An Overview of Psychotropic Pharmacotherapy at Time of Death by Suicide: An Australian-wide Case Series Study Using Administrative and Coronial Data

Background: Psychotropic medicine is an integral component of suicide prevention by way of treatment for mental health conditions. An overview of the medicines used in people who die from suicide gives us an indication of the mental health conditions that are being pharmacologically treated, and not treated, at time of death.

Objectives: To provide an overview of the psychotropic medicines used at the time of death from suicide, using both dispensing data and forensic toxicological data.

Methods: This was a population-based case series study of all suicide deaths in Australia (2013-2019). To rule out medicine utilisation confounded by means of suicide (i.e. overdose), only cases where medicines were not considered by the coroner as a contributor to death were included. National coronial data, including all drugs detected during forensic examination, were linked with prior medicine dispensing data from the Australian Pharmaceutical Benefits Scheme (PBS). Medicines whose derived estimated period of exposure (EPE) overlapped with the date of death were examined and categorised. We calculated the number and proportion of suicide deaths with and without any current pharmacological treatment, overall and by medicine type. In addition, we determined the most common medicine combinations used in the sample.

Results: The sample comprised 12247 suicide decedents. Almost half of the sample (45.8%, n=5612) were not dispensed any medicines (either psychotropic or non-psychotropic) whose EPE overlapped with the date of death, however 14.3% (n = 800) of those did have an antidepressant, anxiolytic or antipsychotic detected at autopsy. Nervous system medicines were the most common dispensed in the sample (42.6%, n=5220) with antidepressants the most common class dispensed to 31.2% (n=3824) of the sample, followed by anxiolytics (11.4%, n=1401), antipsychotics (10.9%, n=1341) and opioids (8.7%, n=1060). Around 1/5 of the sample were on more than one psychotropic medicine, the most commonly prescribed combination was antidepressants and anxiolytics.

Conclusions: The medicine use detected in our study has shed some light on the pharmacological treatment of mental health conditions at time of death from suicide, and there are significant advantages of using both dispensing and coronial data to get a deeper understanding. While nervous system medicines were the most common, they are only used in a little over half of the sample. These results are not consistent with the treatment profile we would expect given psychological autopsy studies conducted in high income countries have estimated between 81 — 98% of suicide decedents have a mental illness at time of death.