Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care.

Autor: Lu CY; Harvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care Institute Boston Massachusetts., Penfold RB; Department of Health Services Research Kaiser Permanente Washington Health Research Institute and University of Washington Seattle, Washington., Wallace J; Harvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care Institute Boston Massachusetts., Lupton C; Harvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care Institute Boston Massachusetts., Libby AM; Department of Emergency Medicine, School of Medicine University of Colorado, Anschutz Medical Campus Denver, Colorado., Soumerai SB; Harvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care Institute Boston Massachusetts.
Jazyk: angličtina
Zdroj: Psychiatric research and clinical practice [Psychiatr Res Clin Pract] 2020 Oct 07; Vol. 2 (2), pp. 43-52. Date of Electronic Publication: 2020 Oct 07 (Print Publication: 2020).
DOI: 10.1176/appi.prcp.20200012
Abstrakt: Objective: Studies show decreased depression diagnosis, psychotherapy, and medications and increased suicide attempts following US Food and Drug Administration antidepressant warnings regarding suicidality risk among youth. Effects on care spilled over to older adults. This study investigated whether suicide deaths increased following the warnings and declines in depression care.
Methods: We conducted an interrupted time series study of validated death data (1990-2017) to estimate changes in trends of US suicide deaths per 100,000 adolescents (ages 10-19) and young adults (ages 20-24) after the warnings, controlling for baseline trends.
Results: Before the warnings (1990-2002), suicide deaths decreased markedly. After the warnings (2005-2017) and abrupt declines in treatment, this downward trend reversed. There was an immediate increase of 0.49 suicides per 100,000 adolescents, 95% confidence interval [CI]: 0.12, 0.86) and a trend increase of 0.03 suicides per 100,000 adolescents per year (95% CI: 0.026, 0.031). Similarly, there was an immediate increase of 2.07 suicides per 100,000 young adults (95% CI: 1.04, 3.10) and a trend increase of 0.05 suicides per 100,000 young adults per year (95% CI: 0.04, 0.06). Assuming baseline trends continued, there may have been 5958 excess suicides nationally by 2010 among yearly cohorts of 43 million adolescents and 21 million young adults.
Conclusions: We observed increases in suicide deaths among youth following the warnings and declines in depression care. Alternative explanations were explored, including substance use, economic recessions, smart phone use, and unintentional injury deaths. Additional factors may have contributed to continued increases in youth suicide during the last decade. Combined with previous research on declining treatment, these results call for re-evaluation of the antidepressant warnings.
(© 2020 The Authors. Psychiatric Research and Clinical Practice published by Wiley Periodicals LLC. on behalf of the American Psychiatric Association.)
Databáze: MEDLINE
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