Project Summary

Mark Olfson, M.D., M.P.H. (Distinguished Investigator 2005) of Columbia University, notes that considerable controversy surrounds whether SSRIs tend to exacerbate or reduce the risk of suicide in depressed youth. Progress on this important and hotly contested issue has been constrained by ethical concerns over withholding active treatment from high risk youth and sample size limitations. The proposed study takes advantage of naturally occurring variation in pharmacological treatment and suicidal behavior. It will determine whether a large cohort of high-risk depressed adolescents and young adults treated with SSRIs have a different rate of suicide and suicide attempts than similar depressed young people who are not treated with these medications. A cohort of approximately 20,000 youth from all fifty states, age 15 to 24 years, will be followed through Medicaid claims files for 12 months following their hospital discharge for the treatment of depression. The type, duration, and number of SSRI, other antidepressant, and other psychotropic prescriptions that they fill over a 12-month follow-up period will be assessed through Medicaid prescription claims. Suicide will be determined through cause of death codes from the National Death Index and suicide attempts will be measured with Medicaid claims for intentional injuries (E-codes). This information will be used to evaluate whether and to what extent direct or inverse associations exist between use of specific SSRIs and suicidal behaviors during the 12-month period following hospital discharge. Analyses will also identify whether the unadjusted association is modified by patient demographic traits (e.g., age, sex, race), clinical characteristics (e.g., treatment of substance use disorders, anxiety disorders, recent treated suicide attempts), and other previous or concurrent mental health treatment (e.g., psychotherapy, other pharmacological treatments, mental health specialist visits). The project will lead to the development of clinical epidemiological research methods with broad potential applications to the study of mental health treatment and suicide risk for a range of severely mentally ill populations and treatments. The specific findings will reveal the extent to which one of the most widely available pharmacological treatments reduces or increases suicide and suicide attempts in low-income youth treated for depression and help to define the appropriate role of SSRIs in the treatment of depressed young people. By identifying the characteristics of patients at greatest risk of suicide and suicide attempts following inpatient care, the findings may also inform the allocation of scarce mental health treatment resources toward patients in greatest clinical need. Finally, by characterizing depressed young people who are most likely to pass untreated, the results will help target clinical initiatives to improve the continuity of safe and effective treatments through the transition from inpatient to outpatient care.

Program Area: MOOD DISORDERS\Unipolar Depression\Suicide

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