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Serotonergic medication enhances the association between suicide and sunshine
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Karolinska Inst, Karolinska Univ Hosp, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Mathematics, Applied Mathematics and Statistics. Sweden..
Karolinska Inst, Ctr Mol Med, Dept Mol Med & Surg, Stockholm, Sweden.;Tiohundra AB, Dept Psychiat, Norrtalje, Sweden..
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2016 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 189, 276-281 p.Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Background: An association between suicide and sunshine has been reported. The effect of sunshine on hormones and neurotransmitters such as serotonin has been hypothesized to exert a possible triggering effect on susceptible individuals. The aim of this study is to examine if there is an association between sunshine and suicide, adjusting for season, and if such an association differs between individuals on different antidepressants. Methods: By using Swedish Registers and the Swedish Meteorological and Hydrological Institute we obtained information, including forensic data on antidepressive medication for 12,448 suicides and data on monthly sunshine duration. The association between monthly suicide and sunshine hours was examined with Poisson regression analyses while stratifying for sex and age and controlling for time trend and season. These analyses were repeated in different groups of antidepressant treatment. Results: We found a significantly increased suicide risk with increasing sunshine in both men and women. This finding disappeared when we adjusted for season. Among both men and women treated with selective serotonin reuptake inhibitors (SSRIs) there was a positive association between sunshine and suicide even after adjustment for season and time trend for suicide. Pair comparisons showed that the sunshine-suicide association was stronger among men treated with SSRIs compared to other antidepressant medications or no medication at all. Limitations: Other meteorological factors were not controlled (i.e. temperature) for in the analyses. Conclusions: There is an enhanced association between sunshine and suicide among those with SSRI medication, even after adjusting for season. This may have interesting theoretical and clinical implications.

Place, publisher, year, edition, pages
2016. Vol. 189, 276-281 p.
Keyword [en]
Seasonality, Suicide, Serotonin
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-269956DOI: 10.1016/j.jad.2015.09.056ISI: 000364170200041PubMedID: 26454332OAI: oai:DiVA.org:uu-269956DiVA: diva2:885612
Available from: 2015-12-19 Created: 2015-12-19 Last updated: 2017-12-01Bibliographically approved
In thesis
1. Suicide Seasonality: Theoretical and Clinical Implications
Open this publication in new window or tab >>Suicide Seasonality: Theoretical and Clinical Implications
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Although suicide seasonality has been well-documented, surprisingly little is known about its underlying mechanisms.

Methods: In this thesis, data from three Swedish registers (Cause of Death Register, National Patient Register, Prescribed Drugs Register) and data from the Swedish Meteorological and Hydrological Institute were used.

In Study I, the amplitude of suicide seasonality was estimated in completed suicides in 1992-2003 in individuals with different antidepressant medications or without antidepressants.

In Study II, monthly suicide and sunshine data from 1992-2003 were used to examine the association between suicide and sunshine in groups with and without antidepressants.

In Study III, the relationship between season of initiation of antidepressant treatment and the risk of suicidal behavior was explored in patients with a new treatment episode with antidepressant medication.

In Study IV, the complex association between sunshine, temperature and suicidal behavior was investigated in patients with a new treatment episode with an antidepressant in two exposure windows (1-4 and 5-8 weeks) before the event.

Findings: Study I: Higher suicide seasonality was found in individuals treated with selective serotonin reuptake inhibitors (SSRIs) compared with those given a different antidepressant treatment or those without any antidepressant treatment.

Study II: In individuals treated with SSRIs, there was a positive association between sunshine and suicide, with the association stronger in men treated with SSRIs compared with men treated with other antidepressants. An effect modification by age was observed.

Study III: The elderly (65+) had a higher risk of suicide when initiating antidepressant treatment in summer and a higher risk of suicide attempt when starting antidepressant therapy in spring and summer. Younger patients (0-24) demonstrated a higher risk of suicide attempt when treatment was initiated in autumn.

Study IV: In the elderly (65+), a harmful association was observed between the risk of suicide attempt and the average daily temperature during the four weeks before the suicide attempt, as well as with average daily sunshine during both exposure windows (1-4 and 5-8 weeks) before the suicide attempt.

Significance: Our results provide epidemiological support for the role of the serotonergic system in seasonality of suicide in which both medication and climate may be involved.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 74 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1383
Keyword
suicide, season, antidepressants, sunshine, temperature
National Category
Neurosciences
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-330907 (URN)978-91-513-0108-2 (ISBN)
Public defence
2017-12-07, Gunnesalen, Ing 10, Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2017-11-16 Created: 2017-10-15 Last updated: 2017-11-16

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Makris, Georgios D.Larsson, RolfEkselius, LisaPapadopoulos, Fotios C.

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