SSRIs and risk of suicide attempts in young people - A Danish observational register-based
historical cohort study, using propensity score
Sammanfattning
Background: SSRIs are widely used in the treatment of mental illness for both children and
adults. Studies have found a slightly increased risk of suicidal thoughts and suicide attempts in
young people using SSRIs but SSRIs’ impact on risk for suicides in youth is not well-established.
Aim: Is there indication that SSRIs might raise risk for suicide attempts in young people? Methods:
We used an observational register-based historical cohort design, a large cohort of all Danish
individuals born in 1983-1989 (n = 392,458) and a propensity score approach to analyse the impact
from SSRIs on risk for suicide attempts. Every suicide attempt and redeemed prescription of SSRIs
was analysed by Cox regression. Results: We found a significant overlap between redeeming a
prescription on SSRIs and subsequent suicide attempt. The risk for suicide attempt was highest in
the first 3 months after redeeming the first prescription. The hazard ratio for suicide attempts after
redeeming a prescription was estimated to 5.23, 95% CI 4.82-5.68. Conclusion: We conclude that the
risk of suicide attempt is higher for young people in the first months after redeeming their first
prescription for SSRIs, compared to non-users. For SSRI users with lower propensity score (fewer
risk factors for SSRIs) the risk of suicide attempt is estimated to be highest. Although the design may
miss some explicit reason for prescription of SSRIs and SSRIs might be a marker for those in high
risk rather than a causal risk factor, we would recommend systematic risk assessment in the period
after redeeming the first prescription.