Treatment with folic acid is associated with a reduced risk of suicide attempts

Summary: A examine discovered that suicidal occasions, together with suicide attempts and self-harm, had been reduced by 44% in depressed sufferers who took folic acid dietary supplements.

A supply: University of Chicago

Suicide is one of the main causes of loss of life within the United States, with greater than 45,000 folks anticipated to die by suicide in 2020.

Experts advocate many methods and coverings to scale back the risk of suicide, together with psychotherapy, peer assist, monetary assist, and medicines comparable to antidepressants.

Few would put folic acid dietary supplements on that checklist, however a latest examine from the University of Chicago might change that.

A examine revealed in JAMA Psychiatry Sept. 28 used knowledge from 866,586 medical insurance claims to look at the affiliation between folic acid remedy and suicide attempts over a two-year interval.

They discovered that sufferers who stuffed prescriptions for folic acid, also called vitamin B9, had a 44% discount in suicidal occasions (suicide attempts and intentional self-harm).

Robert Gibbons, Ph.D., Bloom-Rise Professor of Biostatistics and Medicine on the University of Chicago, lead writer of the examine, mentioned he hopes the findings will enhance suicide prevention efforts, significantly relating to folic acid availability.

“There are actually no uncomfortable side effects, it does not price a lot of cash, you may get it over-the-counter,” Gibbons mentioned. “It might save hundreds of lives.”

Gibbons first grew to become all for folic acid within the context of suicide, as his group regarded for hyperlinks between the risk of suicide attempts and 922 completely different medicines.

The examine concurrently examined every drug for its affiliation with a rise and reduce in suicidal attempts. Surprisingly, folic acid has been associated with a reduced risk of suicide attempts, alongside with medicines associated with suicide risk, comparable to antidepressants, anxiolytics, and antipsychotics.

One of the challenges of this earlier examine was analyzing the consequences of many medication in large-scale knowledge units, which is troublesome. Many folks take multiple treatment, and medicines can have completely different results when taken collectively than when taken alone.

It may also be troublesome to attract significant conclusions from research like these that search for relationships in massive knowledge units, as a result of the examine might look like instantly causally associated to bivariate elements comparable to suicide and drug use. one another.

Sometimes each are associated with confounding elements comparable to socioeconomic standing or health-related attitudes, or as a result of they’re prescribed for a situation associated with suicide (eg, despair).

But as an alternative of evaluating topics who took the drug and those that did not, Gibbons and his staff had been capable of partially eradicate these difficulties by evaluating the themes to themselves earlier than and after they had been prescribed the drug.

In truth, they initially thought that folic acid appeared of their examine as a result of of a easy rationalization, nevertheless it turned out to not be the case.

“When we first noticed this consequence, we thought it was a being pregnant. Pregnant girls use folic acid, pregnant girls have a decrease suicide price, so this is simply a false affiliation. So we did a fast evaluation to restrict it to only males. But we noticed the identical impact in males,” Gibbons mentioned.

To examine and additional affirm the affiliation between folic acid and suicide risk, Gibbons and his coauthors performed this new examine, focusing particularly on folic acid and controlling for a lot of potential confounding elements, together with age, gender, psychological well being diagnoses, and different central nervous system issues. system medication, circumstances affecting folic acid metabolism, and many others.

Even after adjusting for all of these elements, folic acid supplementation was associated with a reduced risk of suicide attempts.

Surprisingly, folic acid has been associated with a reduced risk of suicide attempts, alongside with medicines associated with suicide risk, comparable to antidepressants, anxiolytics, and antipsychotics. Image is within the public area

They even discovered that the extra folic acid a particular person took, the decrease the risk of suicide attempts. Each month of folic acid consumption was associated with an extra 5% discount within the risk of suicide try throughout the examine’s 24-month follow-up interval.

The authors additionally counsel that individuals who take vitamin dietary supplements could also be more healthy and fewer prone to try suicide.

To tackle this chance, they carried out a related assay with one other complement, vitamin B12, as a destructive management. But in contrast to folic acid, there does not appear to be any hyperlink between vitamin B12 and suicide risk.

Although Gibbons and his co-authors had been cautious to regulate for confounding elements, they can not but say for certain whether or not the affiliation between folic acid and suicidal occasions is causal or not; that is, they don’t but know that taking folic acid instantly will increase a particular person’s risk of suicide.

To discover out, the authors are persevering with this examine with a large-scale randomized managed trial (RCT) to check whether or not folic acid instantly reduces the risk of suicidal occasions, together with ideas, attempts, and completion.

This concerned randomly dividing topics into two teams, giving one group placebo and the opposite folic acid, and evaluating charges of suicidal occasions over time.

If their findings are confirmed within the new examine, folic acid might be a secure, reasonably priced and extensively accessible suicide prevention technique that might save hundreds of lives.

Psychology analysis information about it

Author: Press service
A supply: University of Chicago
The connection: University of Chicago Press
Photo: Image is within the public area

Original analysis: Closed entry.
Robert D. Gibbons et al. JAMA Psychiatry


Abstract

Association between folic acid prescriptions and suicide attempts and intentional self-harm amongst privately insured US adults

See additionally

It shows a child playing with building blocks

an necessary

Suicide is the main trigger of loss of life within the United States, rising greater than 30% from 2000 to 2018. Inexpensive, secure, extensively accessible therapies to forestall suicidal conduct might reverse this development.

The purpose

Confirmation of a earlier sign of reduced risk of suicide attempts after filling a prescription for folic acid in a nationwide pharmacoepidemiologic examine of folic acid-treated sufferers.

Design, set up and members

A within-person publicity cohort design was used to research the dynamic relationship between folic acid (vitamin B).9) prescription fills inside 24 months and suicidal attempts and intentional self-harm. Data had been collected from the US Medical Claims Pharmacoepidemiologic Database (MarketScan) for sufferers with non-public medical insurance who stuffed prescriptions for folic acid between 2012 and 2017. The similar assay was repeated with a management complement (cyanocobalamin, vitamin B).12). Data had been analyzed from August 2021 to June 2022.

affect

Folic acid prescription is filling.

Main consequence and measure

Suicide attempts or intentional self-harm had been recognized by codes associated with outpatient visits or inpatient admissions. International Statistical Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification.

Results

Data had been collected on 866,586 sufferers; 704,514 (81.30%) are girls, 90,296 (10.42%) are over 60 years previous. Overall, there have been 261 suicides in months with folic acid (5,521,597 person-months), a price of 4.73 per 100,000, in contrast with 895 suicides in months with out folic acid (8,432,340) and 110. 100,000 per person-month. Adjusted for age and intercourse, diagnoses associated to suicidal conduct, diagnoses associated to folic acid deficiency, folic acid-reducing medicines, historical past of folic acid-reducing medicines, and historical past of suicidal occasions, the hazard ratio (HR) of folic acid for suicidal occasions was. 0.56 (95% CI, 0.48-0.65), modal dose of 1 mg day by day folic acid (HR, 0.57; 95% CI, 0.48-0.69) and girls of childbearing age (HR, 0.60; 95) with related outcomes. %CI, 0.50-0.73). Duration-response evaluation (1-mg dose) revealed a 5% discount in suicide occasions per thirty days of further remedy (HR, 0.95; 95% CI, 0.93–0.97). In the identical evaluation for the destructive management, cyanocobalamin was not associated with suicide try (HR, 1.01; 95% CI, 0.80-1.27).

Conclusions and relevance

This large-scale pharmacoepidemiological examine of folic acid discovered a useful affiliation with decrease charges of suicide attempts. The outcomes name for a randomized medical trial with suicidal ideation and conduct as the result of curiosity. If confirmed, folic acid could also be a secure, cheap, and extensively accessible remedy for suicidal ideas and behaviors.

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