Jonas Forsman1,2, Heidi Taipale3,4, Thomas Masterman3,5, Jari Tiihonen3,6, Antti Tanskanen3,6. 1. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. jonas.forsman@ki.se. 2. National Board of Forensic Medicine, PO Box 4044, SE-141 04, Huddinge, Sweden. jonas.forsman@ki.se. 3. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. 4. School of Pharmacy, University of Eastern Finland, Kuopio, Finland. 5. National Board of Forensic Medicine, PO Box 4044, SE-141 04, Huddinge, Sweden. 6. Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland.
Abstract
OBJECTIVE: To investigate the influence of adherence to psychotropic medications upon the risk of completed suicide by comparing person-level prescriptions and postmortem toxicological findings among complete-suicide cases and non-suicide controls in Sweden 2006-2013. METHODS: Using national registries with full coverage on dispensed prescriptions, results of medico-legal autopsies, causes of death, and diagnoses from inpatient care, estimated continuous drug use for 30 commonly prescribed psychotropic medications was compared with forensic-toxicological findings. Subjects who had died by suicide (cases) were matched (1:2) with subjects who had died of other causes (controls) for age, sex, and year of death. Odds ratios were calculated using logistic regression to estimate the risk of completed suicide conferred by partial adherence and non-adherence to pharmacotherapy. Adjustments were made for previous inpatient care and the ratio of initiated and discontinued dispensed prescriptions, a measure of the continued need of treatment preceding death. RESULTS: In 5294 suicide cases and 9879 non-suicide controls, after adjusting for the dispensation ratio and other covariates, partial adherence and non-adherence to antipsychotics were associated with 6.7-fold and 12.4-fold risks of completed suicide, respectively, whereas corresponding risk estimates for antidepressant treatment were not statistically significant and corresponding risk increases for incomplete adherence to antidepressant treatment were lower (1.6-fold and 1.5-fold, respectively) and lacked statistical significance. CONCLUSION: After adjustment for the need of treatment, biochemically verified incomplete adherence to antipsychotic pharmacotherapy was associated with markedly increased risks of completed suicide.
OBJECTIVE: To investigate the influence of adherence to psychotropic medications upon the risk of completed suicide by comparing person-level prescriptions and postmortem toxicological findings among complete-suicide cases and non-suicide controls in Sweden 2006-2013. METHODS: Using national registries with full coverage on dispensed prescriptions, results of medico-legal autopsies, causes of death, and diagnoses from inpatient care, estimated continuous drug use for 30 commonly prescribed psychotropic medications was compared with forensic-toxicological findings. Subjects who had died by suicide (cases) were matched (1:2) with subjects who had died of other causes (controls) for age, sex, and year of death. Odds ratios were calculated using logistic regression to estimate the risk of completed suicide conferred by partial adherence and non-adherence to pharmacotherapy. Adjustments were made for previous inpatient care and the ratio of initiated and discontinued dispensed prescriptions, a measure of the continued need of treatment preceding death. RESULTS: In 5294 suicide cases and 9879 non-suicide controls, after adjusting for the dispensation ratio and other covariates, partial adherence and non-adherence to antipsychotics were associated with 6.7-fold and 12.4-fold risks of completed suicide, respectively, whereas corresponding risk estimates for antidepressant treatment were not statistically significant and corresponding risk increases for incomplete adherence to antidepressant treatment were lower (1.6-fold and 1.5-fold, respectively) and lacked statistical significance. CONCLUSION: After adjustment for the need of treatment, biochemically verified incomplete adherence to antipsychotic pharmacotherapy was associated with markedly increased risks of completed suicide.
Authors: Carl B Roth; Andreas Papassotiropoulos; Annette B Brühl; Undine E Lang; Christian G Huber Journal: Int J Environ Res Public Health Date: 2021-08-05 Impact factor: 3.390
Authors: Andreas Gremyr; Boel Andersson Gäre; Trisha Greenhalgh; Ulf Malm; Johan Thor; Ann-Christine Andersson Journal: J Med Internet Res Date: 2020-04-23 Impact factor: 5.428