Suicide attempts and unintentional injury among older Americans on psychotropics

描述(由申请人提供)：拟议的队列研究将使用大型卫生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造成的伤害风险是否同样适用于所有抗抑郁药(和抗精神病药物)类别，或者是否有特定的抗抑郁药(和抗精神病药物)方案具有安全优势，应优先开出。分析将审查伤害风险如何取决于社会人口因素、共同发病、联合用药、剂量和使用时间。这项拟议的研究解决了先前观察工作的许多局限性，包括未能考虑与剂量相关的影响、使用持续时间、适应症的混淆、医生通灵偏见以及普遍的用户设计造成的扭曲。当前申请的数据包括1997-2009年期间从全美管理护理计划获得处方药福利的1500多万50岁及以上受益人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物的患者与未服用抗抑郁药物的患者(目标1)的意外伤害风险，将提出本应用的两个关键目标：比较1)SSRI与TCA与SNRI抗抑郁药(目标2)和2)常规与非典型抗精神病药物(目标3)的发起者之间因跌倒、机动车碰撞和自杀行为(导致美国老年人受伤死亡的主要原因)而造成伤害的风险。这项拟议的研究响应了NIMH的战略目标4：“加强NIMH支持的研究对公共健康的影响”。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对公共健康影响的理解。由于特定的抗抑郁药物(和抗精神病药物)制剂的治疗优势尚未针对这些药物通常用于治疗的情况而确定，1-5拟议工作的潜在临床和可能的经济利益可能是巨大的，因为这些药物的使用很常见，而老年人因跌倒、机动车碰撞和自杀行为造成的伤害的后果尤其令人不快。 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卫生保健数据集来确定a)跌倒、b)机动车撞车和c)自杀行为是否同样适用于所有抗抑郁药(和抗精神病药物)类别--或者是否有特定的抗抑郁药(或抗精神病药物)方案具有安全优势，应该优先开出。分析将检查伤害风险是否以及如果是的话，取决于社会人口因素、共同发病、联合用药、剂量和自开始服用抗抑郁药或抗精神病药物以来的时间。

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.