Silent suicide: suicide among people not in contact with mental health services

The evidence relating postpartum mood disorder to endocrine factors is reviewed, with particular reference to thyroid hormones, progesterone, cortisol and oestrogen. The findings on non-psychotic depression and thyroid dysfunction are the most robust, but such biological changes have to be seen as interacting with psychological and social factors to produce depression. Hormone treatment trials in specific subgroups of postnatal women would enhance our understanding of aetiology