PMID-39844933 — Bezin: Suicide/Attempt in GLP-1 RA Users (Nationwide Case-Time-Control)

[DRAFT — authored 2026-04-19. Citation web-verified 2026-04-19 against PubMed.]

Citation

Bezin J, Bénard-Laribière A, Hucteau E, Tournier M, Montastruc F, Pariente A, Faillie JL. Suicide and suicide attempt in users of GLP-1 receptor agonists: a nationwide case-time-control study. EClinicalMedicine. 2024;80:103029. doi: 10.1016/j.eclinm.2024.103029. PMID: 39844933.

External URL: DOI resolver

Study Design

Design: Nationwide case-time-control study
Data source: French National Health Data System
Eligibility: Adults ≥18 years who died by suicide or were hospitalized for suicide attempt between 2013 and 2021, with ≥1 GLP-1 RA dispensing within the preceding 180 days
Methodology: Case-time-control design — compared GLP-1 RA exposure in the 30 days preceding the outcome event to three earlier 30-day reference periods in the same individual
n: 1,102 cases + 5,494 matched controls

Population Characteristics

Mean case age: 57.4 years
44.6% male
67.6% with a recent psychiatric history (key for interpretation)
51.3% with obesity

Key Findings

Primary result: GLP-1 RA use was not associated with an increased risk of suicide or suicide attempt
- OR 0.62 (95% CI 0.51-0.75) — directionally suggests reduced risk, though case-time-control methodology must be interpreted carefully for absolute interpretation
Consistency across subgroups:
- Results held regardless of psychiatric history
- Results held regardless of obesity status
Active-comparator sensitivity: DPP-4 inhibitors (used as control class) showed similar findings — supports that the finding is not artifactual to the GLP-1 RA class specifically but may reflect methodological features of case-time-control designs in this population

Author Conclusion

"This study provides reassurance about the short-term psychiatric safety of GLP-1 RA."

Clinical Relevance

Bezin 2024 is a large nationwide analysis with rigorous self-controlled design that aligns with the triangulation of evidence supporting no causal signal between GLP-1 RA use and suicidality:

Complements the Bushi 2025 meta-analysis (PMID-39945396 – Suicidal Ideation GLP1 Meta-Analysis) — Bushi pooled observational studies for a null finding (RR 0.568); Bezin adds a distinct methodological lens with a large self-controlled case-time-control design
Complements the FDA January 2024 null finding (REG-FDA-Suicidal-Ideation-Review-2024 – FDA GLP1 Suicidal Ideation Null Finding) and subsequent 2025 FDA action removing warning labels
Complements the Sa 2026 psychiatric SR (PMID-41126551 – Psychiatric Effects GLP1 Systematic Review) — broader psychiatric-effects synthesis including depression and substance-use disorders
Teaching anchor: Three methodologically-distinct analyses (meta-analysis of cohort studies, nationwide self-controlled case-time-control, pharmacovigilance + RCT integrated review) all arrive at no-causal-signal — a robust triangulation for clinician counseling

Limitations

Case-time-control methodology detects only short-term (30-day) associations; cannot address long-term risk
French-only data; generalizability to other national contexts requires care
Reliance on claims/dispensing records may under-capture adherence vs possession
Self-controlled designs can be sensitive to time-varying confounders
67.6% of cases had pre-existing psychiatric history — appropriate baseline counseling for similar patients remains important

Evidence Level

Level II (Oxford CEBM for nationwide observational with self-controlled design).

Linked Peptides

Related Studies

PMID-39945396 – Suicidal Ideation GLP1 Meta-Analysis — Bushi 2025 meta-analysis
PMID-41126551 – Psychiatric Effects GLP1 Systematic Review — Sa 2026 broader psychiatric effects SR
REG-FDA-Suicidal-Ideation-Review-2024 – FDA GLP1 Suicidal Ideation Null Finding — FDA null finding + 2025 label-removal action

Orchestrator Notes

Citation web-verified 2026-04-19 via PubMed.
Fourth anchor in the Lesson 5.2 mental-health triangulation: FDA regulatory null + Bushi meta + Sa SR + Bezin nationwide case-time-control. Each uses a different methodology; convergence is meaningful.
Integration note: added as additional triangulation, NOT citation dump. Frame as "and a 2024 nationwide French case-time-control study (Bezin et al.) reached the same null conclusion using a distinct methodology."

PMID-39844933 – Bezin GLP1 Suicide Attempt Case-Time-Control eClinicalMedicine