Antidepressant treatment and suicide attempts and self-inflicted injury in children and adolescents.
Antidepressant treatment and suicide attempts and self-inflicted injury in children and adolescents.
复制标题
儿童和青少年的抗抑郁药治疗和自杀企图和自杀性伤害。
DOI：
10.1002/pds.3713
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发表时间：
2015-02
影响因子：
2.6
通讯作者：
Brent, David A.
中科院分区：
文献类型：
--
作者：
Gibbons, Robert D.;Perraillon, Marcelo Coca;Hur, Kwan;Conti, Rena M.;Valuck, Robert J.;Brent, David A.
关键词：
2004年，FDA对抗抑郁药对儿童和青少年自杀念头和行为的风险设置了黑框警告。本文的目的是在考虑时变混杂因素的情况下，在两个大型观察数据集中检查接受抗抑郁药物治疗的 5-17 岁抑郁儿童的自杀企图和自残风险。我们分析了美国两个大型医疗索赔数据库（MarketScan 和 LifeLink），其中包含 221,028 名新发抑郁症青少年（5 至 17 岁），他们在 2004 年至 2009 年期间接受或未接受抗抑郁治疗。受试者被跟踪长达 180 天。边际结构模型用于调整时间相关的混杂因素。对于这两个数据集，在未调整和简单协变量调整分析中，在抗抑郁治疗期间，自杀未遂和自伤的风险显着增加。边际结构模型显示，大部分关联是由治疗选择过程中的动态混杂产生的，并显示优势比接近 1.0，这与机会预期一致。患者在治疗选择过程中静态和动态特征的不平衡导致抗抑郁治疗与自杀企图和自伤之间出现关联。使用 MSM 来调整动态治疗选择可以调整这种不平衡，并可以解释为什么之前的一些观察性研究发现抗抑郁治疗与青少年自杀及相关行为之间存在正相关。
In 2004 FDA placed a black box warning on antidepressants for risk of suicidal thoughts and behavior in children and adolescents. The purpose of this paper is to examine the risk of suicide attempt and self-inflicted injury in depressed children ages 5–17 treated with antidepressants in two large observational datasets taking account time-varying confounding. We analyzed two large U.S. medical claims databases (MarketScan and LifeLink) containing 221,028 youth (ages 5–17) with new episodes of depression, with and without antidepressant treatment during the period of 2004–2009. Subjects were followed for up to 180 days. Marginal structural models were used to adjust for time-dependent confounding. For both datasets, significantly increased risk of suicide attempts and self-inflicted injury were seen during antidepressant treatment episodes in the unadjusted and simple covariate adjusted analyses. Marginal structural models revealed that the majority of the association is produced by dynamic confounding in the treatment selection process, and revealed odds ratios close to 1.0, which were consistent with chance expectations. The imbalance in both static and dynamic characteristics of patients in terms of the treatment selection process lead to the appearance of an association between antidepressant treatment and suicide attempts and self-inflicted injury. Use of MSM to adjust for dynamic treatment selection adjusts for this imbalance and may explain why some previous observational studies have found positive associations between antidepressant treatment and suicide and related behaviors in youth.
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