Use of Antidepressants and Suicide Rate in Finland: An Ecological Study

Jyrki Korkeila, M.D., Ph.D.; Jouko K. Salminen, M.D., Ph.D.; Heikki Hiekkanen, M.Sc.; and Raimo K. R. Salokangas, M.D., Ph.D., M.Sc.

Objective: The suicide rate has decreased in many countries, while the use of antidepressants has increased greatly. The aim of this study was to investigate the associations between use of antidepressants and suicide rate.

Method: Population-based suicide rates and reimbursed prescriptions of antidepressants between 1994 and 2001 in Finland were analyzed in the whole population, and separately by gender, age, and geographical region.

Results: There were significant differences in suicide rates between men and women (p<.0001), but there were no differences between different regions of the country. The decline in the suicide rate was significantly associated with use of antidepressants among men aged 15 to 44 (p<.0001), 45 to 64 (p=.0005), and 75 years and over (p=.001) and men in 3 regions (p<.001). The decline in the suicide rate was significantly associated with the use of antidepressants among 15- to 44-year-old women (p=.008) and women in 1 region (p=.013). Use of antidepressants had a significant association with the decrease in the suicide rate (risk ratio=0.08, 95% CI 0.02 to 0.30, p<.001), despite the effect of background variables, their interaction, and the course of time.

Conclusions: An increase in the use of antidepressants may decrease the suicide rate. Baseline suicide rate and access to health care may influence this association.

(J Clin Psychiatry 2007;68:505-511)

Received Dec. 19, 2005; accepted Nov. 21, 2006. From the Departments of Psychiatry (Drs. Korkeila and Salokangas) and Biostatistics (Mr. Hiekkanen), University of Turku; Psychiatric Clinic, Turku City Hospital (Drs. Korkeila and Salokangas); the Laboratory for Population Research, Department of Health and Functional Capacity, National Public Health Institute (Dr. Salminen); and Department of Psychiatry, University Central Hospital (Dr. Salokangas), Turku, Finland.

This study received a researcher-applied unrestricted scholarship from the Eli Lilly Foundation, Finland. None of the authors has any affiliations with Eli Lilly or any other pharmaceutical companies.

The authors thank the Chief of Health Research, Research Professor Timo Klaukka, M.D., Ph.D., from the Research Department, Social Insurance Institution, for help in acquiring the necessary data on use of antidepressants.

Corresponding author and reprints: Jyrki Korkeila, M.D., Psychiatric Clinic, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700 Turku, Finland (e-mail: jyrki.korkeila@pp.inet.fi).