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Type: Theses
Title: The association between suicidality and treatment with selective serotonin reuptake inhibitors in older people with major depression: a systematic review
Author: KoKoAung, Edward Wahlu
Issue Date: 2014
School/Discipline: School of Translational Health Science
Abstract: Suicide is a leading cause of death in Australia, most notably amongst elderly men over the age of 75. Currently, treatment with Selective Serotonin Reuptake Inhibitors (SSRI) is regarded as preventive against suicidality in late life depression. The aim of this systematic review was to synthesise the best available evidence, including both experimental and observational data, on the association between treatment with SSRIs and suicidality in older people over the age of 60. A comprehensive literature search was conducted to locate relevant studies. Methodological quality of eligible studies was assessed using Joanna Briggs Institute (JBI) critical appraisal checklists and the McMaster Quality Assessment Scale for Harms (McHarm). Research data was extracted using the JBI data extraction tool for experimental and observational studies. Eight randomised controlled trials on short-term SSRI treatment and five observational studies investigating longer term SSRI exposure in the geriatric population were included. The overall methodological quality of RCTs and observational studies was high. Separate meta-analyses were conducted for the experimental and observational studies. Analysis of experimental studies revealed no difference in the risk of suicide attempt in elderly participants treated with SSRIs compared to Tricyclic Antidepressants with OR 1.0 ( 95% CI 0.14, 7.10) and showed no statistically significant heterogeneity Chi² 3.88, I² 23%, P=1.00. Synthesis of observational studies however, suggested an 18% increased risk of attempting suicide with long-term SSRI treatment compared to no treatment in elderly patients with major depression OR 1.18 (95% CI 1.10, 1.27), Chi² 34.81, I² 94%, P <0.00001. In contrast to the experimental studies, the presence of statistically significant heterogeneity in the included observational studies may predispose them to bias in their meta-analysis. Nevertheless, the results of this systematic review highlight the important clinical implications of the need to systematically monitor the risk of suicide in elderly patients on long-term SSRI treatment.
Advisor: Aromataris, Edoardo Claudio
McArthur, Alexandra Lee
Dissertation Note: Thesis (M.Clin.Sc.) -- University of Adelaide, School of Translational Health Science, 2014.
Keywords: suicidality
older people
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
Appears in Collections:Research Theses

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