title: Comparative risk of self-harm hospitalization amongst depressive disorder patients using different antidepressants: a population-based cohort study in Taiwan.
abstract: The aim of the study was to evaluate the comparative risk of self-harm associated with the use of different antidepressants.
  
  
  
  A cohort study was conducted using data from Taiwan's National Health Insurance Research Database from 2001 to 2012. A total of 751 606 new antidepressant users with depressive disorders were included. The study outcome was hospitalization due to self-harm (International Classification of Diseases, Ninth Revision, Clinical Modification codes: E950-E958 and E980-E988). Cox proportional hazards models with stratification of the propensity score deciles were used to estimate the hazard ratios of self-harm hospitalization during the first year following the initiation of antidepressant treatment.
  
  
  
  There were 1038 hospitalization episodes due to self-harm that occurred during the follow-up of 149 796 person-years, with an overall incidence rate of 6.9 [95% confidence interval (CI) 6.5-7.4] per 1000. Compared with fluoxetine, the risk of self-harm hospitalization was higher for maprotiline [adjusted hazard ratio (aHR) = 3.00, 95% CI 1.40-6.45], milnacipran (aHR = 2.34, 95% CI 1.24-4.43) and mirtazapine (aHR = 1.40, 95% CI 1.06-1.86), lower for bupropion (aHR = 0.51, 95% CI 0.30-0.86), and similar level of risk was found for other selective serotonin reuptake inhibitors (citalopram, escitalopram, fluvoxamine, paroxetine and sertraline).
  
  
  
  The risk of self-harm may vary across different antidepressant drugs. It would be of importance to conduct further research to investigate the influence of antidepressant use on self-harm behaviors.
authors.affiliation: Department of Psychiatry,National Taiwan University Hospital and College of Medicine, National Taiwan University,Taipei,Taiwan.
authors.forename: C-S
authors.initials: CS
authors.lastname: Wu
authors.affiliation: Department of Psychiatry,National Taiwan University Hospital and College of Medicine, National Taiwan University,Taipei,Taiwan.
authors.forename: S-C
authors.initials: SC
authors.lastname: Liao
authors.affiliation: Division of Biostatistics and Bioinformatics,Institute of Population Health Sciences, National Health Research Institutes,Zhunan,Taiwan.
authors.forename: Y-T
authors.initials: YT
authors.lastname: Tsai
authors.affiliation: Institute of Health Behaviors and Community Sciences and Department of Public Health,College of Public Health,National Taiwan University,Taipei,Taiwan.
authors.forename: S-S
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Division of Biostatistics and Bioinformatics,Institute of Population Health Sciences, National Health Research Institutes,Zhunan,Taiwan.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Tsai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000494:pharmacology*; D002648:Child; D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressants; depressive disorder; self-harm