Risk of suicide attempt and suicide associated with benzodiazepine: A nationwide case crossover study

Abstract

BackgroundPrevious studies that found an association between benzodiazepines and suicidal behaviours were confounded by indication bias.AimsTo limit this bias, a case crossover study (CCO) was conducted to estimate the risk of suicide attempt and suicide associated with benzodiazepines.MethodPatients ≥16 years, with hospitalised suicide attempt or suicide between 2013 and 2016, and at least one benzodiazepine dispensing within the 120 days before their act were selected in the nationwide French reimbursement healthcare system databases (SNDS). For each patient, frequency of benzodiazepine dispensing was compared between a risk period (days −30 to −1 before the event) and two matched reference periods (days −120 to −91, and −90 to −61).ResultsA total of 111,550 individuals who attempted suicide and 12,312 suicide victims were included, of who, respectively, 77,474 and 7958 had recent psychiatric history. Benzodiazepine dispensing appeared higher in the 30‐day risk period than in reference ones. The comparison yielded adjusted odds ratios of 1.74 for hospitalised suicide attempt (95% confidence interval 1.69–1.78) and 1.45 for suicide (1.34–1.57) in individuals with recent psychiatric history, and of 2.77 (2.69–2.86) and 1.80 (1.65–1.97) for individuals without.ConclusionThis nationwide study supports an association between recent benzodiazepine use and both suicide attempt and suicide. These results strengthen the need for screening for suicidal risk carefully before initiation and during treatment when prescribing benzodiazepines. Registration No. EUPAS48070 (http://www.ENCEPP.eu).

Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review

“…First, BZD have been associated with worse mood outcomes long-term and may increase suicidality in vulnerable patients with other psychiatric risk-factors. 141 , 142 , 143 , 144 Second, there is a paucity of high-quality controlled trial evidence demonstrating benefits for adjunctive treatment with BZD beyond 4 weeks at the time of antidepressant initiation. 145 …”

Pharmacological Support Treatment of Non-Suicidal Self-Injuries Among Children and Adolescents: A Narrative Review

“…It is worth noting that this relationship should be interpreted cautiously, because of the small number of patients included in the study group and without randomization [11]. Nevertheless, several other studies pointed out that augmentation of BZDs may aggravate suicidal behaviors [12,13]. All in all, the use of BZDs may be justified in individual cases, after considering the balance of potential benefits and losses associated with including them in the treatment regimen [14].…”