Association Between Parental Medical Claims for Opioid Prescriptions and Risk of Suicide Attempt by Their Children
Association Between Parental Medical Claims for Opioid Prescriptions and Risk of Suicide Attempt by Their Children
复制标题
DOI：
10.1001/jamapsychiatry.2019.0940
复制
发表时间：
2019-09-01
期刊：
影响因子：
25.8
通讯作者：
Gibbons, Robert D.
中科院分区：
文献类型：
--
作者：
Brent, David A.;Hur, Kwan;Gibbons, Robert D.
重要性过去15年来，美国青少年自杀率有所上升，父母年龄的成年人因阿片类药物过量而导致的死亡率也在上升。目的探讨父母使用处方阿片类药物与青少年自杀率上升之间的可能联系。设计、背景和参与者从2010年1月1日到2016年12月31日进行了一项药物流行病学研究，将父母开阿片类药物处方的医疗索赔与其子女自杀企图的医疗索赔联系起来。这项研究使用了MarketScan的医疗索赔数据，覆盖了美国超过1.5亿私人保险的人。这项研究包括121306名倾向分数匹配的30至50岁使用阿片类药物的父母和不使用阿片类药物的父母及其10至19岁的孩子(148395名未使用阿片类药物的父母的儿童和184142名使用阿片类药物的父母的儿童)。结果共有148395名儿童(75575名儿子和72820名女儿；平均[SD]年龄，随访开始时11.5[1.6]岁)父母没有使用阿片类药物，184142名儿童(94502名儿子和89640名女儿)的父母没有使用阿片类药物；184142名儿童(儿子94502名和女儿89640名)的父母没有使用阿片类药物；平均年龄[SD]，开始随访时为11.8[1.8]岁)，父母确实使用阿片类药物。有100899名10至14岁的儿童和47496名15至19岁的儿童的父母不使用阿片类药物，还有96975名10至14岁的儿童和87163名15至19岁的儿童的父母确实使用阿片类药物。在父母没有使用阿片类药物的儿童中，212人(0.14%)试图自杀；在父母确实使用阿片类药物的儿童中，678人(0.37%)试图自杀。父母使用阿片类药物与其子女企图自杀的风险增加一倍有关(优势比[OR]，1.99；95%CI，1.71-2.33)。在调整了儿童年龄和性别(OR，1.85；95%CI，1.58-2.17)、儿童和父母抑郁和药物使用障碍的诊断(OR，1.46；95%CI，1.24-1.72)和父母自杀未遂史(OR，1.45；95%CI，1.23-1.71)后，这种关联仍然显著。阿片类药物使用的地域差异没有改变这种关联(OR，2.00；95%CI，1.71-2.34)。结论父母使用处方类阿片类药物的儿童自杀企图的风险增加，这可能是青少年自杀行为时间趋势的一个促成因素。照顾父母使用阿片类药物的家庭应包括对其子女进行心理健康筛查。
IMPORTANCE The rate of youth suicide has increased over the past 15 years in the United States as has the rate of death due to opioid overdose in adults of parental age.OBJECTIVE To explore the possible connection between parental use of prescription opioids and the increasing rate of youth suicide.DESIGN, SETTING, AND PARTICIPANTS A pharmacoepidemiologic study was conducted from January 1, 2010, to December 31, 2016, linking medical claims for parental opioid prescriptions with medical claims for suicide attempts by their children. The study used MarketScan medical claims data covering more than 150 million privately insured people in the United States. The study included 121306 propensity score-matched 30- to 50-year-old parents who used opioids and parents who did not use opioids and their 10- to 19-year-old children (148395 children of parents who did not use opioids and 184142 children of parents who used opioids). Propensity score matching was used to identify relevant control families based on demographic features and concomitant use of psychotropic medication.EXPOSURES Opioid use in a parent was defined as having prescription fills covering more than 365 days of an opioid between 2010 and 2016.MAIN OUTCOMES AND MEASURES Suicide attempt rate in the children of parents who used opioids and those who did not use opioids.RESULTS A total of 148395 children (75575 sons and 72820 daughters; mean [SD] age, 11.5 [1.6] years at the start of follow-up) had parents who did not use opioids and 184142 children (94502 sons and 89640 daughters; mean [SD] age, 11.8 [1.8] years at the start of follow-up) with parents who did use opioids. There were 100899 children aged 10 to 14 years and 47496 children aged 15 to 19 years with parents who did not use opioids and 96975 children aged 10 to 14 years and 87163 children aged 15 to 19 years with parents who did use opioids. Of the children with parents who did not use opioids, 212 (0.14%) attempted suicide; of the children with parents who did use opioids, 678 (0.37%) attempted suicide. Parental use of opioids was associated with a doubling of the risk of a suicide attempt by their offspring (odds ratio [OR], 1.99; 95% CI, 1.71-2.33). The association remained significant after adjusting for child age and sex (OR, 1.85; 95% CI, 1.58-2.17), addition of child and parental depression and diagnoses of substance use disorder (OR, 1.46; 95% CI, 1.24-1.72), and addition of parental history of suicide attempt (OR, 1.45; 95% CI, 1.23-1.71). Geographical variation in opioid use did not change the association (OR, 2.00; 95% CI, 1.71-2.34).CONCLUSIONS AND RELEVANCE Children of parents who use prescription opioids are at increased risk for suicide attempts, which could be a contributing factor to the time trend in adolescent suicidality. The care of families with a parent who uses opioids should include mental health screening of their children.