Benzodiazepine therapy in psychiatric outpatients is associated with deliberate self-poisoning events at emergency departments - A population-based nested case-control study

Hsin-I Shih, Ming Chia Lin, Che Chen Lin, Hsiang-Chin Hsu, Hsin Ling Lee, Chih-Hsien Chi, Fung Chang Sung, Yen Jung Chang, Chia Hung Kao

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Rationale: Deliberate self-poisoning (DSP), the most common form of deliberate self-harm, is closely associated with suicide. Identifying risk factors of DSP is necessary for implementing prevention strategies. Objectives: This study aimed to evaluate the relationship between benzodiazepine (BZD) treatment in psychiatric outpatients and DSP cases at emergency departments (EDs). Methods: We performed a retrospective nested case-control study of psychiatric patients receiving BZD therapy to evaluate the relationship between BZD use and the diagnosis of DSP at EDs using data from the nationwide Taiwan National Health Insurance Research Database. Results: Regression analysis yielded an odds ratio (OR) and 95 % confidence interval (95 % CI) indicating that the use of BZDs in psychiatric outpatients was significantly associated with DSP cases at EDs (OR = 4.46, 95 % CI = 3.59-5.53). Having a history of DSP, sleep disorders, anxiety disorders, schizophrenia, depression, or bipolar disorder was associated with a DSP diagnosis at EDs (OR = 13.27, 95 % CI = 8.28-21.29; OR = 5.04, 95 % CI = 4.25-5.98; OR = 3.95, 95 % CI = 3.32-4.70; OR = 7.80, 95 % CI = 5.28-11.52; OR = 15.20, 95 % CI = 12.22-18.91; and OR = 18.48, 95 % CI = 10.13-33.7, respectively). After adjusting for potential confounders, BZD use remained significantly associated with a subsequent DSP diagnosis (adjusted OR = 2.47, 95 % CI = 1.93-3.17). Patients taking higher average cumulative BZD doses were at greater risk of DSP. Conclusion: Vigilant evaluation of the psychiatric status of patients prescribed with BZD therapy is critical for the prevention of DSP events at EDs.

Original languageEnglish
Pages (from-to)665-671
Number of pages7
JournalPsychopharmacology
Volume229
Issue number4
DOIs
Publication statusPublished - 2013 Oct 1

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Benzodiazepines
Poisoning
Psychiatry
Case-Control Studies
Hospital Emergency Service
Outpatients
Odds Ratio
Confidence Intervals
Population
Therapeutics
Self-Injurious Behavior
National Health Programs
Anxiety Disorders
Taiwan
Bipolar Disorder
Suicide
Schizophrenia
Regression Analysis
Databases
Depression

All Science Journal Classification (ASJC) codes

  • Pharmacology

Cite this

@article{8fdd637b5ba142c582375e3d648d9974,
title = "Benzodiazepine therapy in psychiatric outpatients is associated with deliberate self-poisoning events at emergency departments - A population-based nested case-control study",
abstract = "Rationale: Deliberate self-poisoning (DSP), the most common form of deliberate self-harm, is closely associated with suicide. Identifying risk factors of DSP is necessary for implementing prevention strategies. Objectives: This study aimed to evaluate the relationship between benzodiazepine (BZD) treatment in psychiatric outpatients and DSP cases at emergency departments (EDs). Methods: We performed a retrospective nested case-control study of psychiatric patients receiving BZD therapy to evaluate the relationship between BZD use and the diagnosis of DSP at EDs using data from the nationwide Taiwan National Health Insurance Research Database. Results: Regression analysis yielded an odds ratio (OR) and 95 {\%} confidence interval (95 {\%} CI) indicating that the use of BZDs in psychiatric outpatients was significantly associated with DSP cases at EDs (OR = 4.46, 95 {\%} CI = 3.59-5.53). Having a history of DSP, sleep disorders, anxiety disorders, schizophrenia, depression, or bipolar disorder was associated with a DSP diagnosis at EDs (OR = 13.27, 95 {\%} CI = 8.28-21.29; OR = 5.04, 95 {\%} CI = 4.25-5.98; OR = 3.95, 95 {\%} CI = 3.32-4.70; OR = 7.80, 95 {\%} CI = 5.28-11.52; OR = 15.20, 95 {\%} CI = 12.22-18.91; and OR = 18.48, 95 {\%} CI = 10.13-33.7, respectively). After adjusting for potential confounders, BZD use remained significantly associated with a subsequent DSP diagnosis (adjusted OR = 2.47, 95 {\%} CI = 1.93-3.17). Patients taking higher average cumulative BZD doses were at greater risk of DSP. Conclusion: Vigilant evaluation of the psychiatric status of patients prescribed with BZD therapy is critical for the prevention of DSP events at EDs.",
author = "Hsin-I Shih and Lin, {Ming Chia} and Lin, {Che Chen} and Hsiang-Chin Hsu and Lee, {Hsin Ling} and Chih-Hsien Chi and Sung, {Fung Chang} and Chang, {Yen Jung} and Kao, {Chia Hung}",
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Benzodiazepine therapy in psychiatric outpatients is associated with deliberate self-poisoning events at emergency departments - A population-based nested case-control study. / Shih, Hsin-I; Lin, Ming Chia; Lin, Che Chen; Hsu, Hsiang-Chin; Lee, Hsin Ling; Chi, Chih-Hsien; Sung, Fung Chang; Chang, Yen Jung; Kao, Chia Hung.

In: Psychopharmacology, Vol. 229, No. 4, 01.10.2013, p. 665-671.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Benzodiazepine therapy in psychiatric outpatients is associated with deliberate self-poisoning events at emergency departments - A population-based nested case-control study

AU - Shih, Hsin-I

AU - Lin, Ming Chia

AU - Lin, Che Chen

AU - Hsu, Hsiang-Chin

AU - Lee, Hsin Ling

AU - Chi, Chih-Hsien

AU - Sung, Fung Chang

AU - Chang, Yen Jung

AU - Kao, Chia Hung

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Rationale: Deliberate self-poisoning (DSP), the most common form of deliberate self-harm, is closely associated with suicide. Identifying risk factors of DSP is necessary for implementing prevention strategies. Objectives: This study aimed to evaluate the relationship between benzodiazepine (BZD) treatment in psychiatric outpatients and DSP cases at emergency departments (EDs). Methods: We performed a retrospective nested case-control study of psychiatric patients receiving BZD therapy to evaluate the relationship between BZD use and the diagnosis of DSP at EDs using data from the nationwide Taiwan National Health Insurance Research Database. Results: Regression analysis yielded an odds ratio (OR) and 95 % confidence interval (95 % CI) indicating that the use of BZDs in psychiatric outpatients was significantly associated with DSP cases at EDs (OR = 4.46, 95 % CI = 3.59-5.53). Having a history of DSP, sleep disorders, anxiety disorders, schizophrenia, depression, or bipolar disorder was associated with a DSP diagnosis at EDs (OR = 13.27, 95 % CI = 8.28-21.29; OR = 5.04, 95 % CI = 4.25-5.98; OR = 3.95, 95 % CI = 3.32-4.70; OR = 7.80, 95 % CI = 5.28-11.52; OR = 15.20, 95 % CI = 12.22-18.91; and OR = 18.48, 95 % CI = 10.13-33.7, respectively). After adjusting for potential confounders, BZD use remained significantly associated with a subsequent DSP diagnosis (adjusted OR = 2.47, 95 % CI = 1.93-3.17). Patients taking higher average cumulative BZD doses were at greater risk of DSP. Conclusion: Vigilant evaluation of the psychiatric status of patients prescribed with BZD therapy is critical for the prevention of DSP events at EDs.

AB - Rationale: Deliberate self-poisoning (DSP), the most common form of deliberate self-harm, is closely associated with suicide. Identifying risk factors of DSP is necessary for implementing prevention strategies. Objectives: This study aimed to evaluate the relationship between benzodiazepine (BZD) treatment in psychiatric outpatients and DSP cases at emergency departments (EDs). Methods: We performed a retrospective nested case-control study of psychiatric patients receiving BZD therapy to evaluate the relationship between BZD use and the diagnosis of DSP at EDs using data from the nationwide Taiwan National Health Insurance Research Database. Results: Regression analysis yielded an odds ratio (OR) and 95 % confidence interval (95 % CI) indicating that the use of BZDs in psychiatric outpatients was significantly associated with DSP cases at EDs (OR = 4.46, 95 % CI = 3.59-5.53). Having a history of DSP, sleep disorders, anxiety disorders, schizophrenia, depression, or bipolar disorder was associated with a DSP diagnosis at EDs (OR = 13.27, 95 % CI = 8.28-21.29; OR = 5.04, 95 % CI = 4.25-5.98; OR = 3.95, 95 % CI = 3.32-4.70; OR = 7.80, 95 % CI = 5.28-11.52; OR = 15.20, 95 % CI = 12.22-18.91; and OR = 18.48, 95 % CI = 10.13-33.7, respectively). After adjusting for potential confounders, BZD use remained significantly associated with a subsequent DSP diagnosis (adjusted OR = 2.47, 95 % CI = 1.93-3.17). Patients taking higher average cumulative BZD doses were at greater risk of DSP. Conclusion: Vigilant evaluation of the psychiatric status of patients prescribed with BZD therapy is critical for the prevention of DSP events at EDs.

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