Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.
Department of Women's and Children's Health/Neuropediatrics, Karolinska Institutet, Stockholm, Sweden.
Nat Commun. 2023 Mar 14;14(1):1281. doi: 10.1038/s41467-023-36973-4.
Advanced psychiatric treatments remain uncertain in preventing suicide among adolescents. Across the 21 Swedish regions, using nationwide registers between 2016-2020, we found negative correlation between adolescent excess suicide mortality (AESM) and regional frequencies of clozapine, ECT, and lithium (CEL) usage among adolescents (β = -0.613, p = 0.0003, 95% CI: -0.338, -0.889) and males (β = -0.404, p = 0.009, 95% CI: -0.130, -0.678). No correlation was found among females (p = 0.197). Highest CEL usage among male adolescents was seen in regions with lowest quartile (Q1) AESM (W = 74, p = 0.012). Regional CEL treatment frequency in 15-19-year-olds was related to lower AESM in males, reflecting potential treatment efficacy, treatment compliance or better-quality mental health care. Suicide prevention may benefit from early recognition and CEL treatment for severe mental illness in male adolescents. The results indicate association but further research, using independent samples and both prospective and observational methodologies, is needed to confirm causality.
在预防青少年自杀方面，先进的精神科治疗方法仍存在不确定性。在 2016 年至 2020 年期间，我们利用全国范围内的登记册，在 21 个瑞典地区进行了研究，发现青少年过剩自杀死亡率 (AESM) 与青少年氯氮平、ECT 和锂 (CEL) 使用的地区频率之间存在负相关关系（β=-0.613，p=0.0003，95%置信区间：-0.338，-0.889），且与男性（β=-0.404，p=0.009，95%置信区间：-0.130，-0.678）之间存在负相关关系。但在女性中未发现相关性（p=0.197）。在 AESM 最低四分位数 (Q1) 地区，青少年男性 CEL 使用量最高（W=74，p=0.012）。15-19 岁青少年的地区 CEL 治疗频率与男性 AESM 降低有关，这反映了潜在的治疗效果、治疗依从性或更好的心理健康护理。对于青少年男性的严重精神疾病，早期识别和 CEL 治疗可能有助于预防自杀。结果表明存在关联，但需要进一步研究，使用独立样本和前瞻性及观察性方法学，以确认因果关系。
