Mood stabilizers and risk of all-cause, natural, and suicide mortality in bipolar disorder: A nationwide cohort study

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2022-11-11 DOI:10.1111/acps.13519

Pao-Huan Chen, Shang-Ying Tsai, Po-Yu Chen, Chun-Hung Pan, Sheng-Siang Su, Chiao-Chicy Chen, Chian-Jue Kuo

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引用次数: 6

Abstract

Objectives

People with bipolar disorder have an elevated risk of mortality. This study evaluated associations between the use of mood stabilizers and the risks of all-cause mortality, suicide, and natural mortality in a national cohort of people with bipolar disorder.

Methods

In this nationwide cohort study, we used data from January 1, 2000, to December 31, 2016, collected from Taiwan's National Health Insurance Research Database and included 25,787 patients with bipolar disorder. Of these patients, 4000 died during the study period (including 760 and 2947 from suicide and natural causes, respectively). Each standardized mortality ratio (SMR) was calculated as the ratio of observed mortality in the bipolar cohort to the number of expected deaths in the general population. Multivariable Cox proportional hazards regression with a time-dependent model was performed to estimate the hazard ratio (HR) of each mood stabilizer with each mortality outcome.

Results

The SMRs of all-cause mortality, suicide, and natural mortality in the bipolar disorder cohort were 5.26, 26.02, and 4.68, respectively. The use of mood stabilizers was significantly associated with decreased risks of all-cause mortality (adjusted HR [aHR] = 0.58, p< 0.001), suicide (aHR = 0.60, p < 0.001), and natural mortality (aHR = 0.55, p < 0.001) within a 5-year follow-up period after index admission. Among the individual mood stabilizers, lithium was associated with the lowest risks of all-cause mortality (aHR = 0.38, p < 0.001), suicide (aHR = 0.39, p < 0.001), and natural mortality (aHR = 0.37, p < 0.001).

Conclusion

In addition to having protective effects against suicide and all-cause mortality, mood stabilizers also exert a substantial protective effect against natural mortality, with lithium associated with the lowest risk of mortality.

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情绪稳定剂与双相情感障碍全因、自然和自杀死亡率的风险:一项全国性队列研究

目的双相情感障碍患者有较高的死亡风险。本研究评估了心境稳定剂的使用与双相情感障碍患者全因死亡率、自杀和自然死亡率之间的关系。方法在这项全国性队列研究中，我们使用2000年1月1日至2016年12月31日的数据，收集自台湾国民健康保险研究数据库，包括25,787名双相情感障碍患者。在这些患者中，有4000人在研究期间死亡(其中760人和2947人分别死于自杀和自然原因)。每个标准化死亡率(SMR)计算为双相队列中观察到的死亡率与一般人群中预期死亡人数的比率。采用时间相关模型的多变量Cox比例风险回归来估计每种情绪稳定剂与每种死亡结局的风险比(HR)。结果双相情感障碍患者全因死亡率、自杀和自然死亡率的smr分别为5.26、26.02和4.68。使用情绪稳定剂与入院后5年随访期间全因死亡率(调整HR [aHR] = 0.58, p< 0.001)、自杀(aHR = 0.60, p< 0.001)和自然死亡率(aHR = 0.55, p< 0.001)的风险降低显著相关。在个体情绪稳定剂中，锂与全因死亡率(aHR = 0.38, p < 0.001)、自杀(aHR = 0.39, p < 0.001)和自然死亡率(aHR = 0.37, p < 0.001)的风险最低相关。结论除了对自杀和全因死亡率有保护作用外，情绪稳定剂对自然死亡也有实质性的保护作用，其中锂与死亡率风险最低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.