Risk of Suicidal Behaviors and Antidepressant Exposure Among Children and Adolescents: A Meta-Analysis of Observational Studies

Li, Kuan1,2; Zhou, Guibao1; Xiao, Yan1; Gu, Jiayu1; Chen, Qiuling1; Xie, Shouxia1; Wu, Junyan3

2022-05-26

10.3389/fpsyt.2022.880496

Frontiers in Psychiatry   Impact Factor & Quartile

1664-0640

Objectives: Although several studies have reviewed the suicidal risk of antidepressants, the conclusions remain inconsistent. We, therefore, performed a meta-analysis of observational studies to address the association between exposure to antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and the risk of suicide and suicide attempt in children and adolescents. Methods: MEDLINE and Embase were searched from January 1990 to April 2021. Seventeen cohort and case-control studies were identified that reported suicide or suicide attempt in children and young adults (aged 5-25 years) who were exposed to any antidepressants. We extracted the estimates and corresponding 95% confidence intervals (CIs) from each publication. Results: The results showed that antidepressant exposure significantly increased the risk of suicide and suicide attempt when compared with no antidepressant usage among children and adolescents. The pooled relative risk (RR) was 1.38 (95% CI: 1.16-1.64; I-2 = 83.1%). Among the antidepressants, SSRI use was associated with an increased risk of suicide and suicide attempt, and the pooled RR was 1.28 (95% CI: 1.09-1.51; I-2 = 68.8%). In subgroup analysis, the attempted suicidal risk of antidepressant and SSRI was significantly increased (RR = 1.35, 95% CI: 1.13-1.61; I-2 = 86.2% for all antidepressants; and RR = 1.26, 95% CI: 1.06-1.48; I-2 = 73.8% for SSRIs), while the completed suicidal risk of antidepressant and SSRI was not statistically significant (RR = 2.32, 95% CI: 0.82-6.53; I-2 = 6.28% for all antidepressants; and RR = 1.88, 95% CI: 0.74-4.79; I-2 = 52.0% for SSRIs). In addition, the risk of suicide and suicide attempt between SSRIs and other antidepressants was similar (RR 1.13, 95% CI: 0.87-1.46, I-2 = 32.4%). Conclusion: The main findings of this meta-analysis provide some evidence that antidepressant exposure seems to have an increased suicidal risk among children and young adults. Since untreated depression remains one of the largest risk factors for suicide and the efficacy of antidepressants is proven, clinicians should evaluate carefully their patients and be cautious with patients at risk to have treatment emergence or worsening of suicidal ideation (TESI/TWOSI) when prescribing antidepressants to children and young patients.

antidepressants SSRIs suicide suicide attempt children and adolescents

SCI ; SSCI

English

First ; Corresponding

National Natural Science Foundation of China[81903581] ; Shenzhen Science and Technology Program["JCYJ20190807150005699","RCBS20200714115000009"] ; Shenzhen Key Medical Discipline Construction Fund[SZXK059] ; Shenzhen Key Laboratory of Prevention and Treatment of Severe Infections[ZDSYS20200811142804014]

Psychiatry

Psychiatry

WOS:000808291800001

FRONTIERS MEDIA SA

Web of Science

1.Southern Univ Sci & Technol, Jinan Univ, Shenzhen Peoples Hosp, Affiliated Hosp 1,Clin Med Coll 2,Dept Pharm, Shenzhen, Peoples R China
2.Southern Univ Sci & Technol, Jinan Univ, Shenzhen Peoples Hosp, Affiliated Hosp 1,Shenzhen Key Lab Prevent & Treat, Shenzhen, Peoples R China
3.Sun Yat Sen Univ, Sun Yat sen Mem Hosp, Dept Pharm, Guangzhou, Peoples R China

Li, Kuan,Zhou, Guibao,Xiao, Yan,et al. Risk of Suicidal Behaviors and Antidepressant Exposure Among Children and Adolescents: A Meta-Analysis of Observational Studies[J]. Frontiers in Psychiatry,2022,13.

Li, Kuan.,Zhou, Guibao.,Xiao, Yan.,Gu, Jiayu.,Chen, Qiuling.,...&Wu, Junyan.(2022).Risk of Suicidal Behaviors and Antidepressant Exposure Among Children and Adolescents: A Meta-Analysis of Observational Studies.Frontiers in Psychiatry,13.

Li, Kuan,et al."Risk of Suicidal Behaviors and Antidepressant Exposure Among Children and Adolescents: A Meta-Analysis of Observational Studies".Frontiers in Psychiatry 13(2022).