Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study

Ridwanul Amin,Bo Runeson,Lars Mehlum,Emma Björkenstam,Ping Qin,Syed Rahman,Petter Tinghög,Magnus Helgesson,Ellenor Mittendorfer-Rutz

doi:10.1186/s12939-021-01460-z

Abstract

BackgroundTo identify key information regarding potential treatment differences in refugees and the host population, we aimed to investigate patterns (trajectories) of antidepressant use during 3 years before and after a suicide attempt in refugees, compared with Swedish-born. Association of the identified trajectory groups with individual characteristics were also investigated.MethodsAll 20–64-years-old refugees and Swedish-born individuals having specialised healthcare for suicide attempt during 2009–2015 (n = 62,442, 5.6% refugees) were followed 3 years before and after the index attempt. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models. Associations between the identified trajectory groups and different covariates were estimated by chi2-tests and multinomial logistic regression.ResultsAmong the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees. A ‘low increasing’ group comprised 5.9% of refugees (60–260 annual DDDs before and 510–685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110–190 DDDs) and high (630–765 DDDs) levels (22.5 and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees’ trajectory groups. The patterns and composition of the trajectory groups and their association, discriminated with different covariates, were fairly similar among refugees and Swedish-born, with the exception of previous hypnotic and sedative drug use being more important in refugees.ConclusionsDespite previous reports on refugees being undertreated regarding psychiatric healthcare, no major differences in antidepressant treatment between refugees and Swedish-born suicide attempters were found.

Highlights

Despite the strong association between mental ill-health and suicidal behaviour, a vast majority of people with mental disorders do not die by suicide [1]
Identification of additional risk factors within vulnerable groups such as refugees is important because refugees were reported to have higher levels of mental disorders such as depressive or anxiety disorder and posttraumatic stress disorder (PTSD) [2,3,4,5] but lower rates of suicide attempt [6,7,8], in comparison with the general population in their respective host country
Antidepressants are the most commonly prescribed psychiatric medications [10] and the patterns/ trajectories of antidepressant use, before and after a suicide attempt among refugees may reveal key information regarding treatment for affective and anxiety disorders commonly seen in suicide attempters

Summary

Introduction

Despite the strong association between mental ill-health and suicidal behaviour, a vast majority of people with mental disorders do not die by suicide [1]. Identification of additional risk factors within vulnerable groups such as refugees is important because refugees were reported to have higher levels of mental disorders such as depressive or anxiety disorder and posttraumatic stress disorder (PTSD) [2,3,4,5] but lower rates of suicide attempt [6,7,8], in comparison with the general population in their respective host country In this regard, healthcare contacts and related medical treatment before a suicide attempt may offer opportunities for prevention of suicidal behaviour. Association of the identified trajectory groups with individual characteristics were investigated

Methods

Results

Conclusion