Data_Sheet_1_Antidepressant Use and Suicide Rates in Adults Aged 75 and Above: A Swedish Nationwide Cohort Study.PDF

Background: The treatment of depression is a main strategy for suicide prevention in older adults. We aimed to calculate suicide rates by antidepressant prescription patterns in persons aged ≥ 75 years. A further aim was to estimate the contribution of antidepressants to the change in suicide rates over time.
Methods: Swedish residents aged ≥ 75 years (N = 1,401,349) were followed between 2007 and 2014 in a national register-based retrospective cohort study. Biannual suicide rates were calculated for those with selective serotonin reuptake inhibitor (SSRI) single use, mirtazapine single use, single use of other antidepressants and use of ≥ 2 antidepressants. The contribution of antidepressants to the change in biannual suicide rates was analyzed by decomposition analysis.
Results: There were 1,277 suicides. About one third of these were on an antidepressant during their last 3 months of life. In the total cohort, the average biannual suicide rate in non-users of antidepressants was 13 per 100,000 person-years. The corresponding figure in users of antidepressants was 34 per 100,000 person-years. These rates were 25, 42 and 65 per 100,000 person-years in users of SSRI, mirtazapine and ≥ 2 antidepressants, respectively. In the total cohort, antidepressant users contributed by 26% to the estimated increase of 7 per 100,000 in biannual suicide rates. In men, biannual suicide rates increased by 11 suicides per 100,000 over the study period; antidepressant users contributed by 25% of the change. In women, those on antidepressant therapy accounted for 29% of the estimated increase of 4.4 per 100,000.
Conclusion: Only one third of the oldest Swedish population who died by suicide filled an antidepressant prescription in their last 3 months of life. Higher suicide rates were observed in mirtazapine users compared to those on SSRIs. Users of antidepressants accounted for only one quarter of the increase in the suicide rate. The identification and treatment of suicidal older adults remains an area for prevention efforts.

背景：针对老年群体的抑郁治疗是自杀预防的核心策略之一。本研究旨在针对75岁及以上人群，基于抗抑郁药处方模式计算自杀率；另一研究目标为评估抗抑郁药对随时间推移的自杀率变化的贡献度。
方法：本研究为基于全国登记系统的回顾性队列研究，对2007年至2014年间的1401349名75岁及以上瑞典常住居民进行随访。研究分别计算以下四类人群的半年自杀率：仅使用选择性5-羟色胺再摄取抑制剂（SSRI）者、仅使用米氮平者、仅使用其他抗抑郁药者，以及同时使用≥2种抗抑郁药者。采用分解分析法分析抗抑郁药对半年自杀率变化的贡献度。
结果：本研究共纳入1277例自杀案例，其中约1/3的死者在生命最后3个月内服用过抗抑郁药。全队列中，未使用抗抑郁药者的平均半年自杀率为13/10万人年，抗抑郁药使用者的对应自杀率为34/10万人年。其中，仅使用SSRI、仅使用米氮平、使用≥2种抗抑郁药者的自杀率分别为25/10万人年、42/10万人年、65/10万人年。全队列中，半年自杀率预估上升7/10万人年，抗抑郁药使用者对该上升的贡献度为26%。研究期间，男性群体的半年自杀率上升11/10万人年，抗抑郁药使用者对该变化的贡献度为25%；女性群体的半年自杀率预估上升4.4/10万人年，抗抑郁药使用者对该上升的贡献度为29%。
结论：在瑞典高龄自杀死亡人群中，仅1/3的个体在生命最后3个月内开具过抗抑郁药处方。米氮平使用者的自杀率高于SSRI使用者。抗抑郁药使用者仅能解释自杀率上升的约1/4。针对有自杀倾向老年群体的识别与治疗，仍是自杀预防工作的重点方向。