Article Text

Publication trends in newspapers and scientific journals for SSRIs and suicidality: a systematic longitudinal study
  1. J F Hernandez1,
  2. A K Mantel-Teeuwisse1,
  3. G J M W van Thiel2,
  4. S V Belitser1,
  5. J A M Raaijmakers1,3,
  6. T Pieters1,4
  1. 1Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
  2. 2Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
  3. 3External Scientific Collaborations Europe, GlaxoSmithKline, Zeist, the Netherlands
  4. 4EMGO, VU Medical Centre, Amsterdam, the Netherlands
  1. Correspondence to Professor Dr T Pieters; t.pieters{at}


Background In the period 2003–2008, the regulatory authorities issued several warnings restricting the use of selective serotonin re-uptake inhibitors (SSRIs) in paediatrics, in reaction to safety concerns regarding the risk of suicidality. In this study, the SSRIs and suicidality controversy serves as a template to analyse the long-term publication trends regarding the benefit/risk profile of medications. The aim is to ascertain differences (in terms of numbers, categories and timing) between negative and positive newspaper and journal articles on SSRIs and suicidality and to ascertain correlations between changes in the reports and regulatory warnings.

Methods A systematic review of scientific articles (Embase) and the Netherlands (NL) and the UK newspapers (LexisNexis) was performed between 2000 and 2010. Categorisation was done by ‘effect’ (related treatment effect), ‘type of article’ and ‘age group’. The articles' positive-to-negative effect ratio was determined. Differences in distribution of effect categories were analysed across sources, type of article and age group using the Mann–Whitney (two subgroups) or Kruskal–Wallis test (three or more).

Findings In total, 1141 articles were categorised: 352 scientific, 224 Dutch and 565 British newspaper articles. Scientific articles were predominantly on research and were positive, whereas newspaper articles were negative (ratios=3.50—scientific, 0.69—NL and 0.94—UK; p<0.001). Articles on paediatrics were less positive in scientific journals and more negative in newspapers (ratios=2.29—scientific, 0.26—NL and 0.20—UK; p<0.001), while articles on adults were positive overall (ratios=10.0—scientific, 1.06—NL and 1.70—UK; p<0.001). In addition, negative-effect reporting trends were exacerbated following regulatory warnings and were generally opinion articles, both in scientific journals and in newspapers (2003/2004 and after 2007).

Interpretation The authors found a positive publication tendency inherent in journal research articles. This apparent positive publication bias present in scientific journals, however, does not seem to prevent the dissemination of ‘bad’ news about medications. The negative tendency present in Dutch and British newspapers was perceivable in the paediatrics group and during the warnings, indicating that national news media have informed the public about this international drug safety controversy on time.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Hernandez JF, Mantel-Teeuwisse AK, van Thiel GJMW, et al. Publication trends in newspapers and scientific journals for SSRIs and suicidality: a systematic longitudinal study. BMJ Open 2011;1:e000290. doi:10.1136/bmjopen-2011-000290

  • Competing interests JAMR is part-time professor at the Utrecht University and vice president external scientific collaborations for GlaxoSmithKline (GSK) in Europe and holds stock in GSK. All other authors declare no personal conflict of interest relevant to the subject matter or materials discussed in the manuscript. This study was performed in the context of the Escher project (T6-202), a project of the Dutch Top Institute Pharma. The Division of Pharmacoepidemiology and Clinical Pharmacology, employing authors JFH, AKM-T, SVB, JAMR and TP, has received unrestricted funding for pharmacoepidemiological research from GSK, the private- and public-funded Top Institute Pharma (, includes co-funding from universities, government and industry), the Dutch Medicines Evaluation Board and the Dutch Ministry of Health.

  • Contributors All authors were involved in the design of the study, review of earlier versions of the manuscript and providing final approval for submission. JFH was responsible for the collection, analysis (also statistical) and interpretation of the data, as well as drafting and revising the manuscript. TP was responsible for the analysis and interpretation of the data, drafting supervision and revision. SVB provided support with the statistical analyses, as well.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data deposited at Dryad: doi:10.5061/dryad.gm2534t7.