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Amendola S, Plöderl M, Hengartner MP. Suicide Rates and Prescription of Antidepressants. CRISIS 2024; 45:225-233. [PMID: 38353035 DOI: 10.1027/0227-5910/a000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Background: Previous ecological studies reported that increasing antidepressant prescriptions were associated with decreasing suicide rates. Aim: To determine whether antidepressant prescription prevalence is negatively associated with suicide rates (i.e., as antidepressant prescribing increases, suicide rates decrease) between 1999 and 2020. Method: The study protocol was pre-registered on the Open Science Framework (https://osf.io/978sk/). Publicly available data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) and Medical Expenditure Panel Survey (MEPS) were used. Results: Overall, both the antidepressant prescription prevalence and the suicide rate were increasing from 1990 to 2020 in the United States. Positive trends for both outcomes were also evident when analyses were stratified according to sex and/or race/ethnicity. Pearson's correlation analyses consistently found positive associations between antidepressant prescription prevalence and suicide rates. Limitations: Trends and their associations were examined at the population level. The results cannot clarify the causal nature of the association observed. Conclusion: The results of our analysis consistently demonstrated positive trends for both antidepressant prescription prevalence and suicide rates over time as well as positive associations between them. These findings update those from previous studies and are at odds with the notion that, at a population level, more antidepressant prescriptions would lead to lower suicide rates. However, it needs to be acknowledged that ecological studies provide insufficient evidence to infer causality.
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Affiliation(s)
- Simone Amendola
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Martin Plöderl
- Department of Inpatient Psychotherapy and Crisis Intervention, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
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2
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Currie DW, Schwab-Reese LM, Runyan CW. Psychiatric diagnoses are associated with means selection in united states suicide deaths. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1791-1799. [PMID: 33388799 DOI: 10.1007/s00127-020-01999-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to examine whether the choice of means by persons who die by suicide is associated with a prior psychiatric diagnosis. METHODS In this cross-sectional study, we analyzed suicide surveillance data from 18 states reporting to the National Violent Death Reporting System (NVDRS) between 2003 and 2014. NVDRS compiled data from multiple sources (e.g., coroner's reports, police reports, death certificates) on every violent death within reporting jurisdictions, including information on indicated psychiatric disorders and suicide means. We assessed whether the selected suicide means were associated with diagnoses using multinomial logistic regression. RESULTS Adjusted models suggested that, compared to decedents using firearms, those using poisoning were more likely to have each psychiatric disorder examined, including bipolar disorder (aOR: 2.17 [95% CI 2.03-2.32]), schizophrenia (aOR: 1.81 [1.61-2.04]), depression (aOR: 1.64 [1.58-1.70]), anxiety disorder (aOR: 1.46 [1.35-1.57]), and PTSD (aOR: 1.41 [1.22-1.64]). A far greater proportion of individuals who died from less common means (other than firearms, suffocation, or poisoning) had schizophrenia (aOR: 4.52 [4.00-5.11]). CONCLUSIONS Many existing and proposed means restriction interventions have focused on firearms. Additional focus on access to potential agents of poisoning (e.g., the type and quantity of medication administered to patients) among individuals with psychiatric diagnoses may be warranted.
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Affiliation(s)
- Dustin W Currie
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura M Schwab-Reese
- Department of Public Health, Purdue University, 812 W State St, MTHW 214F, West Lafayette, IN, 47905, USA.
| | - Carol W Runyan
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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3
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Leung MTY, Wong KH, Ho PWH, Ip P, Wei L, Wong ICK, Man KKC. Gestational exposure to antidepressants and risk of seizure in offspring: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 131:345-359. [PMID: 34571118 DOI: 10.1016/j.neubiorev.2021.09.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
In spite of the preliminary evidence suggesting a link between gestational use of antidepressant and neurodevelopmental disorders in their offspring, the association between maternal use of antidepressants during pregnancy and the risk of neurologically-related adverse outcomes such as neonatal seizure is still unclear. This study summarises the available evidence on the association between gestational exposure to any antidepressants and the risk of seizure in neonates and children. We found that gestational antidepressant exposure is associated with a 2.3-fold higher incidence of seizure in offspring. Although a causal relationship cannot be confirmed in view of other potential confounders, our findings warrant future research on related clinical aspects, and possibly more careful monitoring of foetal neurodevelopment in pregnant women taking antidepressants during pregnancy. However, this does not suggest the abrupt withdrawal of antidepressants during pregnancy for all cases at risk of seizure in offspring as this must be balanced with the risk of negative consequences caused by untreated maternal depression, and decision-making should be individualised for each patient.
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Affiliation(s)
- Miriam T Y Leung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Kirstie H Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Phoebe W H Ho
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
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Study of antidepressant use in 5 European settings. Could economic, sociodemographic and cultural determinants be related to their use? J Affect Disord 2019; 249:278-285. [PMID: 30784725 DOI: 10.1016/j.jad.2019.01.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND We aimed at describing the trends in antidepressants use (AD) by age and sex, during 2007-2011, in 5 European settings (Sweden, Norway, Denmark, Catalonia and Veneto), and to assess whether the differences found across settings could be related to economic, social and cultural determinants. METHODS We collected data of AD use expressed in defined daily doses (DDD). Data were retrieved from population-based databases. We calculated DDD/1000 inhabitants/day. We analysed which economic, social, and cultural covariates determined between-settings differences in AD consumption. RESULTS The use of AD showed an increasing trend during the study period, being Selective Serotonin Reuptake Inhibitors the most consumed, followed "others AD". Women and the elderly showed the highest AD consumption. Between-settings variability in AD consumption showed a positive correlation with pharmaceutical expenditure and a negative one with general practitioner's rate. After adjusting by pharmaceutical expenditure and general practitioners rate Masculinity, Long-Term Orientation and Individualism cultural dimensions were associated with AD use by using the Hofstede´s cultural dimensions model. LIMITATIONS This study has been conducted in administrative databases, with no information on AD use by indication; differences among AD use could be related to their prescription for other disorders. Analyses were based on a small dataset and none of the results reached statistical significance. CONCLUSIONS AD use increased through 2007-2011. Pharmaceutical expenditure and General Practitioners rate, Masculinity, Long-Term Orientation and Individualism explained the differences in AD use between countries. People's attitude should be considered when designing national campaigns to improve antidepressant use.
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Hjelmeland H, Jaworski K, Knizek BL, Marsh I. Problematic Advice From Suicide Prevention Experts. ACTA ACUST UNITED AC 2019. [DOI: 10.1891/1559-4343.20.2.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Based on a 10-year systematic review of suicide prevention strategies, “29 suicide prevention experts from 17 European countries” recommend 4 allegedly evidence-based strategies to be included in national suicide prevention programs. One of the recommended strategies is pharmacological treatment of depression. This recommendation is problematic for several reasons. First, it is based on a biased selection and interpretation of available evidence. Second, the authors have failed to take into consideration the widespread corruption in the research on antidepressants. Third, the many and serious side effects of antidepressants are not considered. Thus, the recommendation may have deleterious consequences for countless numbers of people, and, in fact, contribute to an increase in the suicide rate rather than a decrease.
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Gravensteen IK, Ekeberg Ø, Thiblin I, Helweg-Larsen K, Hem E, Rogde S, Tøllefsen IM. Psychoactive substances in natural and unnatural deaths in Norway and Sweden - a study on victims of suicide and accidents compared with natural deaths in psychiatric patients. BMC Psychiatry 2019; 19:33. [PMID: 30658618 PMCID: PMC6339417 DOI: 10.1186/s12888-019-2015-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The extent of post-mortem detection of specific psychoactive drugs may differ between countries, and may greatly influence the national death register's classification of manner and cause of death. The main objective of the present study was to analyse the magnitude and pattern of post-mortem detection of various psychoactive substances by the manner of death (suicide, accidental, undetermined and natural death with a psychiatric diagnosis) in Norway and Sweden. METHODS The Cause of Death Registers in Norway and Sweden provided data on 600 deaths in 2008 from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of death and 200 as natural deaths in individuals with a diagnosis of mental disorder as the underlying cause of death. We examined death certificates and forensic reports including toxicological analyses. RESULTS The detection of psychoactive substances was commonly reported in suicides (66 and 74% in Norway and Sweden respectively), accidents (85 and 66%), undetermined manner of deaths (80% in the Swedish dataset) and in natural deaths with a psychiatric diagnosis (50 and 53%). Ethanol was the most commonly reported substance in the three manners of death, except from opioids being more common in accidental deaths in the Norwegian dataset. In cases of suicide by poisoning, benzodiazepines and z-drugs were the most common substances in both countries. Heroin or morphine was the most commonly reported substance in cases of accidental death by poisoning in the Norwegian dataset, while other opioids dominated the Swedish dataset. Anti-depressants were found in 22% of the suicide cases in the Norwegian dataset and in 29% of suicide cases in the Swedish dataset. CONCLUSIONS Psychoactive substances were detected in 66 and 74% of suicides and in 85 and 66% of accidental deaths in the Norwegian and Swedish datasets, respectively. Apart from a higher detection rate of heroin in deaths by accident in Norway than in Sweden, the pattern of detected psychoactive substances was similar in the two countries. Assessment of a suicidal motive may be hampered by the common use of psychoactive substances in suicide victims.
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Affiliation(s)
- Ida Kathrine Gravensteen
- 0000 0004 0389 8485grid.55325.34Department of Forensic Sciences, Oslo University Hospital, Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Øivind Ekeberg
- 0000 0004 1936 8921grid.5510.1Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1111 Blindern, N-0317 Oslo, Norway ,0000 0004 0389 8485grid.55325.34Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Ingemar Thiblin
- 0000 0004 1936 9457grid.8993.bDepartment of Surgical Sciences, Uppsala University, Box 256, 751 05 Uppsala, Sweden
| | - Karin Helweg-Larsen
- 0000 0001 0674 042Xgrid.5254.6Department of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Erlend Hem
- 0000 0004 1936 8921grid.5510.1Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1111 Blindern, N-0317 Oslo, Norway ,0000 0004 0389 8485grid.55325.34Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Sidsel Rogde
- 0000 0004 0389 8485grid.55325.34Department of Forensic Sciences, Oslo University Hospital, Box 4950 Nydalen, N-0424 Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, University of Oslo, Box 1072 Blindern, N- 0316 Oslo, Norway
| | - Ingvild Maria Tøllefsen
- Division of Medicine, Department of Acute Medicine, Oslo University Hospital Ullevaal, Box 4950 Nydalen, N-0424, Oslo, Norway.
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Toxicological findings in suicides – frequency of antidepressant and antipsychotic substances. Forensic Sci Med Pathol 2018; 15:23-30. [DOI: 10.1007/s12024-018-0041-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 01/02/2023]
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Halonen JI, Koskinen A, Kouvonen A, Varje P, Pirkola S, Väänänen A. Distinctive use of newer and older antidepressants in major geographical areas: A nationally representative register-based study. J Affect Disord 2018; 229:358-363. [PMID: 29331694 DOI: 10.1016/j.jad.2017.12.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/24/2017] [Accepted: 12/31/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is unknown whether newer, mainly selective serotonin reuptake inhibitors, and older tricyclic antidepressants are used similarly regardless of the geographical area of residence and education. METHODS We included four randomly sampled cohorts of the Finnish working aged population (n = 998,540-1,033,135). The sampling (Dec 31st in 1995, 2000, 2004 and 2010) resulted in non-overlapping time windows where each participant was followed up for four years for the first antidepressant use. Using Cox proportional hazards models, we examined whether the hazard of antidepressant use differed between the capital area and three other areas (Southern, Western and Northern/Eastern Finland). Educational differences were examined using four sub-groups: capital area/high education (reference category); other areas/high education; capital area/low education; and other areas/low education. RESULTS Hazard ratios for the use of newer antidepressants were significantly lower in all other areas compared to the capital area after adjustment for age, sex, marital status, employment status, education, income, and area-level unemployment. Findings remained consistent in all time windows, differences increasing slightly. In the sub-group analysis those with low education had the lowest level of use in all areas, also within the capital area. The results were opposite for older antidepressants in all but the last time window. LIMITATIONS Some degree of unmeasured confounding and exposure misclassification is likely to exist. CONCLUSIONS Newer antidepressants were more commonly used in the capital than in the other areas, and among those with high versus low education. These differences in antidepressant use suggest socioeconomic inequalities in the mental health treatment quality.
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Affiliation(s)
- Jaana I Halonen
- Finnish Institute of Occupational Health, PO Box 310, 70101 Kuopio, Finland.
| | - Aki Koskinen
- Finnish Institute of Occupational Health, PO Box 310, 70101 Kuopio, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland; Administrative Data Research Centre (Northern Ireland), Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Pekka Varje
- Finnish Institute of Occupational Health, PO Box 310, 70101 Kuopio, Finland
| | - Sami Pirkola
- Department of Social Sciences, University of Tampere, and Pirkanmaa Hospital District Psychiatry, Finland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, PO Box 310, 70101 Kuopio, Finland; School of Social Policy, Sociology and Social Research, University of Kent, United Kingdom
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9
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Hjelmeland H, Knizek BL. Suicide and mental disorders: A discourse of politics, power, and vested interests. DEATH STUDIES 2017; 41:481-492. [PMID: 28535129 DOI: 10.1080/07481187.2017.1332905] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
One of the most well-established truths in suicidology is that mental disorders play a significant role in at least 90% of suicides, and a causal relationship between the two is often implied. In this article, the authors argue that the evidence base for this truth is weak and that there is much research questioning the 90% statistic. Based on numerous examples, they also argue that ideology, politics, power, and vested interests among influential professionals in the field obstruct argument-based discussion of this issue. The authors also discuss unfortunate consequences of the constant reiteration of the 90% statistic.
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Affiliation(s)
- Heidi Hjelmeland
- a Department of Mental Health , Norwegian University of Science and Technology , Trondheim , Norway
| | - Birthe L Knizek
- a Department of Mental Health , Norwegian University of Science and Technology , Trondheim , Norway
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Blüml V, Helbich M, Mayr M, Turnwald R, Vyssoki B, Lewitzka U, Hartung S, Plener PL, Fegert JM, Kapusta ND. Antidepressant sales and regional variations of suicide mortality in Germany. J Psychiatr Res 2017; 87:88-94. [PMID: 28024215 DOI: 10.1016/j.jpsychires.2016.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
Suicides account for over one million deaths per year worldwide with depression among the most important risk factors. Epidemiological research into the relationship between antidepressant utilization and suicide mortality has shown heterogeneous and contradictory results. Different methodological approaches and limitations could at least partially explain varying results. This is the first study assessing the association of suicide mortality and antidepressant sales across Germany using complex statistical approaches in order to control for possible confounding factors including spatial dependency of data. German suicide counts were analyzed on a district level (n = 402) utilizing ecological Poisson regressions within a hierarchical Bayesian framework. Due to significant spatial effects between adjacent districts spatial models were calculated in addition to a baseline non-spatial model. Models were adjusted for several confounders including socioeconomic variables, quality of psychosocial care, and depression prevalence. Separate analyses were performed for Eastern and Western Germany and for different classes of antidepressants (SSRIs and TCAs). Overall antidepressant sales were significantly negatively associated with suicide mortality in the non-spatial baseline model, while after adjusting for spatially structured and unstructured effects the association turned out to be insignificant. In sub-analyses, analogue results were found for SSRIs and TCAs separately. Suicide risk shows a distinct heterogeneous pattern with a pronounced relative risk in Southeast Germany. In conclusion, the results reflect the heterogeneous findings of previous studies on the association between suicide mortality and antidepressant sales and point to the complexity of this hypothesized link. Furthermore, the findings support tailored suicide preventive efforts within high risk areas.
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Affiliation(s)
- Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Marco Helbich
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
| | - Michael Mayr
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Roland Turnwald
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Benjamin Vyssoki
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Nestor D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Hengartner MP. Methodological Flaws, Conflicts of Interest, and Scientific Fallacies: Implications for the Evaluation of Antidepressants' Efficacy and Harm. Front Psychiatry 2017; 8:275. [PMID: 29270136 PMCID: PMC5725408 DOI: 10.3389/fpsyt.2017.00275] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In current psychiatric practice, antidepressants are widely and with ever-increasing frequency prescribed to patients. However, several scientific biases obfuscate estimates of antidepressants' efficacy and harm, and these are barely recognized in treatment guidelines. The aim of this mini-review is to critically evaluate the efficacy and harm of antidepressants for acute and maintenance treatment with respect to systematic biases related to industry funding and trial methodology. METHODS Narrative review based on a comprehensive search of the literature. RESULTS It is shown that the pooled efficacy of antidepressants is weak and below the threshold of a minimally clinically important change once publication and reporting biases are considered. Moreover, the small mean difference in symptom reductions relative to placebo is possibly attributable to observer effects in unblinded assessors and patient expectancies. With respect to trial dropout rates, a hard outcome not subjected to observer bias, no difference was observed between antidepressants and placebo. The discontinuation trials on the efficacy of antidepressants in maintenance therapy are systematically flawed, because in these studies, spontaneous remitters are excluded, whereas half of all patients who remitted on antidepressants are abruptly switched to placebo. This can cause a severe withdrawal syndrome that is easily misdiagnosed as a relapse when assessed on subjective symptom rating scales. In accordance, the findings of naturalistic long-term studies suggest that maintenance therapy has no clear benefit, and non-drug users do not show increased recurrence rates. Moreover, a growing body of evidence from hundreds of randomized controlled trials suggests that antidepressants cause suicidality, but this risk is underestimated because data from industry-funded trials are systematically flawed. Unselected, population-wide observational studies indicate that depressive patients who use antidepressants are at an increased risk of suicide and that they have a higher rate of all-cause mortality than matched controls. CONCLUSION The strong reliance on industry-funded research results in an uncritical approval of antidepressants. Due to several flaws such as publication and reporting bias, unblinding of outcome assessors, concealment and recoding of serious adverse events, the efficacy of antidepressants is systematically overestimated, and harm is systematically underestimated. Therefore, I conclude that antidepressants are largely ineffective and potentially harmful.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Zurich, Switzerland
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12
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Balsikci A, Uzun O, Erdem M, Doruk A, Cansever A, Ates MA. Side effects that Cause Noncompliance to Antidepressant Medications in the Course of Outpatient Treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20120827114140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Ozcan Uzun
- Gulhane Military Medical Faculty, Department of Psychiatry, Ankara - Turkey
| | - Murat Erdem
- Gulhane Military Medical Faculty, Department of Psychiatry, Ankara - Turkey
| | - Ali Doruk
- Gulhane Military Medical Faculty, Department of Psychiatry, Ankara - Turkey
| | - Adnan Cansever
- Gulhane Military Medical Faculty, Department of Psychiatry, Ankara - Turkey
| | - Mehmet Alpay Ates
- GATA Haydarpasa Psychiatry Training Hospital, Department of Psychiatry, Istanbul - Turkey
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13
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Affiliation(s)
- Peter C Gøtzsche
- Nordic Cochrane Centre, Dept 7811 Rigshospitalet, Copenhagen, Denmark.
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14
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Moustgaard H, Joutsenniemi K, Myrskylä M, Martikainen P. Antidepressant sales and the risk for alcohol-related and non-alcohol-related suicide in Finland--an individual-level population study. PLoS One 2014; 9:e98405. [PMID: 24892560 PMCID: PMC4043885 DOI: 10.1371/journal.pone.0098405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/01/2014] [Indexed: 11/26/2022] Open
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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Affiliation(s)
- Heta Moustgaard
- Population Research Unit, Department of Social Research, University of Helsinki, Finland
| | - Kaisla Joutsenniemi
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Mikko Myrskylä
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, Finland
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15
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Xinxing W, Wei L, Lei W, Rui Z, Baoying J, Lingjia Q. A neuroendocrine mechanism of co-morbidity of depression-like behavior and myocardial injury in rats. PLoS One 2014; 9:e88427. [PMID: 24551098 PMCID: PMC3923793 DOI: 10.1371/journal.pone.0088427] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 01/08/2014] [Indexed: 11/19/2022] Open
Abstract
Depression is generally a recurrent psychiatric disorder. Evidence shows that depression and cardiovascular diseases are common comorbid conditions, but the specific pathological mechanisms remain unclear. The purpose of this study is to determine the effects of depression induced by chronic unpredictable mild stress (CUMS) on myocardial injury and to further elucidate the biological mechanism of depression. Rats were used as a model. The CUMS procedure lasted for a total of 8 weeks. After 4 weeks of CUMS, treated rats exhibited a reduced sucrose preference and changes in scores on an open field test, body weight and content of 5-HT in the brain as compared with the values of these variables in controls. These changes indicated depression-like changes in CUMS rats and demonstrated the feasibility of the depression model. In addition, pathological changes in the myocardium and increased cardiomyocyte apoptosis demonstrated that myocardial injury had occurred after 6 weeks of CUMS and had increased significantly by the end of 8 weeks of CUMS. Plasma serotonin (5-HT), norepinephrine (NE) and epinephrine (E), all depression-related neuroendocrine factors, were measured by HPLC-ECD techniques, and the content of plasma corticosterone (GC) was evaluated by an I(125)-cortisol radioactivity immunoassay in control and CUMS rats. The results indicated that 5-HT had decreased, whereas NE, E and GC had increased in CUMS rats, and these factors might be associated with depression-induced myocardial injury. The effects of 5-HT, NE and GC on the survival rate of cultured cardiomyocytes were determined using an orthogonal design. The results showed that 5-HT was a more important factor affecting cell survival than GC or NE. The results suggested that normal blood levels of 5-HT had a cytoprotective effect. The neuroendocrine disorders characterized by decreased 5-HT combined with increased GC and NE mediated the occurrence of depression-induced myocardial injury.
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Affiliation(s)
- Wang Xinxing
- Beijing Institute of Basic Medical Sciences, Beijing, China
- * E-mail: (WX); (JB); (QL)
| | - Liu Wei
- Institute of Health & Environmental Medicine, Tianjin, China
| | - Wu Lei
- Institute of Health & Environmental Medicine, Tianjin, China
| | - Zhan Rui
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Jin Baoying
- Tianjin Occupational Disease Prevention Hospital (Hospital Workers), Tianjin, China
- * E-mail: (WX); (JB); (QL)
| | - Qian Lingjia
- Beijing Institute of Basic Medical Sciences, Beijing, China
- * E-mail: (WX); (JB); (QL)
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Trend in SSRI-SNRI antidepressants prescription over a 6-year period and predictors of poor adherence. Eur J Clin Pharmacol 2013; 69:2095-101. [PMID: 23904053 DOI: 10.1007/s00228-013-1567-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe antidepressant (AD) use in the Emilia-Romagna Region (Italy) and to evaluate adherence to treatment with selective serotonin receptor inhibitors or selective noradrenaline receptor inhibitors (SSRI-SNRI). METHODS Reimbursed prescriptions of AD were retrieved from the Emilia-Romagna Regional Health Authority Database. The overall AD consumption from the 2006-2011 period was expressed in terms of prevalence and amount of use. Adherence to treatment was assessed in a cohort of patients who received SSRI-SNRI, and was followed throughout a 6-month period from the start of each treatment episode. Adherence was considered according to three parameters: duration of treatment ≥ 120 days, prescription coverage ≥ 80 %, and gaps between prescriptions < 3 months. Determinants of non-adherent regimen, including sociodemographic and clinical variables, were identified by multivariate logistic regression by calculating adjusted Odds Ratio (adjOR) and the relevant 95 % confidence interval (95CI). RESULTS From 2006 to 2011, the prevalence of use of AD increased by 5 % (from 86 to 90 per 1,000 inhabitants) and the amount of antidepressant consumption increased by 20 % (from 43 to 51 defined daily dose per thousand inhabitants per day [DDD/TID]), with a 14 % rise in the intensity of drug use (from 182 to 208 DDD per patient). Out of 347,615 SSRI-SNRI treatment episodes, only 23.8 % were adherent. Comorbidity (adjOR:0.69; 95CI:0.67-0.72) and recurrence of AD treatment in the previous year (0.91; 0.89-0.92) were associated with better adherence. Moreover, patients treated with duloxetine (0.58; 0.55-0.60), escitalopram (0.64; 0.62-0.66) or sertraline (0.65; 0.64-0.67) showed better adherence in comparison with paroxetine. CONCLUSIONS Clinical variables resulting in improved adherence seem to identify patients with more severe disorders and who actually need a pharmacological approach, whereas differences in adherence among ADs could in part be caused by channeling and sponsorship bias. Initiatives addressed at improving cooperation between primary care and psychiatrists could decrease AD prescription for cases of sub-threshold or mild depression that easily drop out because of rapid symptom relief or side effects.
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Gusmão R, Quintão S, McDaid D, Arensman E, Van Audenhove C, Coffey C, Värnik A, Värnik P, Coyne J, Hegerl U. Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study. PLoS One 2013; 8:e66455. [PMID: 23840475 PMCID: PMC3686718 DOI: 10.1371/journal.pone.0066455] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 04/29/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Research concerning the association between use of antidepressants and incidence of suicide has yielded inconsistent results and is the subject of considerable controversy. The first aim is to describe trends in the use of antidepressants and rates of suicide in Europe, adjusted for gross domestic product, alcohol consumption, unemployment, and divorce. The second aim is to explore if any observed reduction in the rate of suicide in different European countries preceded the trend for increased use of antidepressants. METHODS Data were obtained for 29 European countries between 1980 and 2009. Pearson correlations were used to explore the direction and magnitude of associations. Generalized linear mixed models and Poisson regression distribution were used to clarify the effects of antidepressants on suicide rates, while an autoregressive adjusted model was used to test the interaction between antidepressant utilization and suicide over two time periods: 1980-1994 and 1995-2009. FINDINGS An inverse correlation was observed in all countries between recorded Standardised Death Rate (SDR) for suicide and antidepressant Defined Daily Dosage (DDD), with the exception of Portugal. Variability was marked in the association between suicide and alcohol, unemployment and divorce, with countries depicting either a positive or a negative correlation with the SDR for suicide. Every unit increase in DDD of an antidepressant per 1000 people per day, adjusted for these confounding factors, reduces the SDR by 0.088. The correlation between DDD and suicide related SDR was negative in both time periods considered, albeit more pronounced between 1980 and 1994. CONCLUSIONS Suicide rates have tended to decrease more in European countries where there has been a greater increase in the use of antidepressants. These findings underline the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide.
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Affiliation(s)
- Ricardo Gusmão
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal ; Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Rudorfer MV, Hillefors M. Assessing Psychiatric Adverse Effects during Clinical Drug Development. Pharmaceut Med 2012. [DOI: 10.1007/bf03262382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Cai Z, Yan LJ, Ratka A. Telomere Shortening and Alzheimer’s Disease. Neuromolecular Med 2012; 15:25-48. [DOI: 10.1007/s12017-012-8207-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
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Olmer A, Iancu I, Strous RD. Exposure to antidepressant medications and suicide attempts in adult depressed inpatients. J Nerv Ment Dis 2012; 200:531-4. [PMID: 22652619 DOI: 10.1097/nmd.0b013e318257c7e7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The effects of antidepressant medication on suicide risk remain unclear. This study explores any association between antidepressant medication and suicide attempts leading to hospitalization in adult depressed patients.The medical records of 103 patients admitted after a suicide attempt were examined and compared with those of a matched control group of depressed patients (n = 103) admitted without suicide attempts as well as a patient group with and without suicide attempts on separate hospitalizations (n = 25). No significant difference in antidepressant medication exposure before hospitalization was found between groups. Selective serotonin reuptake inhibitor exposure was higher in patients with suicide attempts, albeit nonsignificant, but was identical in patients admitted on two occasions with and without suicide attempts. The most common method for suicide attempt was drug overdose (52.4%). Patients in the group with suicide attempts had significantly more past suicide attempts. Study results do not confirm any relationship between antidepressants and suicide attempts. Close monitoring of depressed patients is advised especially in early treatment.
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Affiliation(s)
- Ahikam Olmer
- Beer-Yaakov Mental Health Center, Beer-Yaakov, Israel.
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Ilyas S, Moncrieff J. Trends in prescriptions and costs of drugs for mental disorders in England, 1998-2010. Br J Psychiatry 2012; 200:393-8. [PMID: 22442100 DOI: 10.1192/bjp.bp.111.104257] [Citation(s) in RCA: 204] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Increasing rates of prescriptions for antidepressants, antipsychotics and stimulants have been reported from various countries. AIMS To examine trends in prescriptions and the costs of all classes of psychiatric medication in England. METHOD Data from the Prescription Cost Analysis 1998-2010 was examined, using linear regression analysis to examine trends. RESULTS Prescriptions of drugs used for mental disorders increased by 6.8% (95% CI 6.3-7.4) per year on average, in line with other drugs, but made up an increasing proportion of all prescription drug costs (P = 0.001). There were rising trends in prescriptions of all classes of psychiatric drugs, except anxiolytics and hypnotics (which did not change). Antidepressant prescriptions increased by 10% (95% CI 9.0-11) per year on average, and antipsychotics by 5.1% (95% CI 4.3-5.9). Antipsychotics overtook antidepressants as the most costly class of psychiatric medication, with costs rising 22% (95% CI 17-27) per year. CONCLUSIONS Rising prescriptions may be partly explained by longer-term treatment and increasing population. Nevertheless, it appears that psychiatric drugs make an increasing contribution to total prescription drug costs, with antipsychotics becoming the most costly. Low-dose prescribing of some antipsychotics is consistent with other evidence that their use may not be restricted to those with severe mental illness.
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Affiliation(s)
- Stephen Ilyas
- General Adult Psychiatry, Tower Hamlets Centre for Mental Health, East London NHS Foundation Trust, London
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Munk-Olsen T, Gasse C, Laursen TM. Prevalence of antidepressant use and contacts with psychiatrists and psychologists in pregnant and postpartum women. Acta Psychiatr Scand 2012; 125:318-24. [PMID: 22118213 DOI: 10.1111/j.1600-0447.2011.01784.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We aimed to study prevalence of antidepressant drug use from 12 months prior childbirth to 12 months postpartum and to compare the prevalences with those in a group of women of similar age who did not give birth. We additionally studied prevalences of contacts with private practicing psychiatrists and psychologists during a similar time period. METHOD Our study population comprised of pregnant women, and their controls were drawn from a 25% sample of the entire Danish population. Information on redeemed prescriptions for antidepressants and referrals to psychiatrists and psychologists was extracted. The outcome measure was period prevalence calculated in 3-month intervals from 12 months before childbirth to 12 months postpartum. RESULTS In the 2-year observation period around childbirth, 2733 (3.17%) women had one or more prescriptions for an antidepressant and 935 (1.18%) and 1399 (1.76%) were referred to consultations with a psychiatrist or psychologist, respectively. Women giving birth had a markedly lower use of antidepressants compared to controls, with the largest observed difference during third trimester of pregnancy (0.6% vs. 2.20%). CONCLUSION We found that the prevalence of redeemed prescriptions for antidepressants decreased during pregnancy and increased postpartum. Similar patterns were observed for contacts with private practicing psychiatrists and psychologists.
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Affiliation(s)
- T Munk-Olsen
- National Centre for Register-Based Research, Aarhus University, Taasingegade, Denmark.
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Abstract
BACKGROUND There are only a few recent studies on secular trends in child and adolescent suicides. We examine here trends in rates and methods of suicide among young people in Finland, where suicide rates at these ages are among the highest in the world. METHODS The data, obtained from Statistics Finland, consisted of all suicides (n = 901) committed by persons under 18 years of age over the period 1969-2008. Gender-specific trends were analysed separately for the years 1969-1989 and 1990-2008 using 3-year moving averages. Trends in methods of suicide were examined from 1975 to 2008 in five-year periods. RESULTS The male-to-female ratio in youth suicides was 3.6:1. The male rates increased in 1969-1989, while the rates among females were inconsistent. After 1990, the rates decreased for males but turned to an increase among females. Shooting was the most common suicide method among males throughout the period, while hanging exceeded poisoning as the most common method among females after 1990. All violent suicides decreased for males and increased for females in 1990-2008. CONCLUSIONS The increase in violent, i.e., more lethal, suicide methods among young females is alarming, as females are known to have higher rates of attempted suicide than males. Alcohol consumption, rates and treatment of depression and violent behaviour among adolescents are discussed as approaches towards explaining this phenomenon.
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Affiliation(s)
- Anniina Lahti
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Finland.
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