{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T02:55:19Z","timestamp":1785207319633,"version":"3.55.0"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"<jats:sec id=\"ab-yoi220063-4\"><jats:title>Importance<\/jats:title><jats:p>Suicide is a leading cause of death in the United States, having increased more than 30% from 2000 to 2018. An inexpensive, safe, widely available treatment for preventing suicidal behavior could reverse this trend.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220063-5\"><jats:title>Objective<\/jats:title><jats:p>To confirm a previous signal for decreased risk of suicide attempt following prescription fills for folic acid in a national pharmacoepidemiologic study of patients treated with folic acid.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220063-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A within-person exposure-only cohort design was used to study the dynamic association between folic acid (vitamin B<jats:sub>9<\/jats:sub>) prescription fills over a 24-month period and suicide attempts and intentional self-harm. Data were collected from a pharmacoepidemiologic database of US medical claims (MarketScan) for patients with private health insurance who filled a folic acid prescription between 2012 and 2017. The same analysis was repeated with a control supplement (cyanocobalamin, vitamin B<jats:sub>12<\/jats:sub>). Data were analyzed from August 2021 to June 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220063-7\"><jats:title>Exposure<\/jats:title><jats:p>Folic acid prescription fills.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220063-8\"><jats:title>Main Outcome and Measure<\/jats:title><jats:p>Suicide attempt or intentional self-harm resulting in an outpatient visit or inpatient admission as identified by codes from the <jats:italic>International Statistical Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220063-9\"><jats:title>Results<\/jats:title><jats:p>Data on 866\u202f586 patients were collected; 704\u202f514 (81.30%) were female, and 90\u202f296 (10.42%) were 60 years and older. Overall, there were 261 suicidal events during months covered by a folic acid prescription (5\u202f521\u202f597 person-months) for a rate of 4.73 per 100\u202f000 person-months, compared with 895 suicidal events during months without folic acid (8\u202f432\u202f340) for a rate of 10.61 per 100\u202f000 person-months. Adjusting for age and sex, diagnoses related to suicidal behavior, diagnoses related to folic acid deficiency, folate-reducing medications, history of folate-reducing medications, and history of suicidal events, the hazard ratio (HR) for folic acid for suicide events was 0.56 (95% CI, 0.48-0.65), with similar results for the modal dosage of 1 mg of folic acid per day (HR, 0.57; 95% CI, 0.48-0.69) and women of childbearing age (HR, 0.60; 95% CI, 0.50-0.73). A duration-response analysis (1-mg dosage) revealed a 5% decrease in suicidal events per month of additional treatment (HR, 0.95; 95% CI, 0.93-0.97). The same analysis for the negative control, cyanocobalamin, found no association with suicide attempt (HR, 1.01; 95% CI, 0.80-1.27).<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220063-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This large-scale pharmacoepidemiologic study of folic acid found a beneficial association in terms of lower rates of suicide attempts. The results warrant the conduct of a randomized clinical trial with suicidal ideation and behavior as outcomes of interest. If confirmed, folic acid may be a safe, inexpensive, and widely available treatment for suicidal ideation and behavior.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2022.2990","type":"journal-article","created":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T15:32:39Z","timestamp":1664379159000},"page":"1118","source":"Crossref","is-referenced-by-count":24,"title":["Association Between Folic Acid Prescription Fills and Suicide Attempts and Intentional Self-harm Among Privately Insured US Adults"],"prefix":"10.1001","volume":"79","author":[{"given":"Robert D.","family":"Gibbons","sequence":"first","affiliation":[{"name":"University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwan","family":"Hur","sequence":"additional","affiliation":[{"name":"University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill E.","family":"Lavigne","sequence":"additional","affiliation":[{"name":"Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, New York"},{"name":"Wegmans School of Pharmacy, St John Fisher College, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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