Association between Antidepressant Prescribing and Suicide Rates in OECD Countries: An Ecological Study

Abstract

Introduction:

We have conducted an ecological study to assess the association between antidepressant prescribing and suicide rates using the Organisation for Economic Co-operation and Development (OECD) health data, making this the largest ecological study in recent times.

Method:

Data were derived for the years 1995–2008 from the OECD health data set. The residuals for all variables were adjusted for country and year within each country. These were then analysed to identify predictors of suicide rate. Pearson’s rank correlation coefficient and linear regression model were employed to assess associations and identify significant predictors of suicide rate.

Results:

Suicide rate has significant positive correlations with antidepressant rates (p=0.031) and unemployment (p=0.028). It also has a significant negative correlation with inpatient psychiatric beds (p=0.039). The actual coefficients are less than ±0.16, indicating weak relationships. After adjusting for other variables, the only variable that is a statistically significant predictor of suicide rate is antidepressant prescribing (p=0.005, r²=0.09).

Discussion:

Our analysis using this large data set suggests a statistically significant, albeit weak positive, association between antidepressant prescribing and suicide rates.

Key words

antidepressant prescribing - OECD - suicide rates

• References

• 1 Foster T, Gillespie K, McClelland R et al. Risk factors for suicide independent of DSM-III-R axis I disorder. Case control psychological autopsy study in Northern Ireland. Br J Psychiatry 1999; 175: 175-180
• 2 Department of Health . Saving lives: Our healthier nation. 1999. London­ TSO:
• 3 Paykel ES, Tylee A, Wright A et al. The defeat depression campaign: psychiatry in the public arena. Am J Psychiatry 1997; 154: 59-65
• 4 Garcia-Cebrian A, Bauer M, Montejo AL et al. Factors influencing depression endpoints research (FINDER):study design and population characteristics. Eur Psychiatry 2008; 23: 57-65
• 5 Hall WD, Mant A, Mitchell PB et al. Association between antidepressant prescribing and suicide in Australia, 1991–2000: trend analysis. BMJ 2003; 326: 1008
• 6 Healy D. Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors. Psychother Psychosom 2003; 72: 71-79
• 7 Barbui C, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ 2009; 180: 291-297
• 8 Issacson G. Suicide prevention – a medical breakthrough?. Acta Psychatr Scand 2000; 102: 113-117
• 9 Kelly CB, Ansari T, Rafferty T et al. Antidepressant prescribing and suicide rate in Northern Ireland. Eur Psychiatry 2003; 18: 325-328
• 10 Olfson M, Shaffer D, Marcus SC et al. Relationship between antidepressant medication treatment and suicide in adolescents. Arch Gen Psychiatry 2003; 60: 978-982
• 11 Ludwig J, Marcotte DE, Norberg K. Anti-depressants and suicide. J Health Econ 2009; 28: 659-676
• 12 Rihmer Z, Belso N, Kalmar S. Antidepressants and suicide prevention in Hungary. Acta Psychiatr Scand 2001; 103: 238-239
• 13 Morgan O, Griffiths C, Majeed A. Antidepressant prescribing and changes in antidepressant poisoning mortality and suicide in England, 1993–2004. J Public Health (Oxf) 2008; 30: 60-68
• 14 Zahl P, De Leo D, Ekeberg O et al. The relationship between sales of SSRI, TCA and suicide rates in the Nordic countries. BMC Psychiatry 2010; 10: 62
• 15 Guaiana G, Andretta M, Griez E et al. Sales of antidepressants, suicides and hospital admissions for depression in Veneto Region, Italy from 2000 to 2005: an ecological study. Ann Gen Psychiatry 2011; 10: 24
• 16 Dahlberg M, Lundin D. Antidepressants and the suicide rate: Is there really a connection? Department of Economics. Uppsala University 2005; http://www.nek.uu.se/Pdf/wp2005_4.pdf
• 17 OECD Health Data. 2008 ISBN 978-92-64-04474-6
• 18 OECD, Health at a Glance . Europe 2010. OECD Publishing; Paris: 2010. http://www.oecd.org/statistics/
• 19 Mathers C, Ma Fat D, Inoue M et al. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Org 2005; 83: 171-177
• 20 Möller HJ, Baldwin D, Goodwin G et al. Do SSRIs or antidepressants in general increase suicidality?. Eur Arch Psychiatry Clin Neurosci 2008; 258 (Suppl. 03) 3-23
• 21 Tunnainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression. Cochrane Database Syst Rev 2004; CD004050
• 22 Pilkington K, Kirkwood G, Rampes H et al. Homeopathy for depression: a systematic review of the research evidence. Homeopathy 2005; 94: 153-163
• 23 Maris R. Suicide. Lancet 2002; 360: 319-326
• 24 Gunnell D, Saperia J, Ashby D. Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA’s safety review. BMJ 2005; 330: 385
• 25 Khan A, Khan S, Kolts R et al. Suicide rates in clinical trials of SSRIs, other antidepressants and placebo: analysis of FDA reports. Am J Psychiatry 2003; 160: 790-792
• 26 NICE clinical guideline 90 . Depression: the treatment and management of depression in adults (update) 2009; www.nice.org.uk/CG90
• 27 Baldessarini RJ, Tondo L. Psychopharmacology of suicide prevention. In: Tatarelli R, Pompili M, Girardi P. eds. Suicide in psychiatric disorder. New York: Nova Science Publications; 2007: 193-213
• 28 Angst J, Azorin JM, Bowden CL et al. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study. Arch Gen Psychiatry 2011; 68: 791-798
• 29 Ceccherini-Nelli A, Priebe S. Economic factors and suicide rates: associations over time in four countries. Soc Psychiatry Psychiatr Epidemiol 2011; 46: 975-982
• 30 Foster T. Dying for a drink. Br Med J 2001; 323: 817-818
• 31 De Leo D. Why are we not getting any closer to preventing suicide?. Br J Psychiatry 2002; 181: 372-374
• 32 Reseland S, Le Noury J, Aldred G et al. National suicide rates 1961–2003: further analysis of nordic data for suicide, autopsies, and ill-defined death rates. Psychother Psychosom 2008; 77: 78-82
• 33 Viola R, Benkő R, Gábor N et al. National trend of antidepressant consumption and its’ impact on suicide rate in Hungary. Pharmacoepidemiol Drug Safety 2008; 17: 401-405
• 34 Stone M, Laughren T, Jones ML et al. Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ 2009; 339: b2880
• 35 Libby AM, Brent DA, Morrato EH et al. Decline in treatment of pediatric depression after FDA advisory on risk of suicidality with SSRIs. Am J Psychiatry 2007; 164: 884-891
• 36 Gibbons RD, Brown CH, Hur K et al. Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry 2007; 164: 1356-1363
• 37 Wheeler BW, Gunnell D, Metcalfe C et al. The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom: ecological study. BMJ 2008; 336: 542-545