University of Michigan, Department of Psychiatry, 4250 Plymouth Rd, SPC 5740, Ann Arbor, MI 48109, USA.
J Clin Psychiatry. 2011 Apr;72(4):515-21. doi: 10.4088/JCP.09m05484gry. Epub 2010 Sep 21.
Sedative-hypnotics have been associated with suicide attempts and completed suicides in a number of toxicologic, epidemiologic, and clinical studies. Most studies, however, inadequately address confounding by insomnia, which not only is a component of many mental health disorders that increase suicidal risk, but also is independently associated with suicidality. Moreover, the association of nonbenzodiazepine benzodiazepine receptor agonists (NBRAs) with suicidality has not been specifically studied in the US general population.
The purpose of this study was to assess the independent contribution of prescription sedative-hypnotic use, particularly the NBRAs, to suicidal ideas, plans, and suicide attempts in the general US population, after adjusting for insomnia and other confounding variables.
Secondary analyses of National Comorbidity Survey Replication data for 5,692 household respondents interviewed between 2001 and 2003 assessed the cross-sectional relationships between prescription sedative-hypnotic use and suicidality in the previous 12 months. Multivariate, hierarchical logistic regression analyses controlled for symptoms of insomnia, past-year mental disorders, lifetime chronic physical illnesses, and demographic variables.
Prescription sedative-hypnotic use in the past year was significantly associated with suicidal thoughts (adjusted odds ratio [AOR] = 2.2; P < .001), suicide plans (AOR = 1.9; P < .01), and suicide attempts (AOR = 3.4; P < .01). It was a stronger predictor than insomnia for both suicidal thoughts and suicide attempts and significantly improved the fit of these regression models (suicidal thoughts, P < .01; suicide attempts, P < .05).
Prescription sleeping pills, as exemplified by zolpidem and zaleplon, are associated with suicidal thoughts and suicide attempts during the past 12 months, but no evidence of causality was provided by this study. Clinical practitioners should recognize that patients taking similar types of sedative-hypnotics have a marker of increased risk for suicidality.
在多项毒理学、流行病学和临床研究中，镇静催眠药与自杀企图和自杀死亡有关。然而，大多数研究都没有充分考虑到失眠的混杂因素，失眠不仅是许多增加自杀风险的精神健康障碍的一个组成部分，而且与自杀意念也有独立的关联。此外，在美国一般人群中，非苯二氮䓬类苯二氮䓬受体激动剂（NBRAs）与自杀意念的关系尚未专门研究过。
本研究旨在评估在美国一般人群中，处方镇静催眠药的使用，特别是 NBRAs，在调整了失眠和其他混杂变量后，对自杀意念、自杀计划和自杀企图的独立贡献。
对 2001 年至 2003 年期间接受访谈的 5692 户家庭应答者的国家共病调查复制数据进行二次分析，评估了过去 12 个月内处方镇静催眠药使用与自杀意念之间的横断面关系。多变量、分层逻辑回归分析控制了失眠症状、过去一年的精神障碍、终身慢性躯体疾病和人口统计学变量。
过去一年中使用处方镇静催眠药与自杀意念（调整后的优势比 [AOR] = 2.2；P <.001）、自杀计划（AOR = 1.9；P <.01）和自杀企图（AOR = 3.4；P <.01）显著相关。与失眠相比，它是自杀意念和自杀企图的更强预测因素，并显著改善了这些回归模型的拟合度（自杀意念，P <.01；自杀企图，P <.05）。
处方安眠药，如唑吡坦和扎来普隆，与过去 12 个月中的自杀意念和自杀企图有关，但本研究并未提供因果关系的证据。临床医生应该认识到，服用类似类型镇静催眠药的患者存在自杀意念风险增加的标志物。
