title: The rapid suicide protection of mood stabilizers on patients with bipolar disorder: A nationwide observational cohort study in Taiwan.
abstract: BACKGROUND
  The suicide rate is high among bipolar disorder (BD) patients. Previous studies have focused on the anti-suicidal effect of long-term treatment with mood stabilizers but less on the immediate preventive effects of interventions. The aim of the study was to evaluate the short-term and immediate anti-suicidal effects of mood stabilizers on recent-onset BD patients.
  
  
  METHODS
  The National Health Insurance Database (NHID) of Taiwan was used to perform a nationwide cohort observation study of suicide behaviors in bipolar disorder. All the recent-onset BD patients (ICD-9-CM code 296 except 296.2 and 296.3) diagnosed between 2000-2005 were collected (n=5091) and followed through 2009. The primary endpoint was the presence of a suicide code or the end of observation; exposure to mood stabilizers in the final month of observation was the independent variable.
  
  
  RESULTS
  The hazard ratios (HRs) of suicide-related events, completed suicide, and all-cause mortality were significantly lower for those treated with lithium, divalproex, or carbamazepine compared with no use in the last month (HRs of suicide-related events were 0.10, 0.14 and 0.10, respectively, and all-cause mortality HRs were 0.03; P<0.0001); there was no significant difference in HR between the mood stabilizers.
  
  
  CONCLUSIONS
  The NIHD does not provide information on the severity, mood status, or treatment adherence of BD patients. Neither substance-related disorder nor personality disorder were included in the analysis. We focused on the effect of the final prescription time period, not the long-term protective effect.
  
  
  CONCLUSIONS
  The immediate recent use of any mood stabilizer significantly lowers the rate of death, suicide, or suicidal behavior in BD.
authors.affiliation: Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan.
authors.forename: Chia-Jui
authors.initials: CJ
authors.lastname: Tsai
authors.affiliation: Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; PhD of Translational Medicine Program, National Taiwan University and Academia Sinica, Taiwan.
authors.forename: Chin
authors.initials: C
authors.lastname: Cheng
authors.affiliation: Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Po-Han
authors.initials: PH
authors.lastname: Chou
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Ching-Heng
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA.
authors.forename: Melvin G
authors.initials: MG
authors.lastname: McInnis
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chia-Li
authors.initials: CL
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan. Electronic address: tosafish@hotmail.com.
authors.forename: Tsuo-Hung
authors.initials: TH
authors.lastname: Lan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D002220:Carbamazepine / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D014635:Valproic Acid / Q000627:therapeutic use; D055815:Young Adult; D000092864:Suicide Prevention
chemical_list: D018692:Antimanic Agents; D002220:Carbamazepine; D014635:Valproic Acid; D008094:Lithium
keywords: Bipolar disorder; Mood stabilizing agents; National Health Insurance Database; Suicide