@article{ref1,
title="Isotretinoin and risk factors for suicide attempt: a population-based comprehensive case series and nested case-control study using 2010-2014 French Health Insurance Data",
journal="Journal of the European Academy of Dermatology and Venereology",
year="2019",
author="Droitcourt, Catherine and Poizeau, Florence and Kerbrat, Sandrine and Balusson, Frédéric and Drezen, Erwan and Happe, André and Travers, David and Oger, Emmanuel and Dupuy, Alain",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Although the causal role of isotretinoin in suicidal behaviour is controversial, suicide attempts (SA) do occur among patients taking isotretinoin. <br><br>OBJECTIVES: To describe patient profiles and the management of isotretinoin among patients who committed or attempted suicide under treatment. To assess the risk factors for SA under isotretinoin. <br><br>METHODS: We performed a comprehensive case series of suicides and SAs under isotretinoin, and a case-control study, using Nationwide French Health Insurance database. The main analysis compared cases (subjects with a SA during a course of isotretinoin) to controls, individually matched for age, gender and rank of the current course; controls were to be exposed to isotretinoin at the index date (date of SA for the corresponding cases). The patients' psychiatric history at isotretinoin initiation was studied. In a secondary analysis, patients who continued their isotretinoin treatment after their SA were compared to patients who discontinued it. <br><br>RESULTS: In all, 328 018 subjects started a course of isotretinoin between January 1, 2010 and December 31, 2014 and 184 patients were hospitalised for a SA; half of them had a psychiatric history at initiation. In the multivariate analysis, psychiatric history and history of anxiety alone were risk factors for SA (OR, 18.21; CI95%, 9.96-33.30 and 4.78; CI95%, 2.44-9.33 respectively). Among 176 cases of SA with sufficient follow-up, 103 (58.5%) carried on with their treatment after their SA. Treatment initiation by a dermatologist was inversely associated with the continuation of the treatment after a SA (OR, 0.38; CI95%, 0.18-0.80). <br><br>CONCLUSIONS: SAs under isotretinoin are rare events and our results suggest that most of the patients concerned have a risk-prone profile detectable at the time of treatment initiation. The risk-benefit ratio of continuing isotretinoin after a SA warrants further careful evaluation.<br><br>© 2019 European Academy of Dermatology and Venereology.<p /> <p>Language: en</p>",
language="en",
issn="0926-9959",
doi="10.1111/jdv.16005",
url="http://dx.doi.org/10.1111/jdv.16005"
}