Antidepressant treatment and suicide attempts and self-inflicted injury in children and adolescents
Open accessAbstract
Purpose: In the 2004, FDA placed a black box warning on antidepressants for risk of suicidal thoughts and behavior in children and adolescents. The purpose of this paper is to examine the risk of suicide attempt and self‐inflicted injury in depressed children ages 5–17 treated with antidepressants in two large observational datasets taking account time‐varying confounding. Methods: We analyzed two large US medical claims databases (MarketScan and LifeLink) containing 221,028 youth (ages 5–17) with new episodes of depression, with and without antidepressant treatment during the period of 2004–2009. Subjects were followed for up to 180 days. Marginal structural models were used to adjust for time‐dependent confounding. Results: For both datasets, significantly increased risk of suicide attempts and self‐inflicted injury were seen during antidepressant treatment episodes in the unadjusted and simple covariate adjusted analyses. Marginal structural models revealed that the majority of the association is produced by dynamic confounding in the treatment selection process; estimated odds ratios were close to 1.0 consistent with the unadjusted and simple covariate adjusted association being a product of chance alone. Conclusions: Our analysis suggests antidepressant treatment selection is a product of both static and dynamic patient characteristics. Lack of adjustment for treatment selection based on dynamic patient characteristics can lead to the appearance of an association between antidepressant treatment and suicide attempts and self‐inflicted injury among youths in unadjusted and simple covariate adjusted analyses. Marginal structural models can be used to adjust for static and dynamic treatment selection processes such as that likely encountered in observational studies of associations between antidepressant treatment selection, suicide and related behaviors in youth. Copyright © 2014 John Wiley & Sons, Ltd.
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In young people, after adjusting for time-varying confounders, the link between antidepressant use and suicide attempts or self-inflicted injury was attenuated and not statistically significant in two US medical claims databases.
“Two US medical claims databases that contain data on 221 028 young people with depression for the period 2004-09 showed that, after accounting for the time varying effect of confounders, the apparent association between antidepressant use and suicide attempts and selfinflicted injury was diminished and not statistically significant.33”
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- Authors
- Gibbons, R. D., Coca Perraillon, M., Hur, K., Conti, R. M., Valuck, R. J., & Brent, D. A.
- Affiliations
- University of Chicago (US)
- Department of Health Studies University of Chicago and Hines VA Chicago IL USA
- University of Colorado Denver (US)
- University of Pittsburgh (US)
- Corresponding author
- Gibbons, Robert D.
- Venue
- Pharmacoepidemiology and Drug Safety
- Publisher
- Wiley
- Published
- 2014-09-29
- Volume
- 24
- Issue
- 2
- Pages
- 208-214
- ISSN
- 1053-8569 (ISSN-L)
- 1099-1557
- PMC
- PMC4312179
- OpenAlex
- W1806804109
- Cited by
- 24
- References
- 27
- Citations by year
- 2023: 3 · 2022: 2 · 2021: 2 · 2020: 1 · 2019: 6 · 2018: 1 · 2017: 2 · 2016: 6 · 2014: 1
- FWCI
- 3.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pharmacoepidemiology and Drug Safety (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH8012201)
- Agency for Healthcare Research and Quality (U18HS016973, T32HS000084)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Keywords
- antidepressants, suicide attempts, self-harm, childhood depression, children and adolescents, black box warning, time-varying confounding, marginal structural models, treatment selection, drug safety
- MeSH terms
- Adolescent, Antidepressive Agents, Child, Humans, Models, Biological, Retrospective Studies, Risk Factors, Suicide, Attempted, United States, Databases, Factual, Self-Injurious Behavior
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