Moustgaard Heta, Joutsenniemi Kaisla, Myrskylä Mikko, Martikainen Pekka
Population Research Unit, Department of Social Research, University of Helsinki, Finland.
Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.
PLoS One. 2014 Jun 3;9(6):e98405. doi: 10.1371/journal.pone.0098405. eCollection 2014.
A marked decline in suicide rates has co-occurred with increased antidepressant sales in several countries but the causal connection between the trends remains debated. Most previous studies have focused on overall suicide rates and neglected differential effects in population subgroups. Our objective was to investigate whether increasing sales of non-tricyclic antidepressants have reduced alcohol- and non-alcohol-related suicide risk in different population subgroups.
We followed a nationally representative sample of 950,158 Finnish adults in 1995-2007 for alcohol-related (n = 2,859) and non-alcohol-related (n = 8,632) suicides. We assessed suicide risk by gender and social group according to regional sales of non-tricyclic antidepressants, measured by sold doses per capita, prevalence of antidepressant users, and proportion of antidepressant users with doses reflecting minimally adequate treatment. Fixed-effects Poisson regression models controlled for regional differences and time trends that may influence suicide risk irrespective of antidepressant sales.
The number of sold antidepressant doses per capita and the prevalence of antidepressant users were unrelated to male suicide risk. However, one percentage point increase in the proportion of antidepressant users receiving minimally adequate treatment reduced non-alcohol-related male suicide risk by one percent (relative risk 0.987, 95% confidence interval 0.976-0.998). This beneficial effect only emerged among men with high education, high income, and employment, among men without a partner, and men not owning their home. Alcohol-related suicides and female suicides were unrelated to all measures of antidepressant sales.
We found little evidence that increase in overall sales or in the prevalence of non-tricyclic antidepressant users would have caused the fall in suicide rates in Finland in 1995-2007. However, the rise in the proportion of antidepressant users receiving minimally adequate treatment, possibly due to enhanced treatment compliance, may have prevented non-alcohol-related suicides among men.
在一些国家，自杀率显著下降的同时抗抑郁药销量增加，但二者趋势之间的因果关系仍存在争议。以往大多数研究都集中在总体自杀率上，而忽略了人群亚组中的差异效应。我们的目的是调查非三环类抗抑郁药销量的增加是否降低了不同人群亚组中与酒精相关和与非酒精相关的自杀风险。
我们对1995 - 2007年间950158名具有全国代表性的芬兰成年人进行跟踪，统计与酒精相关（n = 2859）和与非酒精相关（n = 8632）的自杀情况。我们根据非三环类抗抑郁药的区域销量评估自杀风险，销量以人均销售剂量衡量，同时评估抗抑郁药使用者的患病率以及使用剂量达到最低充分治疗标准的抗抑郁药使用者比例。固定效应泊松回归模型控制了可能影响自杀风险的区域差异和时间趋势，而不考虑抗抑郁药销量。
人均抗抑郁药销售剂量和抗抑郁药使用者患病率与男性自杀风险无关。然而，接受最低充分治疗的抗抑郁药使用者比例每增加一个百分点，与非酒精相关的男性自杀风险就降低1%（相对风险0.987，95%置信区间0.976 - 0.998）。这种有益效果仅出现在高学历、高收入和有工作的男性中，没有伴侣的男性以及没有自有住房的男性中。与酒精相关的自杀和女性自杀与抗抑郁药销售的所有指标均无关。
我们几乎没有发现证据表明总体销量增加或非三环类抗抑郁药使用者患病率上升导致了1995 - 2007年芬兰自杀率的下降。然而，接受最低充分治疗的抗抑郁药使用者比例的上升，可能是由于治疗依从性提高，这可能预防了男性中非酒精相关的自杀。
Zotero 插件