Suicide attempts and unintentional injury among older Americans on psychotropics

描述（申请人提供）：拟议的队列研究将使用大型医疗保健利用数据集和新型药物流行病学方法来确定福尔斯、机动车碰撞、自杀行为同样适用于所有抗抑郁药（和抗精神病药）类-或者是否有特定的抗抑郁药方案（和抗精神病药物）具有安全优势，应优先处方。分析将检查损伤风险如何取决于社会人口统计学因素、合并症、合并用药、剂量和使用持续时间。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、使用持续时间、适应症混淆、医生引导偏倚和普遍用户设计导致的扭曲。本申请的数据包括1997-2009年美国各地每年超过1500万50岁及以上受益人的处方药使用以及医疗和精神状况（包括意外伤害和自杀企图）的信息，这些受益人从管理式护理计划中获得处方药福利。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的意外损伤风险的描述性分析（aim 1）将在本申请的两个关键目的的背景下进行：比较福尔斯、机动车碰撞和自杀行为造成的伤害风险（美国老年人受伤死亡的主要原因）在1）SSRI与TCA与SNRI抗抑郁药（目的2）的启动者中，和2）常规与非典型抗精神病药物（目的3）。拟议的研究响应NIMH的战略目标4：“加强NIMH支持的研究的公共卫生影响”。拟议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的公共卫生影响的理解。因为特定抗抑郁药的治疗优势（和抗精神病药）制剂尚未建立用于这些药物通常被处方治疗的病症，1-5所提出的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，并且由于福尔斯，机动车碰撞，和自杀行为在老年人中尤其不受欢迎。 公共卫生相关性：目前的应用将使用新的药理学方法和50岁及以上美国人的大型医疗保健数据集来确定a）福尔斯，B）机动车碰撞，和c）自杀行为同样适用于所有抗抑郁药（和抗精神病药）类-或者是否有特定的抗抑郁药方案（或抗精神病药物）具有安全优势，应优先处方。分析将检查是否以及如果是，损伤的风险如何取决于社会人口因素，合并症，合并用药，剂量和时间，因为开始抗抑郁药或抗精神病药。

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.