Citation

Fenger-Grøn M, Kjaersgaard MIS, Parner ET, Guldin MB, Vedsted P, Vestergaard M. Clin. Epidemiol. 2018; 10: 1013-1026.

Copyright

(Copyright © 2018, Dove Press)

DOI

10.2147/CLEP.S157996

PMID

unavailable

Abstract

PURPOSE: Losing a loved one to death is a common and natural life-course experience. Still, bereavement has been associated with an increased risk of suicidal behavior and psychiatric hospitalization and little is known of how to counter these adverse events. We aimed to study the effect of early treatment in primary care with talk therapy (TT) or antidepressants (AD) in severely bereaved people.

METHODS: We conducted a population-based cohort study including 207,435 adult Danes who experienced a severe loss in 1996-2013. We compared treatment and no treatment with either of the two treatment regimens within 6 months after the loss. The main outcome was a serious mental health condition (defined as suicide, deliberate self-harm, or psychiatric hospitalization) occurring >6 months after bereavement. Adjusted risk differences (RDs) 2 years after bereavement were calculated using both standard regression analysis and instrumental variable analysis (IVA) in which estimated physician preferences for treatment served as instruments.

RESULTS: The standard adjusted regression analysis showed a higher risk of developing a serious mental health condition associated with both TT (RD, 7.1; 95% CI, 5.0 to 9.1 per 1000 people) and AD (RD, 30.1; 95% CI, 25.7 to 34.6 per 1000 people). The IVA, which was used to control for unmeasured confounding, showed that TT was associated with a lower risk of a serious mental health condition (RD,-17.1; 95% CI,-30.7 to-3.5 per 1000 people), whereas the results were inconclusive for AD (RD,-8.6; 95% CI,-62.6 to 45.4 per 1000 people).

CONCLUSION: This study suggests that early treatment with TT is associated with reduced long-term risk of serious mental health conditions in severely bereaved people. No clear benefit or harm of treatment with AD after bereavement was ascertained since the statistical precision was low. © 2018 Fenger-Grøn et al.

Language: en

Keywords

adult; human; suicide; Suicide; female; male; aged; psychotherapy; Self-harm; suicidal behavior; hospitalization; risk assessment; Bereavement; early intervention; major clinical study; primary medical care; mental disease; controlled study; antidepressant agent; mental health care; behavior disorder; automutilation; age distribution; cohort analysis; Loss; Article; outcome assessment; clinical effectiveness; therapy effect; bereavement support; Practice variation; talk therapy