Exposure of benzodiazepines and the risk of suicide/self-harm in general population and patients with psychiatric diseases : a systematic review and meta-analysis

Abstract

Benzodiazepine (BZD) that increased the effect of gamma amino butyric acid (GABA) had a wide range of indications. Hence it had been widely used in general population and psychiatric patients. In Hong Kong, around 1% of population had been prescribed with benzodiazepines. Suicidal victims had increase concentration of GABA in their central nervous system. However, lack of meta-analysis addressed the association. This systematic review with meta-analysis had summarized the result from 27 clinical studies with 1,333,027 BZD users that included patients with psychiatric disorder. It showed that BZD was associated with suicide and self-harm in general population with pooled odd ratio (OR) 2.67 [95% confidence interval (CI): 1.71-4.17] and psychiatric patients with pooled OR: 2.46 (95% CI: 1,95-3.11). When separating suicide and selfharm as individual endpoints, BZDs could show significant associations with either general population or psychiatric patiemnts. After adjustment of age, sex, psychiatric illness or previous suicidal attempts and hospitalizations, BZD was still significantly associated with suicide and self-harm general population (pooled all adjusted OR: 2.51, 95% CI: 1.60-3.93) and psychiatric patients (pooled all adjusted OR: 2.33, 95% CI: 1.87-2.91). The heterogeneity of different study outcomes is high hence application of the outcome needs to be cautious.