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Comparative risk of self-harm hospitalization amongst depressive disorder patients using different antidepressants: a population-based cohort study in Taiwan

Published online by Cambridge University Press:  23 September 2016

C.-S. Wu ,
S.-C. Liao ,
Y.-T. Tsai ,
S.-S. Chang  and
H.-J. Tsai
C.-S. Wu
Affiliation:
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
S.-C. Liao
Affiliation:
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
Y.-T. Tsai
Affiliation:
Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
S.-S. Chang*
Affiliation:
Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
H.-J. Tsai*
Affiliation:
Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan Department of Public Health, China Medical University, Taichung, Taiwan Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
*
*Addresses for correspondence: H.-J. Tsai, Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan; S.-S. Chang, Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Room 623, No.17, Xu-Zhou Road, Zhongzheng Dist., Taipei City 10055, Taiwan. (Email: [email protected] and [email protected]) [H.-J.T] (Email: [email protected]) [S.-S.C.]
*Addresses for correspondence: H.-J. Tsai, Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan; S.-S. Chang, Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Room 623, No.17, Xu-Zhou Road, Zhongzheng Dist., Taipei City 10055, Taiwan. (Email: [email protected] and [email protected]) [H.-J.T] (Email: [email protected]) [S.-S.C.]
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Abstract

Background

The aim of the study was to evaluate the comparative risk of self-harm associated with the use of different antidepressants.

Method

A cohort study was conducted using data from Taiwan's National Health Insurance Research Database from 2001 to 2012. A total of 751 606 new antidepressant users with depressive disorders were included. The study outcome was hospitalization due to self-harm (International Classification of Diseases, Ninth Revision, Clinical Modification codes: E950–E958 and E980–E988). Cox proportional hazards models with stratification of the propensity score deciles were used to estimate the hazard ratios of self-harm hospitalization during the first year following the initiation of antidepressant treatment.

Results

There were 1038 hospitalization episodes due to self-harm that occurred during the follow-up of 149 796 person-years, with an overall incidence rate of 6.9 [95% confidence interval (CI) 6.5–7.4] per 1000. Compared with fluoxetine, the risk of self-harm hospitalization was higher for maprotiline [adjusted hazard ratio (aHR) = 3.00, 95% CI 1.40–6.45], milnacipran (aHR = 2.34, 95% CI 1.24–4.43) and mirtazapine (aHR = 1.40, 95% CI 1.06–1.86), lower for bupropion (aHR = 0.51, 95% CI 0.30–0.86), and similar level of risk was found for other selective serotonin reuptake inhibitors (citalopram, escitalopram, fluvoxamine, paroxetine and sertraline).

Conclusions

The risk of self-harm may vary across different antidepressant drugs. It would be of importance to conduct further research to investigate the influence of antidepressant use on self-harm behaviors.

Keywords

Antidepressantsdepressive disorderself-harm
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 1 , January 2017 , pp. 81 - 92
Copyright
Copyright © Cambridge University Press 2016 

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