The results of a case-control study published in the Journal of Clinical Psychiatry indicate that individuals using psychotropic medication in a suicide attempt were significantly more likely to have prescribed access to the drug.
Investigators abstracted data on individuals receiving emergency department or inpatient care for a suicide attempt from a US insurance claims dataset (2006-2013) using relevant International Classification of Diseases, 9th Revision, Clinical Modification codes. Cases were defined as individuals who used a psychotropic drug in their suicide attempt; controls used another method. Study exposure was defined as filling a psychotropic drug prescription within 90 days before the attempt. A short exposure window was selected to assess the influence of acute exposure on chosen method of attempt. Multivariable logistic regression analysis was performed to estimate odds ratios (ORs). Confounding variables considered in analysis included demographic factors, prior psychiatric diagnoses in the year before suicide attempt, psychiatric comorbidities, and prior inpatient hospitalization for mental illness.
The final cohort was composed of 10,158 cases and 17,718 controls participants. The most common medication classes used in attempts were anxiolytics (59.4%), antidepressants (35.2%), antipsychotics or mood stabilizers (11.5%), and stimulants (3.6%); 13% of cases used >1 type of psychotropic drug in their attempt. Overall, 18% of the study sample had prescribed access to any psychotropic drug in the 90 days before an attempt. Across all psychotropic drug classes assessed, individuals who used psychotropic medication in a suicide attempt were significantly more likely to have had prescribed access (adjusted OR, 1.8; 95% CI, 1.7-1.9). Among individuals who used any psychotropic drug in a suicide attempt, 23% had prescribed access compared with just 15% of control participants. The greatest drug class-specific ORs were observed for antipsychotics or mood stabilizers (adjusted OR, 6.5; 95% CI, 5.4-7.7) and stimulants (adjusted OR, 7.6; 95% CI, 5.5-10.5). According to multivariable logistic regression, which adjusted for sex, age, region of residence, and use of multiple methods in suicide attempt, resultant adjusted ORs were similar in magnitude to unadjusted ORs. This similarity highlights the significant relationship between prescribed access and use of a psychotropic drug in a suicide attempt.
These data highlight a significant need for safety interventions among individuals at high risk for suicide with prescribed access to psychotropic drugs. Further research is necessary to identify groups at the highest risk for using drugs prescribed to them in a suicide attempt and to parse out effective means of intervention.
Brown TL, Gutierrez PM, Grunwald GK, DiGuiseppi C, Valuck RJ, Anderson HD. Access to psychotropic medication via prescription is associated with choice of psychotropic medication as suicide method: a retrospective study of 27,876 suicide attempts. J Clin Psychiatry. 2018;79(6).