Suicide and drugs. Drug related suicide mortality and physicians' prescription patterns

Abstract

Aim: The aims of the study were to 1) analyse a possible association between changes in drug sales and the occurrence of drug poisoning suicides 2) assess the role of benzodiazepines in elderly suicides 3) analyse changes in suicide mortality after the introduction of the selective serotonin reuptake inhibitors, SSRIs 4) examine physicians' inclination to prescribe benzodiazepines in low and high prescribing areas. Method: Information on suicide mortality and death certificates were obtained from Statistics Sweden. Data concerning drug sales were obtained from the National Prescription Survey, National Corporation of Pharmacies (Apoteket AB). A questionnaire, including hypothetical case vignettes, was employed to rate physicians' inclination to prescribe benzodiazepines.Results: A decrease in barbiturate sales was paralleled by a reduction in suicides using this drug type. Despite a subsequent increase in suicides involving analgesics, antidepressants and benzodiazepines, the total drug related mortality declined after the withdrawal of barbiturates from the Swedish market. Benzodiazepines predominated among drug poisoning suicides in the elderly. Rates of benzodiazepine suicides increased despite decreased sales of these types of drugs. Benzodiazepines were also involved in a number suicides not classified as drug poisonings. A statistically significant change in the decreasing slope in suicide rate was observed in men and women and in different age groups after the introduction of the SSRIs, around 1990. Increased use of SSRIs could not, however, explain the entire decline in suicide rates. Significant differences were observed in physicians' inclination to prescribe benzodiazepines depending on region, physicians' age, speciality and gender. These differences did not, however, explain the variation in the sales of these drug types between regions.Conclusions: This study showed an association between the availability of drugs and the occurrence of suicides. Reduced access to drugs may prevent suicides on an individual as well as a population level. On the other hand, increased antidepressant sales appears to be associated with decreased suicide rates. Intervention studies to assess the effect of reduced availability of drugs should be encouraged. We also welcome better data on drug dispensing.