Marie Tournier

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New research suggests there is a link between benzodiazepine use and suicidal behavior that warrants further exploration.

A team, led by Marie Tournier, University of Bordeaux, INSERM, BPH, Team AHeaD, estimated the risk of suicide attempts and suicide associated with treatment with benzodiazepines.

“Even though some pharmacological and psychological treatments showed preventive effectiveness, most drugs used to treat them did not show a clear effectiveness in preventing suicidal behaviors and some of them might increase suicide risk,” the authors wrote. “The impact of benzodiazepines on the risk of suicidal behaviors is unknown.”

Previously, investigators have identified an association between benzodiazepines and suicidal behaviors that were confounded by indication bias.

The Studies

In the case crossover study, the investigators examined patients aged at least 16 years with hospitalized suicide attempts or suicide between 2013-2016 that were dispensed at least 1 benzodiazepine within the 120 days before the suicidal act.The data was derived from the nationwide French reimbursement healthcare system databases (SNDS).

The investigators compared frequency of benzodiazepine dispensing between a risk period of 30 days to 1 day before the event and 2 matched reference periods of 120 to 91 days, and 90 to 61 days for each patient.

The study included the data from 111,550 individuals who attempted suicide and 12,312 suicide victims. Of this group, 77,474 in the attempted suicide group and 7958 in the suicide group had recent psychiatric history.

Benzodiazepine dispensing was higher in the 30-day risk period compared to the reference ones.

The investigators found an adjusted odds ratio of 1.74 for hospitalized suicide attempts (95% confidence interval [CI], 1.69-1.78) and 1.45 for those who committed suicide (95% CI, 1.34-1/57) in individuals with recent psychiatric history. This was compared to 2.77 (95% CI, 2.69-2.86) for the suicide attempt group and 1.80 (95% CI, 1.65-1.97) for suicide in patients without a recent psychiatric history.

“This nationwide study supports an association between recent benzodiazepine use and both suicide attempt and suicide,” the authors wrote. “These results strengthen the need for screening for suicidal risk carefully before initiation and during treatment when prescribing benzodiazepines.”

Some limitations included in the study were that the study did not allow assessing a potential dose-effect relationship between benzodiazepine and suicidal behaviors and was only designed to investigate short-term associations. The study also did not allow distinguishing between various hypotheses of mechanisms underlying an association, including suicidal ideation triggering, facilitating effect on the transition from ideation to act, cognitive impairment, dissociative behavior, parasomnia, or psychiatric symptoms worsening.

References:

Tournier, M., Bénard‐Laribière, A., Jollant, F., Hucteau, E., Diop, P., Jarne‐Munoz, A., Pariente, A., Oger, E., & Bezin, J. (2023). Risk of suicide attempt and suicide associated with benzodiazepine: A nationwide case crossover study. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.13582