title: SSRIs and risk of suicide attempts in young people - A Danish observational register-based historical cohort study, using propensity score.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: a Erik Christiansen, Department of Child and Adolescent Mental Health Odense and Institute of Regional Health Services Research , University of Southern Denmark , Odense , Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Christiansen
authors.affiliation: b Esben Agerbo, Centre for Integrated Register-based Research, National Centre for Register-based Research, Business and Social Sciences, Aarhus University , Denmark.
authors.forename: Esben
authors.initials: E
authors.lastname: Agerbo
authors.affiliation: c Niels Bilenberg, Department of Child and Adolescent Mental Health Odense , University of Southern Denmark , Odense , Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Bilenberg
authors.affiliation: d Elsebeth Stenager, Department of Psychiatry , Odense and Institute of Regional Health Services Research, University of Southern Denmark , Odense , Denmark.
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Stenager
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology; D057216:Propensity Score; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: SSRIs; children and adolescents; suicide attempts