables). All hazard ratios (HRs) are propensity score weighted; a HR > 1 indicates that SSRI exposure is associated with greater risk for the outcome; <1 would indicate lower risk. We find that overall, SSRI exposure overall is associated with a 1.5 fold increased risk for our primary psychiatric outcome (top, details in Table 2); [2] that this association is found in both female and male children (Table S5); [3] that it is observed in each trimester of use (Table S10) and [4] that the risk of the primary outcome is greater in children who were exposed to SSRIs in utero than those who whose mothers had previously used an SSRI but discontinued it prior to pregnancy (Table S7), and to those whose mothers had a documented psychiatric disorder during pregnancy but no medication (Table S6). Finally, we found that maternal SSRI use only after (but no during) pregnancy (Table S12), and paternal SSRI use during a corresponding pregnancy when the mother did not use SSRI (Table S11) were also associated with increased risk in the children. These findings collectively lead us to conclude that whereas SSRI exposure is associated with worse outcomes related to depressive and anxiety disorders and their treatment, in the children, these are not likely to be driven primarily by the medication, but rather by parental illness severity or other confounders