title: Association Between Zolpidem and Suicide: A Nationwide Population-Based Case-Control Study.
abstract: OBJECTIVE
  To evaluate the association between zolpidem and the risk of suicide.
  
  
  METHODS
  In this nationwide case-control study, the case group comprised 2199 people who committed suicide or were hospitalized due to suicide attempt between January 1, 2002, and December 31, 2011. To create a control group, we randomly selected 10 people matched to each case according to age, sex, urbanization, and occupation. We measured the risk of suicide/suicide attempt in association with zolpidem exposure by using adjusted odds ratios (ORs) and assessed the dose-response effect of zolpidem.
  
  
  RESULTS
  After adjustment for potential confounders such as the comorbidities of schizophrenia, major depression, bipolar disorder, anxiety, insomnia, substance use, and other mental disorders, the Charlson comorbidity index, and use of benzodiazepine or antidepressants, zolpidem exposure was found to be significantly associated with the risk of suicide/suicide attempt with an OR of 2.08 (95% CIs, 1.83-2.36). The risk increased with the level of zolpidem use. The ORs (95% CIs) for cumulative defined daily doses of less than 90, 90 to 179, and 180 mg or more were 1.90 (1.65-2.18), 2.07 (1.59-2.67), and 2.81 (2.33-3.38), respectively (for trend, P<.001). Subgroup analyses showed that the exposure to zolpidem consistently increased the OR in different age groups, sex, urbanization level, occupation, mental disorders, and Charlson comorbidity index levels and in groups of people with or without the presence of insomnia.
  
  
  CONCLUSIONS
  This study demonstrated a significant association between using zolpidem and suicide or suicide attempt in people with or without comorbid psychiatric illnesses (all P<.05).
authors.affiliation: Department of Neurology, En Chu Kong Hospital, New Taipei, Taiwan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Che-Chen
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Neurology, En Chu Kong Hospital, New Taipei, Taiwan.
authors.forename: Chien-Jung
authors.initials: CJ
authors.lastname: Lu
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
authors.forename: Chung-Y
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: d10040@mail.cmuh.org.tw.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D016022:Case-Control Studies; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use*; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult; D000077334:Zolpidem
chemical_list: D000928:Antidepressive Agents; D011725:Pyridines; D000077334:Zolpidem