Lu Christine Y, Penfold Robert B, Wallace Jamie, Lupton Caitlin, Libby Anne M, Soumerai Stephen B
Harvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care Institute Boston Massachusetts.
Department of Health Services Research Kaiser Permanente Washington Health Research Institute and University of Washington Seattle, Washington.
Psychiatr Res Clin Pract. 2020 Oct 7;2(2):43-52. doi: 10.1176/appi.prcp.20200012. eCollection 2020 Dec.
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.
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.
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.
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.
研究表明，在美国食品药品监督管理局发布有关青少年自杀风险的抗抑郁药警告后，抑郁症的诊断、心理治疗和药物治疗有所减少，自杀未遂事件有所增加。对医疗护理的影响蔓延到了老年人。本研究调查了在这些警告以及抑郁症护理减少之后自杀死亡人数是否增加。
我们对经过验证的死亡数据（1990 - 2017年）进行了中断时间序列研究，以估计在发出警告后，每10万名青少年（10 - 19岁）和青年成年人（20 - 24岁）自杀死亡趋势的变化，并对基线趋势进行控制。
在发出警告之前（1990 - 2002年），自杀死亡人数显著下降。在发出警告之后（2005 - 2017年）以及治疗急剧减少之后，这种下降趋势逆转。每10万名青少年的自杀人数立即增加了0.49例，95%置信区间[CI]：0.12，0.86），且每年每10万名青少年的自杀人数呈趋势性增加0.03例（95% CI：0.026，0.031）。同样，每10万名青年成年人的自杀人数立即增加了2.07例（95% CI：1.04，3.10），且每年每10万名青年成年人的自杀人数呈趋势性增加0.05例（95% CI：0.04，0.06）。假设基线趋势持续，到2010年，在每年4300万青少年和2100万青年成年人的队列中，全国可能会有5958例额外的自杀事件。
我们观察到在发出警告以及抑郁症护理减少之后，青少年自杀死亡人数增加。我们探讨了其他解释，包括物质使用、经济衰退、智能手机使用和意外伤害死亡。在过去十年中，可能还有其他因素导致青少年自杀持续增加。结合之前关于治疗减少的研究，这些结果呼吁重新评估抗抑郁药警告。
