Prescribing folic acid supplementation was associated with reduced suicidal behavior

1. In patients with prescription folic acid, the rate of suicidal behavior was lower in months with prescription compared to months without.

2. Additionally, among patients who received vitamin D12 prescriptions, rates of suicidal behavior did not differ between months with and without a prescription.

Level of evidence assessment: 2 (good)

Suicide is a leading cause of death in the United States (USA), with increasing incidence, especially during the COVID-19 pandemic. Therefore, additional treatment options that may modulate suicidal behavior are needed. Folic acid levels have been associated with depression and suicidality in small case-control studies. Additionally, folic acid supplementation has been shown to increase the treatment of patients with depression. However, whether folic acid supplementation alone can modulate suicidal behavior has not been well characterized.

This study was an intra-individual exposure-only cohort study design using insurance claims data from 866,586 adult patients (81.3% female) in the United States. Patients aged 18 or older with private health insurance were included in the study. Exposure was folic acid supplementation measured by folic acid prescription. The negative control group consisted of patients exposed to cyanocobalamin (vitamin B12). The primary outcome was the rate of intentional self-harm captured using diagnostic codes for suicide attempts, depression, anxiety, bipolarity, schizophrenia, sleep disturbance, and pain.

The results of the study demonstrated that there were fewer suicidal events during the months covered by the folic acid prescription compared to the months without (4.73 versus 10.61 per 100,000 person-months). In contrast, there was no difference in the rate of suicidal events between months with vitamin B12 prescription and months without. However, this study was limited because it found that many patients who were prescribed folic acid had a pain disorder or were taking folate-lowering agents, which limits the generalizability of these findings. Nonetheless, these results warrant further investigation of the possible mechanisms of action underlying the association between folic acid and suicidal behavior, as well as randomized control studies to test whether the association is due to a relationship. causal.

Click to read the study in JAMA Psychiatry

Picture: PD

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