Journal of affective disorders · 2025
Utilization of psychiatric and emergency room service and prescriptions of psychotropic drugs during the 180 days prior to suicide.
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Li Yu-Shian, Tsai Shih-Jen, Cheng Chih-Ming, Bai Ya-Mei, Chen Tzeng-Ji, Chen Mu-Hong
Аннотация
BACKGROUND: Suicide is a major global health concern. Evidence from Asian settings on the timing, continuity, and context of psychiatric and emergency room (ER) use and psychotropic prescribing before suicide is limited.
METHODS: In a nationwide matched case-control study using Taiwan's National Health Insurance Research Database, we identified 238 suicide decedents and 2380 controls matched on demographics. We assessed healthcare utilization, psychiatric and ER visits, and psychotropic prescriptions during the 180 days preceding suicide or index date.
RESULTS: Compared with controls, decedents had more psychiatric diagnoses (38.2 % vs. 14.8 %). Alcohol use disorder (OR 2.36), greater comorbidity (per-point OR 1.33), psychiatric visits 91-180 days before death (OR 11.24), and frequent ER use-especially 91-180 days (OR 8.83)-were associated with suicide death. Antidepressant prescribing 31-90 days prior (OR 4.05) and benzodiazepine/Z-drug use across multiple windows (OR 1.80-2.55) conferred risk. Subgroup analyses revealed that new initiation of mood stabilizers (OR 9.29) and benzodiazepines/Z-drugs (OR 3.48) within 30 days strongly predicted suicide, particularly when prescribed outside psychiatric care.
DISCUSSION: Pre-suicide care patterns in Taiwan implicate both psychiatric and nonpsychiatric settings. Consistent psychiatric follow-up appears protective, whereas treatment discontinuity, fragmented care, frequent ER use and new psychotropic initiation in general medical settings mark elevated risk.
METHODS: In a nationwide matched case-control study using Taiwan's National Health Insurance Research Database, we identified 238 suicide decedents and 2380 controls matched on demographics. We assessed healthcare utilization, psychiatric and ER visits, and psychotropic prescriptions during the 180 days preceding suicide or index date.
RESULTS: Compared with controls, decedents had more psychiatric diagnoses (38.2 % vs. 14.8 %). Alcohol use disorder (OR 2.36), greater comorbidity (per-point OR 1.33), psychiatric visits 91-180 days before death (OR 11.24), and frequent ER use-especially 91-180 days (OR 8.83)-were associated with suicide death. Antidepressant prescribing 31-90 days prior (OR 4.05) and benzodiazepine/Z-drug use across multiple windows (OR 1.80-2.55) conferred risk. Subgroup analyses revealed that new initiation of mood stabilizers (OR 9.29) and benzodiazepines/Z-drugs (OR 3.48) within 30 days strongly predicted suicide, particularly when prescribed outside psychiatric care.
DISCUSSION: Pre-suicide care patterns in Taiwan implicate both psychiatric and nonpsychiatric settings. Consistent psychiatric follow-up appears protective, whereas treatment discontinuity, fragmented care, frequent ER use and new psychotropic initiation in general medical settings mark elevated risk.