SSRIs and risk of suicide attempts in young people - A Danish observational register-based historical cohort study, using propensity score
SSRIs and risk of suicide attempts in young people - A Danish observational register-based historical cohort study, using propensity score
复制标题
DOI：
10.3109/08039488.2015.1065291
复制
发表时间：
2016-04-02
影响因子：
1.8
通讯作者：
Stenager, Elsebeth
中科院分区：
文献类型：
--
作者：
Christiansen, Erik;Agerbo, Esben;Stenager, Elsebeth
背景：SSRIs被广泛应用于儿童和成人精神疾病的治疗。研究发现，使用SSRIs类药物的年轻人产生自杀念头和自杀企图的风险略有增加，但SSRIs类药物对青少年自杀风险的影响尚未得到证实。目的：有没有迹象表明SSRIs可能会增加年轻人自杀企图的风险？方法：我们采用基于观察性登记的历史队列设计，对1983-1989年出生的所有丹麦人（n = 392,458）进行大队列研究，并采用倾向评分法分析SSRIs对自杀企图风险的影响。用Cox回归分析每例自杀企图和SSRIs的赎回处方。结果：我们发现赎回SSRIs处方和随后的自杀企图之间有明显的重叠。自杀企图的风险在第一次服药后的前3个月最高。赎回处方后自杀企图的风险比估计为5.23,95% CI 4.82-5.68。结论：我们得出的结论是，与没有服用SSRIs的人相比，年轻人在第一次服用SSRIs后的头几个月里自杀企图的风险更高。对于倾向得分较低的SSRI使用者（SSRIs的风险因素较少），自杀企图的风险估计最高。虽然设计可能会遗漏一些明确的处方SSRIs的原因，并且SSRIs可能是高危人群的标志而不是因果风险因素，但我们建议在赎回第一次处方后进行系统的风险评估。
Background: SSRIs are widely used in the treatment of mental illness for both children and adults. Studies have found a slightly increased risk of suicidal thoughts and suicide attempts in young people using SSRIs but SSRIs' impact on risk for suicides in youth is not well-established. Aim: Is there indication that SSRIs might raise risk for suicide attempts in young people? Methods: We used an observational register-based historical cohort design, a large cohort of all Danish individuals born in 1983-1989 (n = 392,458) and a propensity score approach to analyse the impact from SSRIs on risk for suicide attempts. Every suicide attempt and redeemed prescription of SSRIs was analysed by Cox regression. Results: We found a significant overlap between redeeming a prescription on SSRIs and subsequent suicide attempt. The risk for suicide attempt was highest in the first 3 months after redeeming the first prescription. The hazard ratio for suicide attempts after redeeming a prescription was estimated to 5.23, 95% CI 4.82-5.68. Conclusion: We conclude that the risk of suicide attempt is higher for young people in the first months after redeeming their first prescription for SSRIs, compared to non-users. For SSRI users with lower propensity score (fewer risk factors for SSRIs) the risk of suicide attempt is estimated to be highest. Although the design may miss some explicit reason for prescription of SSRIs and SSRIs might be a marker for those in high risk rather than a causal risk factor, we would recommend systematic risk assessment in the period after redeeming the first prescription.