Mood Disorder Treatment Patterns in the Year Prior to Death by Suicide: A Case-Control Study

Document Type

Conference Proceeding

Publication Date

9-12-2025

Publication Title

Bipolar Disorders

Abstract

Introduction: This study aimed to determine whether individuals with bipolar disorder (BD) or major depressive disorder (MDD) received treatment less concordant with Canadian Network of Mood and Anxiety Treatment (CANMAT) guidelines in the year before death by suicide. Method: Electronic health record and insurance claims data from nine U.S. health systems were curated for 1267 cases who died by suicide (2000-2015) and 22,631 controls, who did not die by suicide, matched by site and year of death (index date; median age: 47). All patients had an ICD-9/ 10 code for BD or MDD in the year before the index date. Chi-squared tests and unconditional logistic regression were used to study dispensation patterns and estimate the odds of having received additional psychotropic classes (pharmacotherapeutic complexity) while controlling for sociodemographic and clinical characteristics. Results: Among cases, 17% had BD and 83% had MDD versus 9% and 91%, respectively, among controls. Within 1 year, 43% of cases and 56% of controls were not dispensed BD-or MDD-targeting psychotropics and lithium dispensation was low for cases (17%) and controls (16%) with BD. Pharmacotherapeutic complexity increased over time, was significantly higher for cases, those with BD, Medicaid beneficiaries, and females, and varied by race. The odds of cases receiving one additional drug class were 1.33 times the odds for controls (95% CI: [1.24, 1.43]). Conclusion: Pharmacotherapeutic complexity was higher among cases, and lithium dispensation was equally low across groups. Given that guidelines recommend lithium monotherapy for BD and suggest it may mitigate suicidality, further research on guideline concordance is warranted.

Volume

27

First Page

S79

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