Kimmo Herttua, Giulio Scola, Tapio Paljarvi, Seena Fazel
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引用次数: 0
Abstract
Background: Despite uncertain benefits, antidepressants are used in the management of personality disorders (PDs). We investigated the association between antidepressants and two adverse outcomes - suicidal behaviour and violent crimes - in individuals with PDs.
Methods: We used nationwide Danish healthcare registries to identify all individuals with a diagnosed PD aged 18-64 years from 2007 to 2016. Antidepressant use was identified using dispensed prescriptions. Individuals were followed up for healthcare presentations of suicidal behaviour and separately for police-recorded charges of violent crimes. We applied a within-individual design comparing rates of suicidal behaviour and violent crimes during time periods of antidepressant treatment with periods without treatment. Subgroup analyses were performed according to PD clusters, individual antidepressants, specific PDs, psychiatric comorbidities, and history of suicidal behaviour and violent crime.
Results: The cohort included 167,319 individuals with a diagnosed PD, 19,519 (12%) of whom were prescribed antidepressants and presented at least one outcome event during follow-up, making them eligible for within-individual analyses. Overall, we found an association with lower rates of suicidal behavior during periods of antidepressant treatment, compared with periods when individuals were not on antidepressants (incidence rate ratio 0.86, 95% CI 0.84-0.89). However, this association was modified by specific PDs, individual antidepressants, comorbidities, and past history. For violent crimes, we did not observe consistent associations in any direction.
Conclusions: Antidepressants were associated with lower rates of suicidal behaviour, but less clearly in violent crimes. Types of PDs, individual antidepressants, and comorbidities modified these associations.
背景：尽管疗效不确定，抗抑郁药仍被用于人格障碍（pd）的治疗。我们调查了抗抑郁药与pd患者的两种不良后果（自杀行为和暴力犯罪）之间的关系。方法：我们使用全国范围内的丹麦医疗保健登记处来识别2007年至2016年期间年龄在18-64岁之间诊断为PD的所有个体。抗抑郁药的使用是通过配发处方确定的。研究人员对个人的自杀行为进行了跟踪调查，并对警方记录的暴力犯罪指控进行了单独调查。我们采用了个体内设计，比较抗抑郁治疗期间和未治疗期间自杀行为和暴力犯罪的发生率。根据PD聚类、个体抗抑郁药、特定PD、精神合并症、自杀行为和暴力犯罪史进行亚组分析。结果：该队列包括167,319名诊断为PD的个体，其中19,519人（12%）服用抗抑郁药，并在随访期间出现至少一个结果事件，使他们有资格进行个体内分析。总的来说，我们发现与未服用抗抑郁药的个体相比，抗抑郁药治疗期间自杀行为发生率较低（发病率比0.86,95% CI 0.84-0.89）。然而，这种关联被特定的pd、个体抗抑郁药、合并症和既往病史所改变。对于暴力犯罪，我们没有观察到任何方向上的一致关联。结论：抗抑郁药与较低的自杀率有关，但与暴力犯罪的关系不太明显。pd的类型、个体抗抑郁药和合并症改变了这些关联。
期刊介绍：
European Psychiatry, the official journal of the European Psychiatric Association, is dedicated to sharing cutting-edge research, policy updates, and fostering dialogue among clinicians, researchers, and patient advocates in the fields of psychiatry, mental health, behavioral science, and neuroscience. This peer-reviewed, Open Access journal strives to publish the latest advancements across various mental health issues, including diagnostic and treatment breakthroughs, as well as advancements in understanding the biological foundations of mental, behavioral, and cognitive functions in both clinical and general population studies.
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