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Abstract：
Guidelines for management of anxiety and sleep disorders emphasize antidepressant medications and/or psychotherapy as first/second-line and benzodiazepines as third-line treatments. We evaluated the association between suicide death and concordance with benzodiazepine guidelines.
Retrospective case-control study of patients with anxiety and/or sleep disorders from health systems across 8 U.S. states within the Mental Health Research Network. Suicide death cases were matched to controls on year and health system. Appropriate benzodiazepine prescribing defined as: no monotherapy, no long duration, and/or age < 65 years. The association between guideline concordance and suicide death was evaluated, adjusting for diagnostic and treatment covariates.
Sample included 6960 patients with anxiety disorders (2363 filled benzodiazepine) and 6215 with sleep disorders (1237 filled benzodiazepine). Benzodiazepine guideline concordance was associated with reduced odds for suicide in patients with anxiety disorders (OR = 0.611, 95% CI = 0.392-0.953, p = 0.03) and was driven by shorter duration of benzodiazepine use with concomitant psychotherapy or antidepressant medication. The association of benzodiazepine guideline concordance with suicide death did not meet statistical significance in the sleep disorder group (OR = 0.413, 95% CI = 0.154-1.11, p = 0.08).
We found reduced odds for suicide in those with anxiety disorders who filled benzodiazepines in short-moderate duration with concomitant psychotherapy or antidepressant treatment.
Retrospective case-control study of patients with anxiety and/or sleep disorders from health systems across 8 U.S. states within the Mental Health Research Network. Suicide death cases were matched to controls on year and health system. Appropriate benzodiazepine prescribing defined as: no monotherapy, no long duration, and/or age < 65 years. The association between guideline concordance and suicide death was evaluated, adjusting for diagnostic and treatment covariates.
Sample included 6960 patients with anxiety disorders (2363 filled benzodiazepine) and 6215 with sleep disorders (1237 filled benzodiazepine). Benzodiazepine guideline concordance was associated with reduced odds for suicide in patients with anxiety disorders (OR = 0.611, 95% CI = 0.392-0.953, p = 0.03) and was driven by shorter duration of benzodiazepine use with concomitant psychotherapy or antidepressant medication. The association of benzodiazepine guideline concordance with suicide death did not meet statistical significance in the sleep disorder group (OR = 0.413, 95% CI = 0.154-1.11, p = 0.08).
We found reduced odds for suicide in those with anxiety disorders who filled benzodiazepines in short-moderate duration with concomitant psychotherapy or antidepressant treatment.
摘要：
焦虑和睡眠障碍的管理指南强调抗抑郁药物和/或心理治疗为一线/二线，苯二氮卓类药物为三线治疗。我们评估了自杀死亡与苯二氮卓指南的一致性之间的关联。
在心理健康研究网络中，来自美国8个州的卫生系统的焦虑和/或睡眠障碍患者的回顾性病例对照研究。自杀死亡病例与年份和卫生系统的对照相匹配。适当的苯二氮卓类药物处方定义为：无单一疗法，没有长的持续时间，和/或年龄<65岁。评估了指南一致性与自杀死亡之间的关联，调整诊断和治疗协变量。
样品包括6960名患有焦虑症的患者（2363填充的苯二氮卓）和6215名患有睡眠障碍的患者（1237填充的苯二氮卓）。苯二氮卓指南的一致性与焦虑症患者的自杀几率降低相关（OR=0.611，95％CI=0.392-0.953，p=0.03），并且是由于苯二氮卓与心理治疗或抗抑郁药物同时使用的持续时间较短。在睡眠障碍组中，苯二氮卓类药物指南与自杀死亡的相关性无统计学意义（OR=0.413，95％CI=0.154-1.11，p=0.08）。
我们发现，在短期-中度服用苯二氮卓类药物并伴随心理治疗或抗抑郁治疗的焦虑症患者的自杀几率降低。
在心理健康研究网络中，来自美国8个州的卫生系统的焦虑和/或睡眠障碍患者的回顾性病例对照研究。自杀死亡病例与年份和卫生系统的对照相匹配。适当的苯二氮卓类药物处方定义为：无单一疗法，没有长的持续时间，和/或年龄<65岁。评估了指南一致性与自杀死亡之间的关联，调整诊断和治疗协变量。
样品包括6960名患有焦虑症的患者（2363填充的苯二氮卓）和6215名患有睡眠障碍的患者（1237填充的苯二氮卓）。苯二氮卓指南的一致性与焦虑症患者的自杀几率降低相关（OR=0.611，95％CI=0.392-0.953，p=0.03），并且是由于苯二氮卓与心理治疗或抗抑郁药物同时使用的持续时间较短。在睡眠障碍组中，苯二氮卓类药物指南与自杀死亡的相关性无统计学意义（OR=0.413，95％CI=0.154-1.11，p=0.08）。
我们发现，在短期-中度服用苯二氮卓类药物并伴随心理治疗或抗抑郁治疗的焦虑症患者的自杀几率降低。
