Gusmão Ricardo, Quintão Sónia, McDaid David, Arensman Ella, Van Audenhove Chantal, Coffey Claire, Värnik Airi, Värnik Peeter, Coyne James, Hegerl Ulrich
CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal ; Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
PLoS One. 2013 Jun 19;8(6):e66455. doi: 10.1371/journal.pone.0066455. Print 2013.
Research concerning the association between use of antidepressants and incidence of suicide has yielded inconsistent results and is the subject of considerable controversy. The first aim is to describe trends in the use of antidepressants and rates of suicide in Europe, adjusted for gross domestic product, alcohol consumption, unemployment, and divorce. The second aim is to explore if any observed reduction in the rate of suicide in different European countries preceded the trend for increased use of antidepressants.
Data were obtained for 29 European countries between 1980 and 2009. Pearson correlations were used to explore the direction and magnitude of associations. Generalized linear mixed models and Poisson regression distribution were used to clarify the effects of antidepressants on suicide rates, while an autoregressive adjusted model was used to test the interaction between antidepressant utilization and suicide over two time periods: 1980-1994 and 1995-2009.
An inverse correlation was observed in all countries between recorded Standardised Death Rate (SDR) for suicide and antidepressant Defined Daily Dosage (DDD), with the exception of Portugal. Variability was marked in the association between suicide and alcohol, unemployment and divorce, with countries depicting either a positive or a negative correlation with the SDR for suicide. Every unit increase in DDD of an antidepressant per 1000 people per day, adjusted for these confounding factors, reduces the SDR by 0.088. The correlation between DDD and suicide related SDR was negative in both time periods considered, albeit more pronounced between 1980 and 1994.
Suicide rates have tended to decrease more in European countries where there has been a greater increase in the use of antidepressants. These findings underline the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide.
关于使用抗抑郁药与自杀发生率之间关联的研究结果并不一致，且存在相当大的争议。第一个目标是描述欧洲抗抑郁药使用趋势以及自杀率，并对国内生产总值、酒精消费、失业率和离婚率进行调整。第二个目标是探究在欧洲不同国家观察到的自杀率下降是否先于抗抑郁药使用增加的趋势。
获取了1980年至2009年期间29个欧洲国家的数据。使用Pearson相关性来探究关联的方向和程度。采用广义线性混合模型和泊松回归分布来阐明抗抑郁药对自杀率的影响，同时使用自回归调整模型来测试两个时间段（1980 - 1994年和1995 - 2009年）内抗抑郁药使用与自杀之间的相互作用。
除葡萄牙外，所有国家记录的自杀标准化死亡率（SDR）与抗抑郁药限定日剂量（DDD）之间均呈负相关。自杀与酒精、失业和离婚之间的关联存在显著差异，各国与自杀SDR之间呈现正相关或负相关。在对这些混杂因素进行调整后，每1000人每天抗抑郁药DDD每增加一个单位，SDR降低0.088。在两个考虑的时间段内，DDD与自杀相关SDR之间的相关性均为负，尽管在1980年至1994年期间更为明显。
在抗抑郁药使用增加幅度更大的欧洲国家，自杀率下降的趋势更为明显。这些发现强调了将适当使用抗抑郁药作为诊断为抑郁症患者常规护理一部分的重要性，从而降低自杀风险。
