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Regional clozapine, ECT and lithium usage inversely associated with excess suicide rates in male adolescents
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Department of Women's and Children's Health/Neuropediatrics, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76, Stockholm, Sweden. adrian.desai.bostrom@ki.se.ORCID iD: 0000-0001-8604-9638
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research, Uppsala University, Dalarna, Falun, Sweden.
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Department of Clinical Sciences Lund, Section of Child and Adolescent Psychiatry, Lund University, Lund, Sweden; Child and Adolescent Psychiatry, Region Halland, Halland, Sweden.
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2023 (English)In: Nature Communications, E-ISSN 2041-1723, Vol. 14, no 1, article id 1281Article in journal (Refereed) Published
Abstract [en]

Advanced psychiatric treatments remain uncertain in preventing suicide among adolescents. Across the 21 Swedish regions, using nationwide registers between 2016-2020, we found negative correlation between adolescent excess suicide mortality (AESM) and regional frequencies of clozapine, ECT, and lithium (CEL) usage among adolescents (β = -0.613, p = 0.0003, 95% CI: -0.338, -0.889) and males (β = -0.404, p = 0.009, 95% CI: -0.130, -0.678). No correlation was found among females (p = 0.197). Highest CEL usage among male adolescents was seen in regions with lowest quartile (Q1) AESM (W = 74, p = 0.012). Regional CEL treatment frequency in 15-19-year-olds was related to lower AESM in males, reflecting potential treatment efficacy, treatment compliance or better-quality mental health care. Suicide prevention may benefit from early recognition and CEL treatment for severe mental illness in male adolescents. The results indicate association but further research, using independent samples and both prospective and observational methodologies, is needed to confirm causality.

Place, publisher, year, edition, pages
Nature Publishing Group, 2023. Vol. 14, no 1, article id 1281
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Psychiatry
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URN: urn:nbn:se:umu:diva-206021DOI: 10.1038/s41467-023-36973-4ISI: 001035072200010PubMedID: 36918566Scopus ID: 2-s2.0-85150306127OAI: oai:DiVA.org:umu-206021DiVA, id: diva2:1746349
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Swedish Research Council, 2020-01183Available from: 2023-03-28 Created: 2023-03-28 Last updated: 2025-04-24Bibliographically approved

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Boström, Adrian Desai E.Jokinen, Jussi

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