Suicide attempts among patients starting depression treatment with medications or psychotherapy
Suicide attempts among patients starting depression treatment with medications or psychotherapy
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DOI：
10.1176/appi.ajp.164.7.1029
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发表时间：
2007-07-01
影响因子：
17.7
通讯作者：
Savarino, James
中科院分区：
文献类型：
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作者：
Simon, Gregory E.;Savarino, James
目的：本研究比较了开始药物治疗或心理治疗的门诊抑郁症患者自杀企图的时间模式。方法：来自预付健康计划的门诊索赔被用来识别从初级保健中的抗抑郁药处方开始的抑郁症治疗的新发作（N= 70，368），精神科医生开具的抗抑郁药处方（N= 7，297），或初次心理治疗访视（N= 54，123）。门诊和住院患者的索赔被用来确定自杀企图或可能的自杀企图在90天前和180天后开始治疗。在接受精神科医生开的抗抑郁药处方的患者中，自杀企图的总体发生率最高（1，124/100，000），在开始心理治疗的人中较低（778/100，000），在初级保健中接受抗抑郁药处方的人中最低（301/100，000）。所有三组的尝试模式都是相同的：开始治疗前一个月最高，开始治疗后一个月次高，此后下降。在排除接受药物和心理治疗重叠治疗的患者后，结果没有变化。自杀企图的总体发病率在青少年和年轻人中较高，但时间模式在所有三种treatment.Conclusions：自杀企图的模式之前和之后开始抗抑郁药治疗是不特定的药物。治疗之间的差异和随时间的变化可能反映了转诊模式和治疗开始后自杀意念的预期改善。
Objective: This study compared the time patterns of suicide attempts among outpatients starting depression treatment with medication or psychotherapy.Method: Outpatient claims from a prepaid health plan were used to identify new episodes of depression treatment beginning with an antidepressant prescription in primary care (N=70,368), an antidepressant prescription from a psychiatrist (N=7,297), or an initial psychotherapy visit (N=54,123). Outpatient and inpatient claims were used to identify suicide attempts or possible suicide attempts during the 90 days before and 180 days after the start of treatment.Results: Overall incidence of suicide attempt was highest among patients receiving antidepressant prescriptions from psychiatrists (1,124 per 100,000), lower among those starting psychotherapy (778 per 100,000), and lowest among those receiving antidepressant prescriptions in primary care (301 per 100,000). The pattern of attempts over time was the same in all three groups: highest in the month before starting treatment, next highest in the month after starting treatment, and declining thereafter. Results were unchanged after eliminating patients receiving overlapping treatment with medication and psychotherapy. overall incidence of suicide attempt was higher in adolescents and young adults, but the time pattern was the same across all three treatments.Conclusions: The pattern of suicide attempts before and after starting antidepressant treatment is not specific to medication. Differences between treatments and changes over time probably reflect referral patterns and the expected improvement in suicidal ideation after the start of treatment.