Antidepressants and suicidal behaviour in late life: a prospective population-based study of use patterns in new users aged 75 and above

Hedna, Khedidja; Sundell, Karolina Andersson; Hamidi, Armina; Skoog, Ingmar; Gustavsson, Sara; Wærn, Margda

doi:10.1007/s00228-017-2360-x

Cited by 12 publications

(17 citation statements)

References 44 publications

(42 reference statements)

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“…As previously reported, 19 half of the cohort had a prescription for citalopram, and one-fifth were on mirtazapine. Over two-thirds received their index prescription in a primary care setting ( table 2 ).…”

Section: Resultssupporting

confidence: 75%

“…Suicide was the cause of death for 295 individuals (199 men and 96 women), corresponding to an incidence rate of 50 per 100 000 person years for the total study population. As previously reported, 19 hanging was the most common method in men; poisoning was the dominant method among women. Suicide methods are shown by sex in online supplementary appendix 1 .…”

Section: Resultsmentioning

confidence: 52%

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Late-life suicidal behaviours among new users of antidepressants: a prospective population-based study of sociodemographic and gender factors in those aged 75 and above

et al. 2018

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ObjectiveTo investigate sociodemographic and gender factors associated with suicide and suicide attempts among new users of antidepressants aged 75 and above.DesignRegister-based cohort study.SettingNational population-based cohort of Swedish residents aged ≥75 years.Participants185 225 patients who initiated antidepressant medication between 1 January 2007 and 31 December 2013 were followed until 31 December 2014.Main outcome measuresSuicide and suicide attempts. Fine and Gray regression models were used to analyse the sociodemographic factors (age, country of birth, marital status, education level, last occupation, income and social allowance) associated with suicidal behaviours in the entire cohort and by gender.ResultsDuring follow-up, 295 suicides and 654 suicide attempts occurred. Adjusted sub-hazard ratios (aSHRs) for suicide were lower among older age groups (aSHR 0.73, 95% CI 0.53 to 0.99 for those 85–89 years; and aSHR 0.53, 95% CI 0.33 to 0.86 for those ≥90 years). A similar pattern was observed for suicide attempts. Suicide attempts were more common among those born in foreign countries (aSHR 1.58, 95% CI 1.16 to 2.15 for those born in another Nordic country; and aSHR 1.43, 95% CI 1.06 to 1.93 for those born in non-Nordic countries). In the gender-stratified analyses, being single or divorced, and born in another Nordic country was associated with a higher risk of suicide among men. Educational and occupational history and being born in a non-Nordic country influenced risk of suicidal behaviours in women.ConclusionSuicidal behaviours occurred more commonly among new users who were ‘younger’ old adults and those with foreign background, suggesting that those groups might require greater support when initiating antidepressant therapy. Our findings suggest the need for gender-specific, multifaceted approaches to the prevention of suicidal behaviours in late life.

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Section: Resultssupporting

confidence: 75%

Section: Resultsmentioning

confidence: 52%

Late-life suicidal behaviours among new users of antidepressants: a prospective population-based study of sociodemographic and gender factors in those aged 75 and above

et al. 2018

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“…Although switching medications drives the dispensation ratio towards 1.0, it may nonetheless indicate a need for augmented treatment. In fact, recent findings suggest that switching of antidepressants confers a more than the two- Table 2 Odds ratios with 95% confidence intervals for completed suicide conferred by biochemically verified partial adherence and nonadherence (defined, respectively, as partial congruence and incongruence between the prescription-based measure of continuous medication use and postmortem forensic-toxicological findings) fold elevated risk of suicidality in late life [44], yet, in the present study, adjustments for dispensation ratio had little effect on risk estimates for incomplete adherence to antidepressants. By contrast, the same adjustment increased risk estimates for incomplete adherence to antipsychotics, reflecting a difference between cases and controls regarding patterns of use of psychotropic medications in the months prior to death.…”

Section: Dispensations Ratiomentioning

confidence: 99%

Adherence to psychotropic medication in completed suicide in Sweden 2006–2013: a forensic-toxicological matched case-control study

Forsman

Taipale

Masterman

et al. 2019

Eur J Clin Pharmacol

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Objective To investigate the influence of adherence to psychotropic medications upon the risk of completed suicide by comparing person-level prescriptions and postmortem toxicological findings among complete-suicide cases and non-suicide controls in Sweden 2006-2013. Methods Using national registries with full coverage on dispensed prescriptions, results of medico-legal autopsies, causes of death, and diagnoses from inpatient care, estimated continuous drug use for 30 commonly prescribed psychotropic medications was compared with forensic-toxicological findings. Subjects who had died by suicide (cases) were matched (1:2) with subjects who had died of other causes (controls) for age, sex, and year of death. Odds ratios were calculated using logistic regression to estimate the risk of completed suicide conferred by partial adherence and non-adherence to pharmacotherapy. Adjustments were made for previous inpatient care and the ratio of initiated and discontinued dispensed prescriptions, a measure of the continued need of treatment preceding death. Results In 5294 suicide cases and 9879 non-suicide controls, after adjusting for the dispensation ratio and other covariates, partial adherence and non-adherence to antipsychotics were associated with 6.7-fold and 12.4-fold risks of completed suicide, respectively, whereas corresponding risk estimates for antidepressant treatment were not statistically significant and corresponding risk increases for incomplete adherence to antidepressant treatment were lower (1.6-fold and 1.5-fold, respectively) and lacked statistical significance. Conclusion After adjustment for the need of treatment, biochemically verified incomplete adherence to antipsychotic pharmacotherapy was associated with markedly increased risks of completed suicide.

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“…“Those who filled a prescription for an antidepressant during this period <1 January 2007 and 31 December 2013> with no such fills during the preceding year were considered treatment initiators.” 23 …”

Section: Discussionmentioning

confidence: 99%

Quality of reporting of drug exposure in pharmacoepidemiological studies

Hempenius

Luijken

Boer

et al. 2020

Pharmacoepidemiology and Drug

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Purpose Exposure definitions vary across pharmacoepidemiological studies. Therefore, transparent reporting of exposure definitions is important for interpretation of published study results. We aimed to assess the quality of reporting of exposure to identify where improvement may be needed. Method We systematically reviewed observational pharmacoepidemiological studies that used routinely collected health data, published in 2017 in six pharmacoepidemiological journals. Reporting of exposure was scored using 11 items of the ISPE‐ISPOR guideline on reporting of pharmacoepidemiological studies. Results Of the 91 studies included, all studies reported the type of exposure (100%), while most reported the exposure risk window (85%) and the exposure assessment window (98%). Operationalization of the exposure window was described infrequently: 16% (14/90) of the studies explicitly reported the presence or absence of an induction period if applicable, 11% (5/47), and 35% (17/49) reported how stockpiling and gaps between exposure episodes were handled, respectively, and 35% (17/49) explicitly mentioned the exposure extension. Switching/add‐on was reported in 62% (50/81). How switching between drugs was dealt with and specific drug codes were reported in 52 (57%) and 24 (26%) studies, respectively. Conclusion Publications of pharmacoepidemiological studies frequently reported the type of exposure, the exposure risk window, and the exposure assessment window. However, more details on exposure assessment are needed, especially when it concerns the operationalization of the exposure risk window (eg, the presence or absence of an induction period or exposure extension, handling of stockpiling and gaps, and specific codes), to allow for correct interpretation, reproducibility, and assessment of validity.

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Antidepressants and suicidal behaviour in late life: a prospective population-based study of use patterns in new users aged 75 and above

Cited by 12 publications

References 44 publications

Late-life suicidal behaviours among new users of antidepressants: a prospective population-based study of sociodemographic and gender factors in those aged 75 and above

Late-life suicidal behaviours among new users of antidepressants: a prospective population-based study of sociodemographic and gender factors in those aged 75 and above

Adherence to psychotropic medication in completed suicide in Sweden 2006–2013: a forensic-toxicological matched case-control study

Quality of reporting of drug exposure in pharmacoepidemiological studies

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