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Antidepressant sales and the risk for alcohol-related and non-alcohol-related suicide in Finland--an individual-level population study.

Moustgaard H, Joutsenniemi K, Myrskylä M, Martikainen P - PLoS ONE (2014)

Bottom Line: However, one percentage point increase in the proportion of antidepressant users receiving minimally adequate treatment reduced non-alcohol-related male suicide risk by one percent (relative risk 0.987, 95% confidence interval 0.976-0.998).This beneficial effect only emerged among men with high education, high income, and employment, among men without a partner, and men not owning their home.We found little evidence that increase in overall sales or in the prevalence of non-tricyclic antidepressant users would have caused the fall in suicide rates in Finland in 1995-2007.

View Article: PubMed Central - PubMed

Affiliation: Population Research Unit, Department of Social Research, University of Helsinki, Finland.

ABSTRACT

Objectives: A marked decline in suicide rates has co-occurred with increased antidepressant sales in several countries but the causal connection between the trends remains debated. Most previous studies have focused on overall suicide rates and neglected differential effects in population subgroups. Our objective was to investigate whether increasing sales of non-tricyclic antidepressants have reduced alcohol- and non-alcohol-related suicide risk in different population subgroups.

Methods: We followed a nationally representative sample of 950,158 Finnish adults in 1995-2007 for alcohol-related (n = 2,859) and non-alcohol-related (n = 8,632) suicides. We assessed suicide risk by gender and social group according to regional sales of non-tricyclic antidepressants, measured by sold doses per capita, prevalence of antidepressant users, and proportion of antidepressant users with doses reflecting minimally adequate treatment. Fixed-effects Poisson regression models controlled for regional differences and time trends that may influence suicide risk irrespective of antidepressant sales.

Results: The number of sold antidepressant doses per capita and the prevalence of antidepressant users were unrelated to male suicide risk. However, one percentage point increase in the proportion of antidepressant users receiving minimally adequate treatment reduced non-alcohol-related male suicide risk by one percent (relative risk 0.987, 95% confidence interval 0.976-0.998). This beneficial effect only emerged among men with high education, high income, and employment, among men without a partner, and men not owning their home. Alcohol-related suicides and female suicides were unrelated to all measures of antidepressant sales.

Conclusion: We found little evidence that increase in overall sales or in the prevalence of non-tricyclic antidepressant users would have caused the fall in suicide rates in Finland in 1995-2007. However, the rise in the proportion of antidepressant users receiving minimally adequate treatment, possibly due to enhanced treatment compliance, may have prevented non-alcohol-related suicides among men.

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National trends in suicide rates and non-tricyclic antidepressant sales in Finland.Alcohol-related and non-alcohol-related suicide rates per 100,000 person-years (panel A), number of defined daily doses (DDDs) of antidepressants sold per capita per year (panel B), prevalence of antidepressant users (panel C), and proportion of individuals among all antidepressant users who have purchased at least 90 defined daily doses of antidepressants during a year (panel D) in 1995–2007 among Finnish men (left) and women (right) aged 20+.
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pone-0098405-g001: National trends in suicide rates and non-tricyclic antidepressant sales in Finland.Alcohol-related and non-alcohol-related suicide rates per 100,000 person-years (panel A), number of defined daily doses (DDDs) of antidepressants sold per capita per year (panel B), prevalence of antidepressant users (panel C), and proportion of individuals among all antidepressant users who have purchased at least 90 defined daily doses of antidepressants during a year (panel D) in 1995–2007 among Finnish men (left) and women (right) aged 20+.

Mentions: Finland experienced a rapid decline in suicide rates in 1995–2007 (Figure 1). Most of this decline was accounted for by suicides where alcohol intoxication was not a contributory cause, whereas the decline in alcohol-related suicide rates was slower and stagnated altogether in the beginning of the 2000s. Around 30% of male suicides and 10–15% of female suicides were alcohol-related, the proportion slowly increasing among men. In the same period, non-tricyclic antidepressant sales increased steadily. The number of sold doses per capita went up from around 5–7 in 1995 to 18 among men and almost 30 among women in 2007. The 2007 sales correspond to an over two week daily use of antidepressants among men and a one-month daily use among women per capita per year. The prevalence of having at least one yearly antidepressant purchase more than doubled during the study period reaching 6% among men and 10% among women in 2007. The proportion of antidepressant users with doses reflecting minimally adequate treatment (i.e. at least 90 defined daily doses annually) increased from around 60% to 80% among both men and women.


Antidepressant sales and the risk for alcohol-related and non-alcohol-related suicide in Finland--an individual-level population study.

Moustgaard H, Joutsenniemi K, Myrskylä M, Martikainen P - PLoS ONE (2014)

National trends in suicide rates and non-tricyclic antidepressant sales in Finland.Alcohol-related and non-alcohol-related suicide rates per 100,000 person-years (panel A), number of defined daily doses (DDDs) of antidepressants sold per capita per year (panel B), prevalence of antidepressant users (panel C), and proportion of individuals among all antidepressant users who have purchased at least 90 defined daily doses of antidepressants during a year (panel D) in 1995–2007 among Finnish men (left) and women (right) aged 20+.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4043885&req=5

pone-0098405-g001: National trends in suicide rates and non-tricyclic antidepressant sales in Finland.Alcohol-related and non-alcohol-related suicide rates per 100,000 person-years (panel A), number of defined daily doses (DDDs) of antidepressants sold per capita per year (panel B), prevalence of antidepressant users (panel C), and proportion of individuals among all antidepressant users who have purchased at least 90 defined daily doses of antidepressants during a year (panel D) in 1995–2007 among Finnish men (left) and women (right) aged 20+.
Mentions: Finland experienced a rapid decline in suicide rates in 1995–2007 (Figure 1). Most of this decline was accounted for by suicides where alcohol intoxication was not a contributory cause, whereas the decline in alcohol-related suicide rates was slower and stagnated altogether in the beginning of the 2000s. Around 30% of male suicides and 10–15% of female suicides were alcohol-related, the proportion slowly increasing among men. In the same period, non-tricyclic antidepressant sales increased steadily. The number of sold doses per capita went up from around 5–7 in 1995 to 18 among men and almost 30 among women in 2007. The 2007 sales correspond to an over two week daily use of antidepressants among men and a one-month daily use among women per capita per year. The prevalence of having at least one yearly antidepressant purchase more than doubled during the study period reaching 6% among men and 10% among women in 2007. The proportion of antidepressant users with doses reflecting minimally adequate treatment (i.e. at least 90 defined daily doses annually) increased from around 60% to 80% among both men and women.

Bottom Line: However, one percentage point increase in the proportion of antidepressant users receiving minimally adequate treatment reduced non-alcohol-related male suicide risk by one percent (relative risk 0.987, 95% confidence interval 0.976-0.998).This beneficial effect only emerged among men with high education, high income, and employment, among men without a partner, and men not owning their home.We found little evidence that increase in overall sales or in the prevalence of non-tricyclic antidepressant users would have caused the fall in suicide rates in Finland in 1995-2007.

View Article: PubMed Central - PubMed

Affiliation: Population Research Unit, Department of Social Research, University of Helsinki, Finland.

ABSTRACT

Objectives: A marked decline in suicide rates has co-occurred with increased antidepressant sales in several countries but the causal connection between the trends remains debated. Most previous studies have focused on overall suicide rates and neglected differential effects in population subgroups. Our objective was to investigate whether increasing sales of non-tricyclic antidepressants have reduced alcohol- and non-alcohol-related suicide risk in different population subgroups.

Methods: We followed a nationally representative sample of 950,158 Finnish adults in 1995-2007 for alcohol-related (n = 2,859) and non-alcohol-related (n = 8,632) suicides. We assessed suicide risk by gender and social group according to regional sales of non-tricyclic antidepressants, measured by sold doses per capita, prevalence of antidepressant users, and proportion of antidepressant users with doses reflecting minimally adequate treatment. Fixed-effects Poisson regression models controlled for regional differences and time trends that may influence suicide risk irrespective of antidepressant sales.

Results: The number of sold antidepressant doses per capita and the prevalence of antidepressant users were unrelated to male suicide risk. However, one percentage point increase in the proportion of antidepressant users receiving minimally adequate treatment reduced non-alcohol-related male suicide risk by one percent (relative risk 0.987, 95% confidence interval 0.976-0.998). This beneficial effect only emerged among men with high education, high income, and employment, among men without a partner, and men not owning their home. Alcohol-related suicides and female suicides were unrelated to all measures of antidepressant sales.

Conclusion: We found little evidence that increase in overall sales or in the prevalence of non-tricyclic antidepressant users would have caused the fall in suicide rates in Finland in 1995-2007. However, the rise in the proportion of antidepressant users receiving minimally adequate treatment, possibly due to enhanced treatment compliance, may have prevented non-alcohol-related suicides among men.

Show MeSH
Related in: MedlinePlus