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Cited by 136Suicide and Self-Harm StudiesMental Health Treatment and AccessTreatment of Major Depression

Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study

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Gusmão, Ricardo, Quintão, Sónia, McDaid, David, Arensman, Ella, Van Audenhove, Chantal, Coffey, Claire, Värnik, Airi, Värnik, Peeter +2 more·2013·PLoS ONE
DOI 10.1371/journal.pone.0066455PMC PMC3686718
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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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  • Because the trial population lacked ethnic diversity and all patients were treated in the U.K. health system, the results cannot be generalized to non-White patients and to other health systems.

    “Our trial population also lacked ethnic diversity, and all the patients were being treated in the U.K. health system, so we cannot generalize our results to non-White patients and to other health systems. 27”

    From Maintenance or Discontinuation of Antidepressants in Primary Care (2021) · cites this paper as [27]

    The Methods (Ethics Statement; page unavailable) says this paper analyzed aggregated population-level data and had no individual-patient information. Its Discussion (Previous Studies; page unavailable) identifies countries, not trial patients, as the observation units. Searches for ethnic diversity, non-White patients, and the U.K. health system found no passage addressing the citing authors’ trial or its generalizability. (LLM, conf=0.78)

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Authors
Gusmão, R., Quintão, S., McDaid, D., Arensman, E., Van Audenhove, C., Coffey, C., Värnik, A., Värnik, P., Coyne, J., & Hegerl, U.
Affiliations
  • Hospital de Egas Moniz (PT)
  • Universidade Nova de Lisboa (PT)
  • London School of Economics and Political Science (GB)
  • National Suicide Research Foundation (IE)
  • Estonian-Swedish Mental Health and Suicidology Institute (EE)
  • University Medical Center Groningen (NL)
  • Leipzig University (DE)
Corresponding author
Gusmão, Ricardo
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2013-06-19
Volume
8
Issue
6
Pages
e66455
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0066455
PMC
PMC3686718
OpenAlex
W2059190479
Cited by
136
References
5
Citations by year
2026: 1 · 2025: 4 · 2024: 7 · 2023: 9 · 2022: 9 · 2021: 12 · 2020: 15 · 2019: 7 · 2018: 13 · 2017: 8 · 2016: 19 · 2015: 17 · 2014: 12 · 2013: 2
FWCI
18.54
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
  • London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (acceptedVersion)
  • London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
  • Lirias (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
Funders
  • University of Pennsylvania
  • European Commission (223138)
  • Karolinska Institutet
  • Universidade Nova de Lisboa
  • Norwegian Institute of Public Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
antidepressant use, suicide rates, depression treatment, suicide prevention, alcohol consumption, unemployment, divorce, suicide trends
MeSH terms
Antidepressive Agents, Depression, Europe, Humans, Suicide, Drug Utilization Review

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