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High impact child abuse may predict risk of elevated suicidality during antidepressant initiation

Singh, Ajeet B., Bousman, Chad A., Ng, Chee H. and Berk, Michael 2013, High impact child abuse may predict risk of elevated suicidality during antidepressant initiation, Australian & New Zealand journal of psychiatry, vol. 47, no. 12, pp. 1191-1195, doi: 10.1177/0004867413510212.

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Title High impact child abuse may predict risk of elevated suicidality during antidepressant initiation
Author(s) Singh, Ajeet B.
Bousman, Chad A.
Ng, Chee H.
Berk, MichaelORCID iD for Berk, Michael orcid.org/0000-0002-5554-6946
Journal name Australian & New Zealand journal of psychiatry
Volume number 47
Issue number 12
Start page 1191
End page 1195
Total pages 6
Publisher Sage Publications
Place of publication London, Eng.
Publication date 2013-12
ISSN 1440-1614
Keyword(s) Child abuse
antidepressant
major depression
suicidality
Adult
Adult Survivors of Child Abuse
Antidepressive Agents, Second-Generation
Citalopram
Cyclohexanols
Depressive Disorder, Major
Female
Humans
Male
Risk Factors
Suicidal Ideation
Suicide, Attempted
Venlafaxine Hydrochloride
Science & Technology
Life Sciences & Biomedicine
Psychiatry
Summary BACKGROUND: Concerns have emerged that initiation of an antidepressant can lead to or exacerbate suicidality. If those more at risk could be identified prior to treatment, treatment risk benefit analysis and patient risk management could be assisted.
AIMS: This study investigated the role of child abuse and ongoing emotional impact from abuse on the risk of suicidality during the first week of treatment with an antidepressant. The patient sample for this study was drawn from one site of a larger pharmacogenetic study. The hypothesis was that subjects with high impact child abuse would have greater elevation of suicidality during the first week of antidepressant treatment.
METHODS: Fifty-one subjects were initiated on either venlafaxine (VEN) or escitalopram (ESC) for major depressive disorder (MDD) and had pre-treatment suicidality assayed with the reasons for living scale (RFLS), which was repeated after one week of treatment. Several clinical, demographic and genotype variables were controlled for. The 15-item Impact of Event Scale (IES-15) was administered to subjects reporting abuse to dichotomise the abuse group into low and high (IES-15 ≥ 26) impact groups for sub-analysis as per the scales validated rating guidelines.
RESULTS: Subjects reporting no child abuse exposure were less likely to have increased suicidality during the first week of antidepressant treatment (7.6%) compared to subjects with low impact abuse (38.5%, p = 0.041) and high impact abuse (58.3%, p = 0.009). Only high impact abuse predicted increased suicidality after adjustment for potential confounders such as depression severity (OR = 31.5, 95% CI = 1.3 to 748.7, p = 0.03).
CONCLUSIONS: If these findings are replicated in larger samples, child abuse history could become an important element of assessing risk benefit balance when initiating antidepressants and may help guide the level of patient review needed during antidepressant initiation.
Language eng
DOI 10.1177/0004867413510212
Field of Research 110319 Psychiatry (incl Psychotherapy)
111714 Mental Health
Socio Economic Objective 920410 Mental Health
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2013, The Royal Australian and New Zealand College of Psychiatrists
Persistent URL http://hdl.handle.net/10536/DRO/DU:30067201

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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