Antidepressant use and risk of self-harm among people aged 40 years or older: A population-based cohort and self-controlled case series study

Chai, Yi; Luo, Hao; Man, Kenneth K C; Lau, Wallis C.Y.; Yip, Paul S. F.; Wong, Ian C. K.

doi:10.1016/j.lanwpc.2022.100557

Cited by 9 publications

(6 citation statements)

References 44 publications

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“…Anonymous psychiatric emergency admission data was retrieved from the public sector healthcare Clinical Data Analysis and Reporting System (CDARS), an electronic medical database of all the public hospitals governed by the Hospital Authority which is the only institution providing psychiatric inpatient care in Hong Kong. CDARS has been used in other cost-effectiveness and population-based studies, 32 , 33 , 34 including longitudinal research on self-harm outcome of psychiatric diagnoses. 35 Information of psychiatric emergency admission of adults aged from 18 to 64 years and with a principal diagnosis by International Classification Diseases tenth revision of schizophrenia-spectrum disorders (F20–F29), bipolar affective disorders (F30, F31), unipolar mood disorders (F32–39), neuroses (F40–48), or substance use disorders (F10–19), and without comorbidity of learning disabilities (F70–79), organic or neurological disorders (F00–F09) between January 2001 and December 2020 were obtained from the CDARS.…”

Section: Methodsmentioning

confidence: 99%

Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study

Fai

Luo

Leung

et al. 2023

The Lancet Regional Health - Western Pacific

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Section: Methodsmentioning

confidence: 99%

Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study

Fai

Luo

Leung

et al. 2023

The Lancet Regional Health - Western Pacific

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“…All available covariates that were included in the generalized boosting model. This method was developed for comparing multiple treatments and has been widely validated in previous studies 24,25 . These stabilized weights allowed us to estimate the average treatment effect with no patients excluded and the original sample size similarly preserved 26 .…”

Section: Methodsmentioning

confidence: 99%

“…This method was developed for comparing multiple treatments and has been widely validated in previous studies. 24 , 25 These stabilized weights allowed us to estimate the average treatment effect with no patients excluded and the original sample size similarly preserved. 26 The balance diagnostic tests were assessed using standardized mean differences (SMD) before and after weighting.…”

Section: Methodsmentioning

confidence: 99%

Comparison of conservative management, microsurgery only, and microsurgery with preoperative embolization for unruptured arteriovenous malformations: A propensity score weighted prospective cohort study

Han,

Chen,

et al. 2023

CNS Neurosci Ther

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AimsTo compare the efficacy and deficiency of conservative management (CM), microsurgery (MS) only, and microsurgery with preoperative embolization (E + MS) for unruptured arteriovenous malformations (AVMs).MethodsWe prospectively included unruptured AVMs undergoing CM, MS, and E + MS from our institution between August 2011 and August 2021. The primary outcomes were long‐term neurofunctional outcomes and hemorrhagic stroke and death. In addition to the comparisons among CM, MS, and E + MS, E + MS was divided into single‐staged hybrid and multi‐staged E + MS for further analysis. Stabilized inverse probability of treatment weighting using propensity scores was applied to control for confounders by treatment indication across the three groups.ResultsOf 3758 consecutive AVMs admitted, 718 patients were included finally (266 CM, 364 MS, and 88 E + MS). The median follow‐up duration was 5.4 years. Compared with CM, interventions (MS and E + MS) were associated with neurological deterioration. MS could lower the risk of hemorrhagic stroke and death. Multi‐staged E + MS was associated with neurological deterioration and higher hemorrhagic risks compared with MS, but the hybrid E + MS operation significantly reduced the hemorrhage risk.ConclusionIn this study, unruptured AVMs receiving CM would expect better neurofunctional outcomes but bear higher risks of hemorrhage than MS or E + MS. The single‐staged hybrid E + MS might be promising in reducing inter‐procedural and subsequent hemorrhage.

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“…CDARS generates unique, anonymized patient identifiers to protect privacy and to link all medical records. This database has been used to conduct high-quality population-based studies on psychiatric disorders including schizophrenia and BD (Chan et al, 2021b(Chan et al, , 2021a(Chan et al, , 2022bChang et al, 2020;Yung et al, 2021Yung et al, , 2020 and pharmacoepidemiological investigations (Chai et al, 2022;Hung et al, 2023;Kan et al, 2022;Law et al, 2023).…”

Section: Data Sourcementioning

confidence: 99%

Mortality risk and mood stabilizers in bipolar disorder: a propensity-score-weighted population-based cohort study in 2002–2018

Chan,

Wong,

Fang

et al. 2024

Epidemiol Psychiatr Sci

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Aims Accumulating studies have assessed mortality risk associated with mood-stabilizers, the mainstay treatment for bipolar disorder (BD). However, existing data were mostly restricted to suicide risk, focused on lithium and valproate and rarely adequately adjusted for potential confounders. This study aimed to assess comparative mortality risk with all, natural and unnatural causes between lithium, valproate and three frequently prescribed second-generation antipsychotics (SGA), with adjustment for important confounders. Methods This population-based cohort study identified 8137 patients with first-diagnosed BD, who had exposed to lithium (n = 1028), valproate (n = 3580), olanzapine (n = 797), quetiapine (n = 1975) or risperidone (n = 757) between 2002 and 2018. Data were retrieved from territory-wide medical-record database of public healthcare services in Hong Kong. Propensity-score (PS)-weighting method was applied to optimize control for potential confounders including pre-existing chronic physical diseases, substance/alcohol use disorders and other psychotropic medications. PS-weighted Cox proportional-hazards regression was conducted to assess risk of all-, natural- and unnatural-cause mortality related to each mood-stabilizer, compared to lithium. Three sets of sensitivity analyses were conducted by restricting to patients with (i) length of cumulative exposure to specified mood-stabilizer ≥90 days and its medication possession ratio (MPR) ≥90%, (ii) MPR of specified mood-stabilizer ≥80% and MPR of other studied mood-stabilizers <20% and (iii) monotherapy. Results Incidence rates of all-cause mortality per 1000 person-years were 5.9 (95% confidence interval [CI]: 4.5–7.6), 8.4 (7.4–9.5), 11.1 (8.3–14.9), 7.4 (6.0–9.2) and 12.0 (9.3–15.6) for lithium-, valproate-, olanzapine-, quetiapine- and risperidone-treated groups, respectively. BD patients treated with olanzapine (PS-weighted hazard ratio = 2.07 [95% CI: 1.33–3.22]) and risperidone (1.66 [1.08–2.55]) had significantly higher all-cause mortality rate than lithium-treated group. Olanzapine was associated with increased risk of natural-cause mortality (3.04 [1.54–6.00]) and risperidone was related to elevated risk of unnatural-cause mortality (3.33 [1.62–6.86]), relative to lithium. The association between olanzapine and increased natural-cause mortality rate was consistently affirmed in sensitivity analyses. Relationship between risperidone and elevated unnatural-cause mortality became non-significant in sensitivity analyses restricted to low MPR in other mood-stabilizers and monotherapy. Valproate- and lithium-treated groups did not show significant differences in all-, natural- or unnatural-cause mortality risk. Conclusion Our data showed that olanzapine and risperidone were associated with higher mortality risk than lithium, and further supported the clinical guidelines recommending lithium as the first-line mood-stabilizer for BD. Future research is required to further clarify comparative mortality risk associated with individual SGA agents to facilitate risk-benefit evaluation of alternative mood-stabilizers to minimize avoidable premature mortality in BD.

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Antidepressant use and risk of self-harm among people aged 40 years or older: A population-based cohort and self-controlled case series study

Cited by 9 publications

References 44 publications

Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study

Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study

Comparison of conservative management, microsurgery only, and microsurgery with preoperative embolization for unruptured arteriovenous malformations: A propensity score weighted prospective cohort study

Mortality risk and mood stabilizers in bipolar disorder: a propensity-score-weighted population-based cohort study in 2002–2018

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