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Comparative risk of self-harm hospitalization amongst depressive disorder patients using different antidepressants: a population-based cohort study in Taiwan

  • C.-S. Wu (a1) (a2), S.-C. Liao (a1), Y.-T. Tsai (a3), S.-S. Chang (a4) and H.-J. Tsai (a3) (a5) (a6)...



The aim of the study was to evaluate the comparative risk of self-harm associated with the use of different antidepressants.


A cohort study was conducted using data from Taiwan's National Health Insurance Research Database from 2001 to 2012. A total of 751 606 new antidepressant users with depressive disorders were included. The study outcome was hospitalization due to self-harm (International Classification of Diseases, Ninth Revision, Clinical Modification codes: E950–E958 and E980–E988). Cox proportional hazards models with stratification of the propensity score deciles were used to estimate the hazard ratios of self-harm hospitalization during the first year following the initiation of antidepressant treatment.


There were 1038 hospitalization episodes due to self-harm that occurred during the follow-up of 149 796 person-years, with an overall incidence rate of 6.9 [95% confidence interval (CI) 6.5–7.4] per 1000. Compared with fluoxetine, the risk of self-harm hospitalization was higher for maprotiline [adjusted hazard ratio (aHR) = 3.00, 95% CI 1.40–6.45], milnacipran (aHR = 2.34, 95% CI 1.24–4.43) and mirtazapine (aHR = 1.40, 95% CI 1.06–1.86), lower for bupropion (aHR = 0.51, 95% CI 0.30–0.86), and similar level of risk was found for other selective serotonin reuptake inhibitors (citalopram, escitalopram, fluvoxamine, paroxetine and sertraline).


The risk of self-harm may vary across different antidepressant drugs. It would be of importance to conduct further research to investigate the influence of antidepressant use on self-harm behaviors.


Corresponding author

*Addresses for correspondence: H.-J. Tsai, Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan; S.-S. Chang, Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Room 623, No.17, Xu-Zhou Road, Zhongzheng Dist., Taipei City 10055, Taiwan. (Email: and [H.-J.T] (Email: [S.-S.C.]


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