The public health impact of antidepressants: an instrumental variable analysis.
ABSTRACT There has been a marked increase in antidepressant medication prescription and use over the past three decades with unclear effects on the mental health status of the population. This study examined the impact of expansion of antidepressant use on prevalence and characteristics of depression and suicidal ideations in the community.
Instrumental variable models were used to assess the impact of antidepressant treatments on the prevalence of depressive episodes, mixed anxiety and depression states and suicidal ideations in 22,845 participants of the 1993, 2000 and 2007 National surveys of psychiatric morbidity of Great Britain who were between 16 and 64 years of age.
Increased prevalence of antidepressant treatment did not impact the prevalence of depressive episodes or mixed anxiety and depression states. However, antidepressant treatment was associated with decreased prevalence of severe and, to a lesser extent, mild depressive episodes and suicidal ideations and a corresponding increase in prevalence of moderate depressive episodes.
The data were cross-sectional and based on self-report of symptoms in the past month and current medication use with no information on dose and duration of medication treatment.
Expansion of antidepressant treatments in recent years has not changed the community prevalence of depression overall, but it has reduced the prevalence of more severe depression and suicidal ideations. The findings call for better targeting and more judicious use of antidepressants in cases of more severe depressive episodes which are more likely to respond to such treatments.
Australian and New Zealand Journal of Psychiatry 09/2014; 48(9):795-801. DOI:10.1177/0004867414546387 · 3.77 Impact Factor
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ABSTRACT: Objective: This study explores the spatiotemporal variations of suicide across Australia from 1986 to 2005, discusses the reasons for dynamic changes, and considers future suicide research and prevention strategies. Design: Suicide (1986-2005) and population data were obtained from the Australian Bureau of Statistics. A series of analyses were conducted to examine the suicide pattern by sex, method and age group over time and geography. Results: Differences in suicide rates across sex, age groups and suicide methods were found across geographical areas. Male suicides were mainly completed by hanging, firearms, gases and self-poisoning. Female suicides were primarily completed by hanging and self-poisoning. Suicide rates were higher in rural areas than in urban areas (capital cities and regional centres). Suicide rates by firearms were higher in rural areas than in urban areas, while the pattern for self-poisoning showed the reverse trend. Suicide rates had relatively stable trend for the total population and those aged between 15 and 54, while suicide decreased among 55 years and over during the study period. There was a decrease in suicides by firearms during the study period especially after 1996 when a new firearm control law was implemented, while suicide by hanging continued to increase. Areas with a high proportion of indigenous population (eg, northwest of Queensland and top north of the Northern Territory) had shown a substantial increase in suicide incidence after 1995. Conclusions: Suicide rates varied over time and space and across sexes, age groups and suicide methods. This study provides detailed patterns of suicide to inform suicide control and prevention strategies for specific subgroups and areas of high and increased risk.BMJ Open 07/2014; 4(7):e005311. DOI:10.1136/bmjopen-2014-005311 · 2.06 Impact Factor
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ABSTRACT: To assess the trend in long-term use of antidepressants by persons aged ≥ 18 years, and the correlates of such use, in the United States from 1999 to 2010. We examined trends in duration of antidepressant use and correlates of long-term use in data from 6 waves of the cross-sectional National Health and Nutrition Examination Survey (N = 35,379), a representative survey of the general population. The overall prevalence of antidepressant use increased from 6.5% in 1999-2000 to 10.4% in 2009-2010 (odds ratio [OR] = 1.54; 95% CI, 1.31-1.81; P < .001). This included an increase from 3.0% to 6.9% in long-term use (≥ 24 months; OR = 2.12; 95% CI, 1.75-2.57; P < .001). Medium-term (6 to < 24 months; from 1.3% to 1.6%) and short-term use (< 6 months; from 2.2% to 1.8%) of antidepressants did not change appreciably in this period. The increasing trend in long-term antidepressant use was limited to adults who received their care from general medical providers (adjusted OR = 3.86; 95% CI, 2.57-5.80; P < .001). From 1999 to 2010, there was a marked increase in long-term use of antidepressant medications in the United States, explaining the overall increasing trend in antidepressant use. This trend calls for greater vigilance in prescribing antidepressants for long periods of time.The Journal of Clinical Psychiatry 12/2013; 75(2). DOI:10.4088/JCP.13m08443 · 5.81 Impact Factor