近期抗感染药物暴露作为儿科患者首次出现自杀念头和/或行为的危险因素。

Recent anti-infective exposure as a risk factor for first episode of suicidal thoughts and/or behaviors in pediatric patients.

作者信息

Prichett Laura M, Severance Emily G, Yolken Robert H, Carmichael Destini, Lu Yongyi, Zeng Yong, Young Andrea S, Kumra Tina

机构信息

Department of Pediatrics, Division of General Pediatrics, Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA.

Department of Pediatrics, Stanley Division of Developmental Neurovirology, Johns Hopkins School of Medicine, 600 N. Wolfe, Baltimore, MD, 21287, USA.

出版信息

Brain Behav Immun Health. 2024 Feb 17;36:100738. doi: 10.1016/j.bbih.2024.100738. eCollection 2024 Mar.

DOI:10.1016/j.bbih.2024.100738

PMID:38435723

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10906143/

Abstract

OBJECTIVES

We conducted a retrospective cohort study of medical records from a large, Maryland, U.S.-based cohort of pediatric primary care patients for potential associations between antibacterial, antifungal and antiviral prescriptions and subsequent suicidal thoughts and/or behaviors.

METHODS

Using first suicide-related diagnosis as the outcome and prior prescription of antibacterial, antifungal, and/or antiviral use as the exposure, we employed a series of multivariate Cox proportional hazards models. These models examined the hazard of developing newly recognized suicidal thoughts and/or behaviors, controlling for age, sex, race, insurance, number of encounters during the study period, prior mood disorder diagnosis and number of chronic health conditions. We constructed the same series of models stratified by the groups with and without a prior recorded mental or behavioral health diagnosis (MBHD).

RESULTS

Suicidal thoughts and/or behaviors were associated with the previous prescription of an antibacterial, antifungal and/or antiviral medication (HR 1.31, 95 %-CI 1.05-1.64) as well as the total number of such medications prescribed (HR 1.04, 95 %-CI 1.01-1.08), with the strongest relationship among patients with three or more medications (HR 1.44, 95 %-CI 1.06-1.96). Among individual medications, the strongest association was with antibacterial medication (HR 1.28, 95 %-CI 1.03-1.60). Correlations were strongest among the subgroup of patients with no previous (MBHD).

INTERPRETATION

Infections treated with antimicrobial medications were associated with increased risks of a suicide-related diagnosis among patients who had not had a previous mental or behavioral health diagnosis. This group should be considered for increased levels of vigilance as well as interventions directed at suicide screening and prevention.

FUNDING

National Institutes of Health, Stanley Medical Research Institute.

摘要

目的

我们对美国马里兰州一个大型儿科初级保健患者队列的病历进行了一项回顾性队列研究，以探讨抗菌、抗真菌和抗病毒药物处方与随后的自杀念头和/或行为之间的潜在关联。

方法

以首次自杀相关诊断为结局，以先前使用抗菌、抗真菌和/或抗病毒药物为暴露因素，我们采用了一系列多变量Cox比例风险模型。这些模型检验了出现新确认的自杀念头和/或行为的风险，同时控制了年龄、性别、种族、保险、研究期间的就诊次数、先前的情绪障碍诊断以及慢性健康状况的数量。我们构建了相同系列的模型，按有无先前记录的精神或行为健康诊断（MBHD）进行分层。

结果

自杀念头和/或行为与先前使用抗菌、抗真菌和/或抗病毒药物处方（风险比[HR] 1.31，95%置信区间[CI] 1.05 - 1.64）以及此类药物的总处方数量（HR 1.04，95% CI 1.01 - 1.08）相关，在使用三种或更多药物的患者中这种关系最强（HR 1.44，95% CI 1.06 - 1.96）。在个别药物中，最强的关联是与抗菌药物（HR 1.28，95% CI 1.03 - 1.60）。在没有先前MBHD的患者亚组中相关性最强。