Professor of Epidemiology and Medicine Johns Hopkins Bloomberg School of Public Health, United States
Individuals with bipolar disorder are at heightened risk of suicide attempt, yet it is unclear whether nonfatal suicide attempts prompt changes in pharmacologic care for patients with bipolar disorder age ≥50 years. It is also unknown whether such changes are associated with the likelihood of subsequent suicide attempts. The objectives were to 1) characterize bipolar disorder antipsychotic and mood stabilizer prescribing practices before and after a first nonfatal suicide attempt and 2) evaluate if new prescriptions for mood stabilizers and antipsychotics within 14 days of a nonfatal suicide attempt are an indicator for reduced risk of subsequent suicide attempt.
This study used a retrospective cohort design with national US Veterans Affairs (VA) inpatient and outpatient healthcare services, Centers for Medicare & Medicaid Services data, VA pharmacy benefit management, National Suicide Prevention Applications Network (non-fatal suicide attempts) and Mortality Data Repository (fatal suicide attempts). Data was drawn from all VA medical centers in the US. Participants include all veterans aged 50 years and older diagnosed with bipolar disorder, a documented nonfatal suicide attempt between January 2012 and December 2020, and at least one fill of a mood stabilizer or antipsychotic medication. Medication classes included mood stabilizer and antipsychotics. Prescription fills of these classes and combinations of classes were evaluated before and after the index nonfatal attempt. Risk of subsequent suicide attempt was evaluated by presence or absence of new mood stabilizer and/or antipsychotic prescriptions within the first two weeks after the index nonfatal attempt were evaluated. The outcome was subsequent suicide attempt within one year of the index nonfatal attempt.
Of the 2,180 patients, 273 (12%) reattempted suicide under follow-up. Medication utilization increased in the first 90 days after index – driven by antipsychotics, but returned to baseline levels after a year. Patients who received a new prescription for a mood stabilizer or antipsychotic medication within the first 14 days of the index nonfatal suicide attempt did not have reduced risk for subsequent suicide attempts. While utilization increased in the first 90 days, prescribing practices alone were not sufficient to preventing repeat suicide attempts in this high-risk population.
