IN THE NEWS
Melatonin was found to decrease the risk of self-harm,
particularly in female adolescents with depression or anxiety.
Leone M, Kuja-Halkola R, Lagerberg T, et al. Melatonin use and the risk of self-harm and unintentional injuries in youths with and without psychiatric disorders [published online ahead of print, 2023 Mar 23]. J Child Psychol Psychiatry. 2023;10.1111/jcpp.13785. doi:10.1111/jcpp.13785
Overview
A population-based cohort study including 25,575 children and adolescents (ages 6-18) was completed in Sweden to examine the risks of self-harm and unintentional injuries before and after melatonin treatment. The findings of this study suggests that melatonin use is associated with a decreased risk of intentional self-harm, particularly among females diagnosed with depression and anxiety.
Our comments/takeaway from the article
For clinicians working with the pediatric population, this study sheds light on the importance of correcting sleep disturbances and disorders, not only for its many health benefits but also to aid in reducing self-harm and injury in this vulnerable population.
Article summary
A population-based cohort study including 25,575 children and adolescents (ages 6-18) was completed in Sweden to examine the risks of self-harm and unintentional injuries before and after melatonin treatment. The authors hypothesized that the risk for self-harm would be decreased with melatonin therapy, since a connection between sleep disturbances/disorders and self-harm in youth has been established.
During the time frame that this study was conducted, melatonin was only available as a prescription in Sweden, making this data easy to capture and monitor. (In 2020 melatonin became available as a supplement.) Participants were followed from 1 year proceeding melatonin treatment to one-year post-treatment, with the mean length of use of 6.4 months. Of note, melatonin treatment initiation was highest in the month of November and lowest in July and August.
It was noted that 87.2% of melatonin users had at least one psychiatric disorder, with ADHD being the most prevalent (50%). Additionally, females displayed a 4-5 times higher prevalence of self-harm than males, with poisoning being the most common form (57.7%), followed by cutting practices (34.1%).
The authors found that the risk for self-harm was highest in the month preceding melatonin treatment and decreased immediately after treatment was initiated. They explain that several mechanisms may be the reason for this improvement:
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Reduced risk of self-harm by treating the underlying sleep disturbances/concerns
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Melatonin’s role in pain modulation
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Melatonin therapy (being only available as a prescription) could indicate the level of care received by adolescents. (i.e., caregivers increased awareness and monitoring, behavioral interventions, psychotherapy).
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For some individuals diagnosed with depression and/or anxiety, concurrent use for anti-depressants may have influenced the outcomes, as a prior study demonstrated decreased risk of self-harm after administration of anti-depressant therapy.
The findings of this study suggest that melatonin therapy, initiated to address sleep problems, is associated with a decreased risk of intentional self-harm, particularly among females diagnosed with depression and anxiety.
“…improving youth’s sleep hygiene may be an important intervention to reduce
self-harm in this pediatric population.”
Limitations noted by Author(s)
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Injuries and psychiatric disorders diagnosed by primary care were not included in this study, limiting the cases to more severe cases or those specifically seeking treatment.
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It is possible that other hypnotic medications were used by individuals during the “off melatonin” use time period, though the authors note that it is rare to use medications, other than melatonin, in this population, due to the adverse effects of the medications.
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This study did not include adolescents that died by injury prior to melatonin treatment.
Other limitations noted in this review
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The dose of melatonin used was not indicated.
Article review completed by Kim Ross, DCN
Content reviewed by Deanna Minich, PhD
April 3, 2023