Suicide attempts and unintentional injury among older Americans on psychotropics

美国老年人服用精神药物的自杀未遂和意外伤害

• 批准号: 7987507
• 负责人: Matthew J Miller
• 金额: $ 28.99万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7987507
• 关键词: Accidental Injury; Accounting; Acute; Address; Affinity; Age; Akathisia; American; Antidepressive Agents; Antipsychotic Agents; Arthritis; Cessation of life; Characteristics; Cohort Studies; Comorbidity; Comparative Study; Data; Data Set; Dementia; Demographic Factors; Dopamine D2 Receptor; Dose; Drug Prescriptions; Drug usage; Economics; Elderly; Failure; Fracture; Gender; Goals; Haloperidol; Healthcare; Heart Diseases; Hyperprolactinemia; Incidence; Injury; Managed Care; Measures; Medical; Mental disorders; Methods; Motor Vehicles; Nature; Nursing Homes; Orthostatic Hypotension; Outcome; Patients; Pharmaceutical Preparations; Physicians; Population; Preparation; Public Health; Regimen; Relative (related person); Relative Risks; Research; Research Support; Risk; Safety; Selective Serotonin Reuptake Inhibitor; Self-Injurious Behavior; Series; Severity of illness; Stroke; Suicide; Suicide attempt; Symptoms; Therapeutic; Time; Tricyclic Antidepressive Agents; United States; Vehicle crash; Work; age group; aged; atypical antipsychotic; base; beneficiary; bone; clinically relevant; cohort; comparative effectiveness; demineralization; design; effectiveness research; experience; falls; health care service utilization; high risk; novel; older patient; public health relevance; residence; sex; suicidal act; suicidal behavior

DESCRIPTION (provided by applicant): The proposed cohort study will use a large health care utilization data set and novel pharmacoepidemiologic methods to determine whether the risk of injury from falls, motor vehicle crashes, and suicidal behavior applies equally to all antidepressant (and antipsychotic) classes -- or whether there are particular regimens of antidepressants (and antipsychotics) with safety advantages that should be prescribed preferentially. Analyses will examine how the risk of injury depends on socio-demographic factors, co-morbidity, co-medication, dose and duration of use. The proposed study addresses many of the limitations of prior observational work, including failure to account for dose-related effects, duration of use, confounding by indication, physician channeling bias, and distortions resulting from prevalent user designs. Data for the current application comprise information about prescription drug use and both medical and psychiatric conditions (including unintentional injuries and suicide attempts) for an annual population of over 15 million beneficiaries aged 50 years and older who received prescription drug benefits from managed care plans throughout the United States, 1997-2009. Descriptive analyses comparing the risk of unintentional injury among patients taking antidepressants or antipsychotics to those not (aim1) will place in context the two key aims of this application: to compare the risk of injury due to falls, motor vehicle crashes, and suicidal behavior (the leading causes of injury deaths in older Americans) among initiators of 1) SSRI vs. TCA vs. SNRI antidepressants (aim 2), and 2) conventional vs. atypical antipsychotics (aim 3). The proposed research responds to the NIMH's Strategic Objective 4: "Strengthen the Public Health Impact of NIMH-Supported Research". The proposed series of comparative studies on treatment emergent injury-related outcomes will advance understanding of the public health influence of the most common strategies used today to treat mental illness among older Americans. Because the therapeutic superiority of particular antidepressant (and antipsychotic) preparations have not been established for the conditions these agents are commonly prescribed to treat, 1-5 the potential clinical and possibly economic benefits of the proposed work could be large, since use of these agents is common and the consequences of injuries due to falls, motor vehicle crashes, and suicidal behavior are particularly untoward among older adults. PUBLIC HEALTH RELEVANCE: The current application will use novel pharmacologic methods and a large health care data set of Americans aged 50 and older to determine whether the risk of injury from a) falls, b) motor vehicle crashes, and c) suicidal behavior applies equally to all antidepressant (and antipsychotic) classes -- or whether there are particular regimens of antidepressants (or antipsychotics) with safety advantages that should be prescribed preferentially. Analyses will examine whether, and if so, how the risk of injury depends on socio-demographic factors, co-morbidity, co-medication, dose and time since starting an antidepressant or antipsychotic.

描述（由申请人提供）：拟议的队列研究将使用大量医疗保健利用数据集和新的药物流行病学方法来确定跌倒、机动车碰撞和自杀行为的伤害风险是否同样适用于所有抗抑郁药（和抗精神病药）类别，或者是否存在具有安全优势的抗抑郁药（和抗精神病药）的特定方案，应该优先开处方。分析将检查伤害风险如何取决于社会人口因素、合并症、合用药物、剂量和使用时间。拟议的研究解决了先前观察工作的许多局限性，包括未能解释剂量相关效应、使用时间、适应症混淆、医生引导偏差以及流行用户设计导致的扭曲。当前申请的数据包括1997-2009年美国各地每年有1 500多万50岁及以上受益人从管理式护理计划中获得处方药福利的处方药使用情况以及医疗和精神状况（包括意外伤害和自杀企图）的信息。描述性分析比较服用抗抑郁药或抗精神病药的患者与未服用抗抑郁药或抗精神病药的患者意外伤害的风险（目的1）将在本应用程序的两个主要目的背景下进行：比较1)SSRI、TCA、SNRI抗抑郁药（目的2）和2)传统抗精神病药与非典型抗精神病药（目的3）的发起者中跌倒、机动车碰撞和自杀行为（美国老年人伤害死亡的主要原因）造成的伤害风险（目的2）。拟议的研究响应了NIMH的战略目标4：“加强NIMH支持的研究对公共卫生的影响”。提出的一系列关于治疗紧急伤害相关结果的比较研究将促进对当今用于治疗美国老年人精神疾病的最常见策略对公共卫生影响的理解。由于特定抗抑郁药（和抗精神病药）制剂的治疗优势尚未被确定用于这些药物通常用于治疗的病症，1-5拟议工作的潜在临床和可能的经济效益可能很大，因为这些药物的使用是常见的，并且由于跌倒，机动车碰撞和自杀行为造成的伤害的后果在老年人中特别不可取。