Poor Access To SSRIs May Result In Suicide Inequalities

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Sean Clouston Ph.D. Assistant Professor Core Faculty, Program in Public Health Department of Preventive Medicine Stony Brook University  Health Sciences Center Stony Brook, NY 11794MedicalResearch.com Interview with:
Sean Clouston Ph.D.
Assistant Professor
Core Faculty, Program in Public Health
Department of Preventive Medicine
Stony Brook University  Health Sciences Center
Stony Brook, NY 11794

Medical Research: What is the background for this study:

Dr. Clouston: A number of epidemiological studies have found that suicide rates have decreased rapidly with the widespread distribution of SSRI antidepressants. Our group has found that proliferation of preventive medicine has, with regard to other causes of death, tended to occur unequally. We hypothesized that if SSRI antidepressants prevent suicide by treating depression, then suicide might also be susceptible to such inequality. Our study used mortality data to show that decreases in suicide were concentrated in regions with higher socioeconomic status.

Medical Research: What are the main findings of the study?

Dr. Clouston We used the best available data from the US and found that socioeconomic inequalities have increased dramatically in conjunction with the proliferation of SSRI antidepressants.


Medical Research: Were any of the findings unexpected?

Dr. Clouston: There were two surprising results:

Suicide has not historically been associated with socioeconomic inequality, so the main finding was quite surprising.

We were also somewhat surprised to have found that suicide has not decreased to the same extent in states within the U.S. where NAMI has rated the mental health system as failing, suggesting perhaps that there is more that we can do to improve public health and prevent suicide.

Medical Research: What should clinicians and patients take away from your report?

Dr. Clouston: Socioeconomic inequalities are both inequitable and inefficient. It is unlikely that SSRIs will effectively prevent all suicides, but many suicides may be preventable. Depression is a key determinant of suicide, and most individuals who commit suicide have sought help in the months prior to taking action. However, once individuals decide to take action they often act quickly and without warning. Prevention is therefore of primary importance, so clinicians and patients should be aware that if patients seem  suicidal, they should seek immediate help from a trained mental health professional.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Clouston: Suicide is somewhat rare, so studying cause and effect can be difficult. Further research is needed to ensure that SSRIs have caused reductions in suicide, as well as identifying for whom such treatments may not work.  Furthermore, suicide reductions have been reported in the United Kingdom, Sweden, Denmark, and Canada, among others; international researchers should also be aware that socioeconomic inequalities may also be evident in suicide internationally.

Citation:

Social Inequalities in Suicide: The Role of Selective Serotonin Reuptake Inhibitors
Am J Epidemiol. 2014 Aug 28. pii: kwu191. [Epub ahead of print]

Clouston SA, Rubin MS, Colen CG, Link BG.

 

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