Hemminki Elina, Merikukka Marko, Gissler Mika, Wahlbeck Kristian, Savolainen Jukka, Ristikari Tiina, Aaltonen Mikko
THL, Health and Social Care Systems, Helsinki, Finland.
Children, Adolescents and Families Unit, THL, Oulu, Finland.
J Epidemiol Community Health. 2017 Jan;71(1):12-18. doi: 10.1136/jech-2016-207265. Epub 2016 Jun 28.
The use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), has been questioned due to poor efficacy and safety. We examined whether young violent offenders were more likely antidepressant users prior to their first violent offence than other young persons.
The study is a follow-up of children born in Finland in 1987 (n=59 120), linking national registers to each other using personal identity codes. Data on psychotropic drug use came from a register of reimbursed drugs and data on crimes from a register on court convictions (after the age of 14 years). Participants were followed until the age of 18 years, and for some analyses until the end of the follow-up (mean 21 years). To adjust for differences in background characteristics, regression analyses for antidepressant use were made, using the no-conviction group as the reference.
Proportions of young people convicted by the age of 18 years were: 5% of boys (1.7% for violent crimes) and 1% (0.5%) of girls. Antidepressant use (both overall and for SSRIs) prior to violent crime was more common among those convicted than among those without convictions. Among boys with repeated violent crimes, it was also more common than among boys with non-violent crimes. Adjustment for differences in background characteristics decreased the associations between antidepressant use and violent crime, but did not eliminate them.
The results add further evidence for caution in prescribing antidepressants among young persons. It also calls for a reanalysis of violence measures in the original trial data.
由于疗效不佳和安全性问题，抗抑郁药的使用，尤其是选择性5-羟色胺再摄取抑制剂（SSRIs），受到了质疑。我们研究了年轻暴力犯罪者在首次暴力犯罪之前是否比其他年轻人更有可能使用抗抑郁药。
该研究是对1987年出生在芬兰的儿童（n = 59120）的随访，使用个人身份代码将国家登记册相互关联。精神药物使用数据来自报销药物登记册，犯罪数据来自法院定罪登记册（14岁以后）。对参与者进行随访至18岁，部分分析随访至结束（平均21岁）。为了调整背景特征的差异，以未定罪组为参照，对抗抑郁药使用情况进行回归分析。
18岁前被定罪的年轻人比例为：男孩5%（暴力犯罪为1.7%），女孩1%（0.5%）。暴力犯罪前使用抗抑郁药（总体和SSRIs）在被定罪者中比未被定罪者中更常见。在多次暴力犯罪的男孩中，也比非暴力犯罪的男孩更常见。调整背景特征差异后，抗抑郁药使用与暴力犯罪之间的关联有所降低，但并未消除。
研究结果进一步证明在年轻人中开具抗抑郁药时需谨慎。这也呼吁对原始试验数据中的暴力测量方法进行重新分析。
