Decreased Risk of Self-Harm in Youths Following Melatonin Treatment

Marica Leone, PhD

Recent results support the use of melatonin for the treatment of intentional self-harm, especially for girls with depression and anxiety. This finding highlights the potential of sleep interventions in reducing the risk of self-harm in this population.

Investigators assessed youth between the ages of 6-18 years–a population commonly affected by sleep disorders as well as an increased risk of self-injury which can lead to suicidal behavior. According to the data, melatonin was associated with a decreased risk of self-injury after initiating the intervention.

Melatonin is the most commonly prescribed medication for sleep disturbances among youth in Sweden. To validate this approach, investigators aimed to determine whether melatonin was associated with a decreased risk of injury in youths who have sleep disturbances.

Melatonin Treatment for Psychiatric Disorders

Marica Leone, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, and the team of investigators found that body injuries, falls, and transport accident rates were comparable in the year before and after melatonin-treatment initiation.

However, the risk of self-harm was highest in the months immediately prior to medication initiation and then decreased thereafter. The adolescents with depression and/or anxiety showed a particularly prominent difference with females displaying greater absolute risks than males.

Compared with the last unmedicated month, the 12 months before medication was initiated, results demonstrated decreased relative risks for self-harm, with an IRR [95% CI] in the month following melatonin-treatment initiation of 0.46 [0.27–0.76] among adolescent females with psychiatric disorders, after excluding antidepressant users.

Evaluating Sleep Interventions for Self-Harm

The population-based cohort study included 25,575 youths who initiated melatonin treatment. Investigators used Poisson regression to estimate the rate of injuries in the year prior to and following melatonin treatment initiation.

A within-individual design to estimate relative risks by comparing injury risk in the last unmedicated month with injury risks in the 12 months after medication initiation was also utilized. Then, analyses were stratified by sex, injury type, psychiatric comorbidities, and age at melatonin-treatment initiation.

It’s important to note that this study has some limitations, including the fact that it was an observational study and that the results may not generalize to other populations or settings, investigators noted.

This study was the first to assess the absolute and relative risks of intentional self-harm and unintentional injuries among a pediatric population treated with melatonin. The study acknowledged further research is needed to confirm these findings and to explore the mechanisms underlying the relationship between sleep disturbances and self-harm.

“Our findings show that, while the risks of unintentional injuries were comparable in the year before and after melatonin-treatment initiation, the risks of self-harm and poisoning were highest in the month immediately prior to medication initiation, and decreased directly after,” the team wrote. “Given the extensive overlap between poisoning and self-harm diagnoses, it is not surprising these two types of injuries showed similar risk patterns.”

References:

1. Leone, M., Kuja-Halkola, R., Lagerberg, T., Bjureberg, J., Butwicka, A., Chang, Z., Larsson, H., D'Onofrio, B.M., Leval, A. and Bergen, S.E. (2023), Melatonin use and the risk of self-harm and unintentional injuries in youths with and without psychiatric disorders. J Child Psychol Psychiatr. https://doi.org/10.1111/jcpp.13785