Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
J Child Psychol Psychiatry. 2023 Jul;64(7):1027-1036. doi: 10.1111/jcpp.13785. Epub 2023 Mar 23.
Sleep disorders in youth have been associated with increased risks of injury, including suicidal behavior. This study investigated whether melatonin, which is the most common medication for sleep disturbances in youth in Sweden, is associated with a decreased risk of injury.
This population-based cohort study included 25,575 youths who initiated melatonin treatment between ages 6 and 18. Poisson regression was used to estimate rate of injuries in the year prior to and following melatonin treatment initiation. A within-individual design was used to estimate relative risks by comparing injury risk in the last unmedicated month with injury risks in the 12 months after medication initiation. Analyses were stratified by sex, injury type, psychiatric comorbidities and age at melatonin-treatment initiation.
While body injuries, falls and transport accident rates were comparable in the year before and after melatonin-treatment initiation, the risk of self-harm was highest in the months immediately prior to medication, and decreased thereafter. This was particularly prominent among adolescents with depression and/or anxiety, with females displaying greater absolute risks than males. Compared to the last unmedicated month, the 12 months post medication initiation had decreased relative risks for self-harm, with an IRR [95% CI] in the month following melatonin-treatment initiation of 0.46 [0.27-0.76] among adolescent females with psychiatric disorders, after excluding antidepressant users.
Decreased risk of intentional self-harm was observed following melatonin-treatment initiation among females with depression and anxiety, suggesting that sleep interventions could be considered in an effort to reduce risk of self-harm in this population.
青少年的睡眠障碍与受伤风险增加有关，包括自杀行为。本研究调查了在瑞典，最常用于治疗青少年睡眠障碍的褪黑素是否与受伤风险降低有关。
这项基于人群的队列研究纳入了 25575 名在 6 至 18 岁之间开始使用褪黑素治疗的青少年。采用泊松回归估计褪黑素治疗开始前一年和开始后一年的受伤率。采用个体内设计，通过比较末次未用药月份和用药后 12 个月的受伤风险，来估计相对风险。分析按性别、受伤类型、精神共病和褪黑素治疗开始时的年龄分层。
尽管身体伤害、跌倒和交通意外的发生率在褪黑素治疗开始前和开始后一年相似，但在用药前几个月自我伤害的风险最高，此后风险降低。这在患有抑郁和/或焦虑的青少年中尤为明显，女性的绝对风险高于男性。与末次未用药月份相比，用药后 12 个月的自我伤害相对风险降低，在排除抗抑郁药使用者后，有精神障碍的青春期女性在褪黑素治疗开始后的第一个月，IRR[95%CI]为 0.46[0.27-0.76]。
在患有抑郁和焦虑的女性中，褪黑素治疗开始后自我伤害的风险降低，这表明可以考虑进行睡眠干预，以降低该人群的自我伤害风险。
