Central Nervous System (CNS) Medication Use Before Suicide Among Older Adults in Sweden From 2007 to 2020: A...

Older adults represent a high-risk group for suicide and are frequently exposed to central nervous system (CNS) drugs. Yet, the role of CNS drugs in late-life suicide remains unclear.

We conducted a nationwide register-based matched case-control study (1:30) including all individuals aged 65 years and older who died by suicide in Sweden between 2007 and 2020. Each case was matched to controls from the general population on age and sex, alive at the index date. Use of CNS medications was examined within 1-month, 3-month, and 12-month windows prior to the index date (date of suicide). Conditional logistic regression was used to estimate odds ratios (ORs) with adjustment for sociodemographic factors, number of other classes of medications (proxy for comorbidities), frailty score, self-harm history and major psychiatric diagnoses.

Among 5971 older adults who died by suicide, 71.7% of cases used at least one type of CNS drug (vs. 35.2% of controls), while 34.7% of cases had dispensations for three or more CNS drug types (vs. 7.3% of controls) within one year before death by suicide. The most common drug classes among cases were hypnotics and sedatives (46.5%) and antidepressants (38.8%). About one third of cases used anxiolytics (32.3%) or minor analgesics and antipyretics (29.9%). Compared with controls, individuals who died by suicide more often used hypnotics and sedatives (adjusted OR 3.54, 95% CI 3.32-3.77), anxiolytics (aOR 3.27, 95% CI 3.04-3.52), antidepressants (aOR 2.50, 95% CI 2.33-2.68), and opioids (aOR 1.93, 95% CI 1.79-2.09) within 12 months before suicide. Patterns were consistent across time windows.

CNS medications are commonly dispensed before suicide in older adults, particularly hypnotics and sedatives, antidepressants, anxiolytics, and opioids. These findings describe medication use patterns preceding suicide and identify drug classes for further investigation.