The Association of Zolpidem and Suicidality in Psychiatric Outpatients With Insomnia

Zolpidem is widely prescribed to psychiatric outpatients for the management of insomnia due to its rapid and potent efficacy. However, concerns persist regarding its potential association with suicidal tendencies. While studies have suggested that Z-drugs may influence suicidal behavior in the general population, the specific association of Z-drug use and suicide risk in psychiatric outpatients with insomnia remains unclear. This study aims to investigate the association of zolpidem use and suicidal tendencies in this population. This retrospective study analyzed the medical records of psychiatric outpatients who visited a mental health clinic between January 2018 and December 2022. Of the 6,193 patients assessed, 3,128 (average age: 49.4 years; 36.6% male) reported insomnia, and 364 (11.6%) were prescribed zolpidem. Suicidal tendencies including past suicide attempts, current suicidal ideation, and plans were evaluated in relation to zolpidem use. Psychiatric outpatients with insomnia who used zolpidem demonstrated significantly higher rates of suicidal tendencies (χ2=3.97, p=0.046) and suicide attempts (χ2=8.12, p=0.004, 23.6% in zolpidem users) compared to non-users. Logistic regression analysis revealed that zolpidem use was significantly associated with increased suicidal tendencies (β=0.314, standard error=0.137, odds ratio= 1.368, 95% confidence interval CI 1.05-1.79, p=0.022), suicidal ideation (β=0.326, standard error=0.138, odds ratio=1.386, 95% CI 1.06-1.82, p=0.018), and suicide attempts (β=0.379, standard error=0.157, odds ratio=1.460, 95% CI 1.07-1.98, p=0.016), even after adjusting for relevant clinical factors. This study highlights a significant association of zolpidem use and elevated suicidal tendencies among psychiatric outpatients with insomnia. Although a causal relationship cannot be definitively established, these findings highlight the critical importance of thorough suicide risk assessment and ongoing monitoring in patients prescribed zolpidem.