Empty Bottles, Rising Risks: A Case-Crossover Study on Psychotherapeutic Medication Depletion and Suicide Triggers

OBJECTIVES: The use of psychotherapeutic medications has been associated with reducing the risk of suicide among people who may struggle with a mental health disorder. However, the literature is limited on exploring the association between exhausting the supply of these medications and suicide. This study analyzes the temporal relationship between running out of psychotherapeutic medications and suicide using a case-crossover study design.

METHODS: Pharmacy and medical claims data from the Arkansas All-Payers Claims Database were linked to death certificates to identify decedents of suicide from 2013 through 2021. Dispensed psychotherapeutic medications were categorized using a National Drug Code (NDC) categorization ontology derived by the First DataBank®. The dispensed date and days’ supply obtained from pharmacy claims were used to estimate when a decedent would exhaust their supply of medicine. A dichotomous variable was created to indicate if a decedent exhausted at least one medication during the hazard window – defined as the seven days leading up to and including the date of death. The exposure during the hazard window was then compared to 11 control windows, which were the 11 weeks immediately preceding the hazard window. Conditional logistic regression analysis was used to estimate the odds of exhausting at least one medication during the hazard window relative to the control windows.

RESULTS: A total of 853 decedents received 4,375 psychotherapeutic prescriptions. During the hazard window, 17.0% of the study population depleted at least one medication, the most among all study windows. There was a 46% increase in the odds of exhausting at least one medication during the hazard window compared to the control windows (AOR: 1.46; p=0.0001).

CONCLUSIONS: There is a temporal relationship between exhausting at least one psychotherapeutic medication and suicide. Patients who are treated with these medications must be closely followed by a medical provider to ensure adequate supply of medications.