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Mental health
Regulatory guidance on prescribing selective serotonin reuptake inhibitor antidepressants to young people: ecological study of effects on international suicide trends
  1. B. Wheeler,
  2. D. Gunnell,
  3. C. Metcalfe,
  4. R. Martin
  1. Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK

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    Objective

    In 2003 many international medicine regulatory agencies issued warnings concerning the prescribing of selective serotonin reuptake inhibitor (SSRI) antidepressants to young people, due to concerns that they increase risks of suicidal behaviour. A US study suggested that this action may have actually caused an increase in suicide rates due to under-treatment of depression, whilst a UK study did not find such an increase. This study investigates the population impact of globally significant regulatory action on youth suicide trends in a number of countries.

    Design

    Ecological study.

    Setting

    22 economically developed countries with relevant data in the WHO mortality database.

    Populations

    National populations aged 10 to 19 ears.

    Main Outcome Measures

    Annual suicide mortality rates (ICD-10 codes X60-X84, Y10-Y34, Y87.0 and Y87.2, and equivalent ICD9 codes) from 1990 to the most recent date available for each country (2004–2006).

    Results

    Trends in suicide rates amongst young people varied substantially across the 22 countries. There was no clear, consistent change in trends following the regulatory action in 2003. Random-effects Poisson regression models were used to model whether suicide rates post-2003 were higher or lower than expected, given country specific trends up to that date. Amongst 15–19-year-olds the rate ratio for the post-2003 period relative to preceding trends was 0.999 (95% CI 0.971 to 1.028), and in 10–14-year-olds was 0.999 (95% CI 0.929 to 1.074). There was some evidence that trends differed in males and females. The rate ratios for 15–19-year-olds were 0.982 (95% CI 0.950 to 1.015) amongst males and 1.081 (95% CI 1.019 to 1.146) amongst females in the 15–19 age group, with a similar pattern amongst 10–14-year-olds, although with much greater uncertainty. Despite this average finding, post-2003 rates amongst 15–19-year-old females were lower than expected in a majority of countries (13 of 22).

    Conclusions

    There was no evidence of an overall effect of regulatory action to restrict prescribing of SSRIs to young people on suicide trends in these 22 countries, either favourable or unfavourable.

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