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Fusaroli M, Pelletti G, Giunchi V, Pugliese C, Bartolucci M, Necibi EN, Raschi E, De Ponti F, Pelotti S, Poluzzi E. Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System. Drug Saf 2023; 46:283-295. [PMID: 36689131 PMCID: PMC9869307 DOI: 10.1007/s40264-022-01269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Deliberate self-poisoning (DSP) using drugs is the preferred method of suicide at a global level. Its investigation is hampered by limited sample sizes and data reliability. We investigate the role of the US FDA Adverse Event Reporting System (FAERS), a consolidated pharmacovigilance database, in outlining DSP habits and toxidromes. METHODS We retrieved cases of 'intentional overdose' and 'poisoning deliberate' from the FAERS (January 2004-December 2021). Using descriptive and disproportionality analyses, we estimated temporal trends, potential risk factors, toxidromes, case-fatality rates and lethal doses (LDs) for the most frequently reported drugs. RESULTS We retrieved 42,103 DSP cases (17% fatal). Most cases were submitted in winter. Reports of DSP involved younger people, psychiatric conditions, and alcohol use, compared with non-DSP, and fatality was higher in men and older patients. Suspected drugs were mainly antidepressants, analgesics, and antipsychotics. Multiple drug intake was recorded in more than 50% of the reports, especially analgesics, psychotropics, and cardiovascular agents. The most frequently reported drugs were paracetamol, promethazine, amlodipine, quetiapine, and metformin. We estimated LD25 for paracetamol (150 g). CONCLUSION Worldwide coverage of the FAERS complements existing knowledge about DSP and may drive tailored prevention measures to timely address the DSP phenomenon and prevent intentional suicides.
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Affiliation(s)
- Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Guido Pelletti
- Legal Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Valentina Giunchi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Chiara Pugliese
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mattia Bartolucci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Elena Narmine Necibi
- School of Emergency Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Susi Pelotti
- Legal Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Kouli M, Al Houri HN, Jomaa S, Issa A, Arrouk DMN, Alhouri A, Almhanni G, Alhouri AN, Wardeh R, Kouli M. Epidemiology of poisoning in Syria (1999 through 2020). Clin Toxicol (Phila) 2023; 61:116-122. [PMID: 36524826 DOI: 10.1080/15563650.2022.2156882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Acute poisoning is a significant international public health issue and one of the leading causes of death in the emergency department (ED). In the absence of any previous reports describing the poisoning profile in Syria, we present this study to assess the epidemiological and clinical characteristics of poisoning over 21 years. METHODS We collected the data retrospectively from the Syrian Poisons Information Centre (SPIC) from January 1999 until December 2020. The data included patients who had accidental or non-accidental exposure to poisons, either by drugs, medicaments, and biological substances or substances chiefly nonmedicinal sources such as soaps and detergents, corrosive substances, pesticides, and other miscellaneous products. RESULTS We collected the data of 120,972 poisoned patients, of whom 52.6% were females, and 47.4% were males. Aleppo governorate reported the highest number of poisoned cases (28.6%), followed by Damascus governorate (19.9%). The highest poisoning rates were recorded in 2020, 2014, and 2010. Pharmaceutical (37.0%) and animal (33.8%) sources were the most common causative agents. The oral route was the route of poisoning in 58.3% of patients, and 33.4% through the skin. The most common poison was scorpion stings 19.5% while the most common cause of death was organophosphates 15.7%. DISCUSSION The differences in socioeconomic status, cultural habits, and agricultural and industrial activities between countries have led to a state of fluctuation regarding the most common poisoning agents. CONCLUSION Damascus and Aleppo, the two major governorates in Syria, had the highest poisoning cases. Oral administration of pharmaceutical agents was responsible for most of the poisoning cases. The most common individual poison was the scorpion poison, while the top killer was organophosphates.
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Affiliation(s)
- Moudar Kouli
- Doctor of Medicine M.D, Syrian Arab Republic Ministry of Health, Damascus, Syria
| | - Hasan Nabil Al Houri
- Internal Medicine Department, Damascus University, Al Assad University Hospital and Al Mouwasat University Hospital, Damascus, Syria
- Internal Medicine Department, Al-Sham Private University, Damascus, Syria
| | - Sami Jomaa
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Abdulmoez Issa
- Department of Radiology, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Abdullah Alhouri
- Division of Gastroenterology, Department of Medicine, Royal Berkshire Hospital, Reading, United Kingdom
| | - Ghaith Almhanni
- Department of Radiology, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Rahaf Wardeh
- Department of pediatrics, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Maher Kouli
- Head of Syrian Poison Information Center, Ministry of Health, Damascus, Syria
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Francis M, Spiller HA, Badeti J, Casavant MJ, Michaels NL, Zhu M, Smith GA. Antidepressant Exposures Associated with Exploratory Behavior Among Young Children Reported to United States Poison Control Centers, 2000-2020. Pharmacoepidemiol Drug Saf 2022; 31:1206-1216. [PMID: 35999648 DOI: 10.1002/pds.5534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/31/2022] [Accepted: 08/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This study investigates characteristics and trends of antidepressant exposures among children <6 years old related to exploratory behavior reported to US poison control centers. METHODS Using data from the National Poison Data System for 2000-2020, population-based annual exposure rates by sex, antidepressant category, serious medical outcome, and health care facility admission were analyzed and odds ratios to assess associations of exposure type and antidepressant category with medical outcome and admission were calculated. RESULTS There were 215,909 first-ranked unintentional exploratory exposures involving antidepressants among children <6 years old during the study period, averaging 10,281 annually. Most cases were <3 years old (77.8%), involved a single substance (86.9%), and did not receive treatment at a health care facility (57.6%); however, 7.9% were admitted and 3.4% had serious medical outcomes, including 13 deaths. SSRIs were involved in 56.9% of all cases. Compared with SSRIs, bupropion (OR: 5.22, 95% CI: 4.68 - 5.82), TCAs (OR: 3.74, 95% CI: 3.44 - 4.07), SNRIs (OR: 2.39, 95% CI: 2.11 - 2.71), and lithium salts (OR: 2.00, 95% CI: 1.63 - 2.46) were more likely to be associated with a serious medical outcome. TCAs were the first-ranked substance in 7 of the 13 deaths. CONCLUSIONS Although most unintentional antidepressant exposures related to pediatric exploratory behavior were inconsequential, an important minority of cases required admission to a HCF or had a serious medical outcome, including 13 deaths. Therefore, increased efforts to prevent these exposures among young children are needed, including public education and improved medication packaging. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matilda Francis
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH.,Eastern Virginia Medical School, Norfolk, VA
| | - Henry A Spiller
- The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH.,Central Ohio Poison Center at Nationwide Children's Hospital, Columbus, OH
| | - Jaahnavi Badeti
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH
| | - Marcel J Casavant
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH.,The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH.,Central Ohio Poison Center at Nationwide Children's Hospital, Columbus, OH
| | - Nichole L Michaels
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH.,The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH
| | - Motao Zhu
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH.,The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH
| | - Gary A Smith
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH.,The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH.,Child Injury Prevention Alliance, Columbus, OH
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Francis M, Spiller HA, Badeti J, Funk AR, Casavant MJ, Michaels NL, Zhu M, Smith GA. Suspected suicides and nonfatal suicide attempts involving antidepressants reported to United States poison control centers, 2000-2020. Clin Toxicol (Phila) 2022; 60:818-826. [PMID: 35188444 DOI: 10.1080/15563650.2022.2041202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
CONTEXT/OBJECTIVE This study investigates characteristics of suspected suicides and nonfatal suicide attempts involving antidepressants among individuals 13 years and older reported to US poison control centers from 2000-2020. METHODS Data from the National Poison Data System were retrospectively analyzed. RESULTS/DISCUSSION There were 744,853 suspected suicides and nonfatal suicide attempts among individuals 13 years and older involving antidepressants as the first-ranked substance during the study period. Teenagers accounted for 28.6% of cases and females represented 68.7% of cases. From 2000-2019, the rate of calls received by US poison control centers for suspected suicides and nonfatal suicide attempts involving antidepressants per 100,000 US population 13 years and older increased from 17.4 to 28.4 (p < 0.0001); however, teenagers experienced the largest increase in rate from 30.4 in 2000 to 83.3 in 2019, with a rapid rate increase beginning in 2011. Individuals 60 years and older were more likely to be admitted to a health care facility than teenagers (OR: 2.18, 95% CI: 2.12-2.25). A serious medical outcome was documented in 36.3% of cases, with death occurring in 0.2% of cases. A serious medical outcome was more than twice as likely (OR: 2.57, 95% CI: 2.51-2.64) and death was 16 times more likely (OR: 16.19, 95% CI: 13.29-19.73) to occur among individuals 60 years or older than teenagers. SSRIs were most often involved (41.0%) in cases; however, TCAs had the largest proportion of serious medical outcomes (59.8%). TCAs were more likely to result in a serious medical outcome (OR: 4.36, 95% CI: 4.29-4.43) or death (OR: 12.56, 95% CI: 10.91-14.46) than SSRIs. CONCLUSIONS The increase in the rate of suspected suicides and nonfatal suicide attempts involving antidepressants reported to US poison control centers, particularly among teenagers, emphasizes the need for increased prevention efforts. The greater severity of medical outcomes among older adults also warrants attention.
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Affiliation(s)
- Matilda Francis
- Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH, USA.,Eastern Virginia Medical School, Norfolk, VA, USA
| | - Henry A Spiller
- Nationwide Children's Hospital, Central Ohio Poison Center, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jaahnavi Badeti
- Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH, USA
| | - Alexandra R Funk
- Nationwide Children's Hospital, Central Ohio Poison Center, Columbus, OH, USA.,Tampa General Hospital, Florida Poison Information Center, Tampa, FL, United States
| | - Marcel J Casavant
- Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH, USA.,Nationwide Children's Hospital, Central Ohio Poison Center, Columbus, OH, USA
| | - Nichole L Michaels
- Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Motao Zhu
- Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gary A Smith
- Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Prabhakar Abhilash K, Murugan S, S. Rabbi NA, Pradeeptha S, Kumar S, Selvaraj B, Gunasekaran K. Deliberate self-poisoning and harm: A meticulous quest of methods in vogue. J Family Med Prim Care 2022; 11:233-239. [PMID: 35309643 PMCID: PMC8930158 DOI: 10.4103/jfmpc.jfmpc_1184_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/20/2021] [Accepted: 10/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Deliberate self-poisoning and harm (DSPH) is an unabating problem with a wide variation in the methods used across the world. Hence, this study was conducted to understand the current spectrum of methods used for DSPH by patients in our geographic locality and catchment area with special emphasis on newer compounds and drugs used. Methods: This retrospective study included patients presenting with DSPH to the emergency department (ED) between January 2017 and December 2018. Results: This study included 1802 patients, with a mean age of 32 ± 12.7 years. Of the patients, 85% were in the young to middle age group (16–45 years). Agrochemicals (n = 604, 33.5%), drugs (n = 498, 27.6%), plant toxins (n = 150, 8.3%) and rodenticides (n = 145, 8%) were the predominantly used compounds. The major emergency resuscitation procedures required in the ED were intubation (n = 321, 18%), vasopressor support (n = 73, 4%) and cardiopulmonary resuscitation (n = 27, 1.4%). A quarter (23.2%) was discharged stable from the ED, whereas a further 56.5% were discharged stable after hospital admission. The in-hospital mortality rate was 3% (n = 47). Multivariate logistic regression analysis showed rodenticides (odds ratio (OR): 22.32; 95% confidence interval (CI): 8.05–61.88; P = 0.005) and plant poisons (OR: 23.92; 95% CI: 8.95–63.94; P = 0.005) to be the independent predictors of mortality. Conclusion: DSPH is prevalent in the highly productive young age group. Agrochemical ingestion and drug overdose are the most common methods used, whereas rodenticide and plant poisoning are associated with significant mortality.
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Valipour R, Shekari A, Setareh M, Soltaninejad K. Pattern of Suicide Methods and Postmortem Toxicological Findings in Suicide-Related Deaths: A Retrospective 7-Year Forensic-Based Study in Iran. Am J Forensic Med Pathol 2021; 42:23-29. [PMID: 32868498 DOI: 10.1097/paf.0000000000000607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Suicide is a public health threat that leads to morbidity and mortality worldwide. In this study, we evaluated postmortem toxicological finding among forensic autopsies on suicidal deaths from 2010 to 2016 at the Legal Medicine Center of Zanjan Province (northwest of Iran). All suicide fatal cases were investigated to define the cause and manner of death. Toxicological analyses were performed using thin-layer chromatography, high-performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography, and gas chromatography equipped with nitrogen phosphorus detector. Demographic data (age, sex, educational level, residential location, and marital status), cause of death, and postmortem toxicological findings were extracted from forensic reports and were entered into the designed questioners. During this period, a total of 181 cases of suicide deaths were investigated. Among them, 74% were male. The most often used suicide method was hanging, followed by self-poisoning in young people. Aluminum phosphide was the most frequent poison detected in the fatal suicidal cases (33 cases), followed by opioids. Hanging and self-poisoning were the frequent suicidal method in young male population. It seems that psychological and social supports in young people along with restriction to easy access to drugs and poisons should be considered by policy making and healthcare authorities.
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Affiliation(s)
| | | | | | - Kambiz Soltaninejad
- Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Maronezi LFC, Felizari GB, Gomes GA, Fernandes JDF, Riffel RT, Lindemann IL. Prevalência e características das violências e intoxicações exógenas autoprovocadas: um estudo a partir de base de dados sobre notificações. JORNAL BRASILEIRO DE PSIQUIATRIA 2021. [DOI: 10.1590/0047-2085000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo: Descrever os casos autoprovocados de violência e de intoxicação exógena aguda ocorridos no Rio Grande do Sul (RS) entre os anos de 2013 e 2017. Métodos: Estudo transversal incluindo todos os casos notificados no Sistema de Agravos de Notificação (Sinan) entre 2013 e 2017, selecionados por meio das fichas de violência interpessoal/autoprovocada, por meio da variável lesão provocada, e de investigação de intoxicação exógena, pela variável circunstância da exposição/contaminação. A análise compreendeu a estatística descritiva, o cálculo das prevalências por 100.000 habitantes e a estratificação por sexo conforme características sociodemográficas e clínicas. Resultados: No perío-do proposto, foram notificados 18.544 casos autoprovocados de violência e 5.624 de intoxicação exógena, com predomínio de mulheres (67% e 75,3%), entre 30 e 59 anos (46,4% e 49%), brancas (86% e 86%), com ensino fundamental completo/incompleto (58,3% e 47,3%), residentes em zona urbana/periurbana (89,2% e 89,6%) e com episódios ocorridos na própria residência (88,8% e 96,6%). Quanto aos métodos de violência empregados, destacaram-se os envenenamentos/intoxicações (39,7%), enforcamentos (13,8%), agentes perfurocortantes (13,6%) e armas de fogo (2,0%). Verificou-se diferença conforme o sexo nas variáveis sociodemográficas e clínicas referentes a ambos os agravos, bem como um aumento de 169% e 381,1%, respectivamente, nas prevalências de violência e intoxicação entre os anos de 2013 e 2017. Conclusões: Evidenciou-se um expressivo e crescente número de casos no estado, com maiores implicações no gênero feminino, importantes diferenças de acordo com sexo e populações mais acometidas, fomentando a necessidade da implementação de medidas preventivas específicas nos grupos vulneráveis.
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Kline JN, Badolato GM, Goyal MK. Trends in Pediatric Poisoning-Related Emergency Department Visits: 2001-2011. Pediatr Emerg Care 2021; 37:e7-e12. [PMID: 30973499 DOI: 10.1097/pec.0000000000001817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We sought to understand the burden of pediatric poisonings on the health care system by characterizing poisoning-related emergency department (ED) visits among children on a national level. METHODS This was a repeated cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey from 2001 to 2011 of children 21 years or younger who presented to an ED. We measured annual rates of visits, trends over time, and patient and visit characteristics associated with poisoning-related ED visits using multivariable logistic regression. We also compared accidental to intentional poisonings. RESULTS There were an estimated 713,345 ED visits per year for poisoning in children, and intentional poisoning-related visits increased over the study period (P trend < 0.001). Compared with all other ED visits, poisoning-related ED visits were more common among males (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.26-1.64) and uninsured patients (aOR, 1.26; 95% CI, 1.05-1.51). Poisoned children were more likely to arrive by ambulance (aOR, 3.38; 95% CI, 2.85-4.01) and be admitted (aOR, 1.35; 95% CI, 1.12-1.61). Compared with accidental poisonings, intentional poisonings were more common as age increased (aOR, 1.16; 95% CI, 1.13-1.92) and in children of non-Hispanic black race/ethnicity (aOR, 1.81; 95% CI, 1.12-2.93) and more likely to be associated with ambulance arrival (aOR, 1.49; 95% CI, 1.07-2.08) and hospital admission (aOR, 1.76; 95% CI, 1.25-2.48). CONCLUSIONS Poisoning-related ED visits among children have remained stable, with significant increase in intentional ingestions from 2001 to 2011. Poisoned children, and particularly those with intentional poisonings, require more health care resources than children with other health concerns. More study is needed on circumstances leading to pediatric poisonings, so that preventive efforts can be targeted appropriately.
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Affiliation(s)
- Jaclyn N Kline
- From the Division of Emergency Medicine, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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9
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Park JM, Kim MJ. Epidemiologic characteristics of hospitalised patients after suicidal acts from 2005 to 2016 in Korea: Analysis of the Korean National Hospital Discharge Survey. J Affect Disord 2020; 275:238-246. [PMID: 32734914 DOI: 10.1016/j.jad.2020.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/21/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Suicide is a major cause of death in many countries, and previous suicidal attempt is known to be the predictor of future suicide. Korea is considered one of the countries with the highest suicide rate among the Organisation for Economic Co-operation and Development (OECD) members for over a decade. We aimed to investigate the epidemiologic characteristics of hospitalised patients after suicidal acts in Korea. METHODS Data from the Korean National Hospital Discharge In-depth Injury Survey were analysed, and patients older than 9 years admitted to nationwide hospitals after suicidal acts from 2005 to 2016 were included. Their epidemiologic characteristics were explored, and we divided them into groups according to suicidal means (injury vs. poisoning) and treatment outcome (good vs. poor). The association of each characteristic with injury as suicidal means and with poor treatment outcome were explored. RESULTS The sample included 7609 patients (corresponding to 227,571 in national population). More patients were female than male, and most were in their 40s in both sexes. Hospitalisation rate peaked in patients older than 80 years for both sexes. Male and young patients aged 10-19 years and capital residents showed relatively higher odds of choosing injury as suicidal means. Males and patients aged 40-64 and ≥65 years showed relatively higher odds of poor treatment outcome. LIMITATIONS Some suicide attempters were excluded from the survey such as those who did not visit a hospital after the suicide attempt. CONCLUSIONS This epidemiologic feature of suicide attempters might serve as baseline data for preventive policies regarding suicide.
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Affiliation(s)
- Joon Min Park
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do 10380, Republic of Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
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Thapa S, Dawadi BR, Upreti AR. Acute Poisoning among Patients Presenting to the Emergency Department of a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:470-473. [PMID: 32827007 PMCID: PMC7580394 DOI: 10.31729/jnma.4997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Acute poisoning is a major global public health problem contributing to one of the leading causes for a visit to an emergency department. This study aims to analyse the demographic and psychosocial characteristics of patients with acute poisoning presented to the emergency department. Methods: This was a descriptive cross-sectional study conducted in a tertiary care hospital from June to December 2019 after obtaining ethical approval from Institutional review board (reference number. 041-075/0760). A convenient sampling method was applied. Epidemiological factors, types of poison consumed, reason, motive, and place to take poison, time elapse in the presentation to the hospital were studied. Statistical analysis was done using statistical package for the social sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 76 cases of acute poisoning, the organophosphorus poisoning was 18 (23.7%) followed by unknown 12 (15.8). Of total, 28 (36.8%) had quarrel before taking poison and 41 (53.9%) had intention to commit suicide. Sixty-seven (88.2%) took a poison at home. The average elapsed time to the visit of the emergency department was 110±80 minutes Conclusions: The most common poisoning was organophosphorus with a suicide being the most common intention. Quarrel was the most frequent reason to take poison and the home was the most common place to take poison.
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Affiliation(s)
- Sameer Thapa
- Department of Emergency and General Practice, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
| | - Bishwa Raj Dawadi
- Department of Emergency and General Practice, Grande International Hospital, Dhapasi, Kathmandu, Nepal
| | - Anup Raj Upreti
- Clinical Pharmacist, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
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Spiller HA, Ackerman JP, Smith GA, Kistamgari S, Funk AR, McDermott MR, Casavant MJ. Suicide attempts by self-poisoning in the United States among 10-25 year olds from 2000 to 2018: substances used, temporal changes and demographics. Clin Toxicol (Phila) 2019; 58:676-687. [PMID: 31587583 DOI: 10.1080/15563650.2019.1665182] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To evaluate the substances used, outcomes, temporal and demographics associated with suicide attempts by self-poisoning in children and young adults aged 10-25 years old from 2000 to 2018.Methods: This is a retrospective review of suspected-suicide self-poisoning cases reported to the National Poison Data System (NPDS) from US Poison Centers from 2000 to 2018 for patients 10-25 years old. For comparison of annual rates, we obtained population data by year of age from the US Census Bureau. We evaluated changes in: monthly and annual incidence/rate per 100,000 population, substances used and outcome by patient age and demographics.Results: There were 1,677,435 cases of suicide attempt by self-poisoning among individuals 10-25 years old reported to US PCCs from 2000 to 2018. There were 410,940 self-poisoning cases (24.5%) with a serious medical outcome, and the proportion of exposures that resulted in a serious medical outcome increased with increasing age group. For the age groups of 10-12, 13-15 and 16-18 years of age, there was a significant increase after 2011, which was influenced primarily by females. The substance groups with the greatest number of serious medical outcomes were OTC analgesics, antidepressants, antihistamines and antipsychotics. ADHD medications were common in the younger age groups of 10-15 years, while the sedative/hypnotics occurred more commonly in the older age groups. The groups with the greatest increase in serious medical outcomes after 2011 were antidepressants, OTC analgesics, antihistamines and ADHD medications. Opiates were less commonly involved (7.4%) in cases with serious medical outcomes and decreased significantly in the 19-25 year-old age groups after 2012. States with a lower population per square mile had a greater number of reported cases with serious medical outcomes. There was a significant decrease in the number of cases in the age groups of 10-18 years during the traditional non-school months of June-August compared with September-May. This seasonal trend occurred among cases with all outcomes and among cases with serious medical outcomes. This decrease did not occur in the age group of 19-21 years, and there was an increase during summer months in the age group 22-25 years.Conclusions: The substances used during self-poisoning varies by age group but appears to include substances available to that age group, with a significant increase after 2011, increased rates in more rural states, and a seasonal variation of increased rates during school months among adolescents but not among young adults. Two of the top substances, OTC analgesics and antihistamines, in all age groups, comprising more than a third of all substances used, are widely available over-the-counter with no restrictions regarding access. Of additional concern, ADHD medications had the highest risk of a serious medical outcome.
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Affiliation(s)
- Henry A Spiller
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA.,College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John P Ackerman
- College of Medicine, The Ohio State University, Columbus, OH, USA.,Center for Suicide Prevention and Research, Behavioral Health Services, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gary A Smith
- College of Medicine, The Ohio State University, Columbus, OH, USA.,Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Child Injury Prevention Alliance, Columbus, OH, USA
| | - Sandhya Kistamgari
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Alexandra R Funk
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael R McDermott
- Heritage College of Osteopathic Medicine, Ohio University, Columbus, OH, USA
| | - Marcel J Casavant
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA.,College of Medicine, The Ohio State University, Columbus, OH, USA
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12
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Kang AM. Substances Involved in Suicidal Poisonings in the United States. Suicide Life Threat Behav 2019; 49:1307-1317. [PMID: 30430638 DOI: 10.1111/sltb.12525] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study investigated specific substances most commonly involved in suicidal poisonings, causing severe clinical effects, and leading to intensive treatments. METHOD Suicidal poisoning cases for individuals ≥13 years old were obtained from the National Poison Data System for 2011-2015. The most common products involved in single and multiple-product poisonings were identified. Single product cases were used to calculate substances causing the largest numbers of serious clinical effects and leading to intensive treatments. RESULTS More than half of reported cases involved only a single product (54.4%), but this frequency was higher at the extremes of age (66.7% in adolescents 13-19 years old and 70.5% in individuals ≥90 years old) and among pregnant women (65.8%). The top three substances involved in single-product poisonings were over-the-counter (OTC) medications, while alcohol and prescription sedatives were most common in multiple-product poisonings. One OTC medication, diphenhydramine, was a frequent cause of several serious clinical effects and intensive treatments. CONCLUSIONS Single product suicidal poisonings were more frequent with extremes of age and in pregnancy. OTC products were more frequently used in single product attempts. Products causing serious clinical effects can be targeted for suicide prevention efforts as well as education of health care providers.
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Affiliation(s)
- Aaron Min Kang
- Department of Child Health and Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA.,Department of Medical Toxicology, Banner-University Medical Center Phoenix, Phoenix, AZ, USA.,Banner Poison and Drug Information Center, Phoenix, AZ, USA
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13
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Titidezh V, Arefi M, Taghaddosinejad F, Behnoush B, Akbar Pour S, Mahboobi M. Epidemiologic profile of deaths due to drug and chemical poisoning in patients referred to Baharloo Hospital of Tehran, 2011 to 2014. J Forensic Leg Med 2019; 64:31-33. [PMID: 30927562 DOI: 10.1016/j.jflm.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/15/2018] [Accepted: 02/15/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND In developing countries with high mortality rates, poisoning is one of the most common causes of admission to emergency rooms. To minimize future deaths related to poisoning, the epidemiological profile of deceased individuals is essential. METHODS The medical records of all dead patients due to poisoning during 2011-2014 in Baharloo Hospital, Tehran, were evaluated. Exclusion criteria include: incomplete records, unknown causes of death, and persons less than 6 years of age. Data analysis was done by means of SPSS at the significance level of P < 0.05. RESULTS The study included 184 males and 65 females. The mean age range was 37.65 ± 16.78 years. The highest mortality rate was seen in the age range of 21-30 years (30.5%). The most common cause of poisoning was aluminum phosphide (101 cases). The average time of hospitalization was 3.61 days. Most deaths occurred during the first 10 days of admission with intentional poisoning being the most common type (81.5%). CONCLUSION The outcome of this study indicates that the main cause of death among young people is intentional poisoning with AIP. This study proves that a greater focus when diagnosing mental health patients, as well as an increase in restrictions when accessing lethal drugs and toxins, is crucial.
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Affiliation(s)
- Vahid Titidezh
- Department of Forensic Medicine and Toxicology, Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Arefi
- Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Behnam Behnoush
- Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Samaneh Akbar Pour
- Occupational Sleep Research Center (OSRC), Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Marzieh Mahboobi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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14
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Feelings, thoughts and experiences of nurses working in a mental health clinic about individuals with suicidal behaviors and suicide attempts. Collegian 2018. [DOI: 10.1016/j.colegn.2017.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Lu CY, Penfold RB, Toh S, Sturtevant JL, Madden JM, Simon G, Ahmedani BK, Clarke G, Coleman KJ, Copeland LA, Daida YG, Davis RL, Hunkeler EM, Owen-Smith A, Raebel MA, Rossom R, Soumerai SB, Kulldorff M. Near Real-time Surveillance for Consequences of Health Policies Using Sequential Analysis. Med Care 2018; 56:365-372. [PMID: 29634627 PMCID: PMC5896783 DOI: 10.1097/mlr.0000000000000893] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND New health policies may have intended and unintended consequences. Active surveillance of population-level data may provide initial signals of policy effects for further rigorous evaluation soon after policy implementation. OBJECTIVE This study evaluated the utility of sequential analysis for prospectively assessing signals of health policy impacts. As a policy example, we studied the consequences of the widely publicized Food and Drug Administration's warnings cautioning that antidepressant use could increase suicidal risk in youth. METHOD This was a retrospective, longitudinal study, modeling prospective surveillance, using the maximized sequential probability ratio test. We used historical data (2000-2010) from 11 health systems in the US Mental Health Research Network. The study cohort included adolescents (ages 10-17 y) and young adults (ages 18-29 y), who were targeted by the warnings, and adults (ages 30-64 y) as a comparison group. Outcome measures were observed and expected events of 2 possible unintended policy outcomes: psychotropic drug poisonings (as a proxy for suicide attempts) and completed suicides. RESULTS We detected statistically significant (P<0.05) signals of excess risk for suicidal behavior in adolescents and young adults within 5-7 quarters of the warnings. The excess risk in psychotropic drug poisonings was consistent with results from a previous, more rigorous interrupted time series analysis but use of the maximized sequential probability ratio test method allows timely detection. While we also detected signals of increased risk of completed suicide in these younger age groups, on its own it should not be taken as conclusive evidence that the policy caused the signal. A statistical signal indicates the need for further scrutiny using rigorous quasi-experimental studies to investigate the possibility of a cause-and-effect relationship. CONCLUSIONS This was a proof-of-concept study. Prospective, periodic evaluation of administrative health care data using sequential analysis can provide timely population-based signals of effects of health policies. This method may be useful to use as new policies are introduced.
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Affiliation(s)
- Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Robert B Penfold
- Department of Health Services Research, Kaiser Permanente Washington Health Research Institute, University of Washington, Seattle, WA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Jessica L Sturtevant
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Jeanne M Madden
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
- School of Pharmacy, Northeastern University, Boston, MA
| | - Gregory Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health System, Detroit, MI
| | - Gregory Clarke
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Laurel A Copeland
- Center for Applied Health Research, Baylor Scott & White Health jointly with Central Texas Veterans Health Care System, Temple, TX
| | - Yihe G Daida
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI
| | - Robert L Davis
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN
| | - Enid M Hunkeler
- Emeritus, Division of Research, Kaiser Permanente, Oakland, CA
| | - Ashli Owen-Smith
- Health Management & Policy, Georgia State University School of Public Health, Atlanta, GA
- Kaiser Permanente Georgia, The Center for Clinical and Outcomes Research, Atlanta, GA
| | - Marsha A Raebel
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO
| | | | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Martin Kulldorff
- Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
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16
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Pillans PI, Page CB, Ilango S, Kashchuk A, Isbister GK. Self‐poisoning by older Australians: a cohort study. Med J Aust 2017; 206:164-169. [DOI: 10.5694/mja16.00484] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/19/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Peter I Pillans
- Princess Alexandra Hospital, Brisbane, QLD
- University of Queensland, Brisbane, QLD
| | - Colin B Page
- Princess Alexandra Hospital, Brisbane, QLD
- University of Queensland, Brisbane, QLD
| | | | | | - Geoffrey K Isbister
- University of Newcastle, Newcastle, NSW
- Calvary Mater Newcastle, Newcastle, NSW
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17
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Mento C, Presti EL, Mucciardi M, Sinardi A, Liotta M, Settineri S. Serious Suicide Attempts: Evidence on Variables for Manage and Prevent this Phenomenon. Community Ment Health J 2016; 52:582-8. [PMID: 26399518 DOI: 10.1007/s10597-015-9933-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 08/24/2015] [Indexed: 11/25/2022]
Abstract
The aim of this study is to investigate the variables shown to be linked to serious suicide attempts. Cases requiring emergency admission to intensive care were collected from medical records of the University Hospital in Messina (Italy) for the years 2006-2010. 107 cases of serious attempted suicide were examined, 39 of which ended in the death of the patient. The results showed the following variables to be linked highly significantly (P < 0.01) and have good nominal association (V > 0.30) with a fatal suicidal attempt: the year of the attempt, deceased father, history of physical illness prior to hospitalization and method used to carry out the suicide attempt. These results confirm the severity and the multidisciplinary importance of this phenomenon.
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Affiliation(s)
- Carmela Mento
- Department of Neurosciences, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | | | - Massimo Mucciardi
- Department of Economics, Business, Environmental Sciences and Quantitative Methods, Division of Mathematics and Statistics, University of Messina, Messina, Italy
| | - Angelo Sinardi
- Department of Anesthesia and Intensive Care, University of Messina, Messina, Italy
| | | | - Salvatore Settineri
- Department of Humanities and Social Sciences, University of Messina, Messina, Italy
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18
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Reuter Morthorst B, Soegaard B, Nordentoft M, Erlangsen A. Incidence Rates of Deliberate Self-Harm in Denmark 1994-2011. CRISIS 2016; 37:256-264. [PMID: 27278571 PMCID: PMC5137321 DOI: 10.1027/0227-5910/a000391] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND The validity and reliability of suicide statistics have been questioned and few nationwide studies of deliberate self-harm have been presented. AIM To calculate rates of deliberate self-harm in Denmark in order to investigate trends and assess the reliability of hospital records. METHOD A register study based on all individuals recorded with an episode of deliberate self-harm or probable deliberate self-harm in nationwide registers during 1994-2011. RESULTS A substantial difference in the rates of deliberate self-harm and probable deliberate self-harm was noted for both genders. The average incidence rate of deliberate self-harm for women and men was 130.7 (95% CI = 129.6-131.8) per 100,000 and 86.9 (95% CI = 86.0-87.8) per 100,000, respectively. The rates of deliberate self-harm for women increased from 137.6 (95% CI = 132.9-142.3) per 100,000 in 1994 to 152.7 (95% CI = 147.8-157.5) in 2011. For a subgroup of younger women aged 15-24 years, an almost threefold increase was observed, IRR = 2.5 (95% CI = 2.4-2.7). The most frequently used method was self-poisoning. CONCLUSION The rates of deliberate self-harm and probable deliberate self-harm differed significantly. An increased incidence of deliberate self-harm among young Danish women was observed, despite detection bias. An improved registration procedure of suicidal behavior is needed.
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Affiliation(s)
- Britt Reuter Morthorst
- Research Unit, Mental Health Centre Copenhagen,
Capital Region of Denmark, Denmark
- Faculty of Health Sciences, University of
Copenhagen, Capital Region of Denmark, Denmark
| | - Bodil Soegaard
- Department of Psychiatry, Region of Southern
Denmark, Aabenraa, Denmark
| | - Merete Nordentoft
- Research Unit, Mental Health Centre Copenhagen,
Capital Region of Denmark, Denmark
- Faculty of Health Sciences, University of
Copenhagen, Capital Region of Denmark, Denmark
| | - Annette Erlangsen
- Research Unit, Mental Health Centre Copenhagen,
Capital Region of Denmark, Denmark
- Department of Mental Health, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
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19
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Tyrrell EG, Orton E, Tata LJ. Changes in poisonings among adolescents in the UK between 1992 and 2012: a population based cohort study. Inj Prev 2016; 22:400-406. [PMID: 27185793 DOI: 10.1136/injuryprev-2015-041901] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Poisonings are a common cause of morbidity and mortality among adolescents. Yet surveillance data indicating current incidence rates (IRs) and time trends are lacking, making policy development and service planning difficult. We utilised population based primary care data to estimate adolescent poisoning rates according to intent across the UK. METHODS A cohort study of 1 311 021 adolescents aged 10-17 years, between 1992 and 2012, was conducted using routine primary care data from The Health Improvement Network. IRs and adjusted IRRs with 95% CIs were calculated for all poisonings, intentional, unintentional, unknown intent and alcohol related poisonings, by age, sex, calendar time and socioeconomic deprivation. RESULTS Overall poisoning incidence increased by 27% from the period 1992-1996 to 2007-2012, with the largest increases in intentional poisonings among females aged 16-17 years (IR 391.4/100 000 person years (PY), CI 328.9 to 465.7 for age 17 years in 1992-1996; 767.0/100 000 PY, CI 719.5 to 817.7 in 2007-2012) and alcohol related poisonings in females aged 15-16 years (IR 65.7/100 000 PY, CI 43.3 to 99.8 rising to 130.0/100 000 PY, CI 110.0 to 150.0 for age 15 years). A strong socioeconomic gradient for all poisonings persisted over time, with higher rates among the more deprived (IRR 2.63, CI 2.41 to 2.88 for the most vs least deprived quintile in 2007-2012). CONCLUSIONS Adolescent poisonings, especially intentional poisonings, have increased substantially over time and remain associated with health inequalities. Social and psychological support for adolescents should be targeted at more deprived communities, and child and adolescent mental health and alcohol support service provision should be commissioned to reflect the changing need.
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Affiliation(s)
- Edward G Tyrrell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Elizabeth Orton
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Laila J Tata
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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20
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Reydel T, Callahan JC, Verley L, Teiten C, Andreotti C, Claessens YE, Missud D, L'Her E, Le Roux G, Lerolle N. Routine biological tests in self-poisoning patients: results from an observational prospective multicenter study. Am J Emerg Med 2016; 34:1383-8. [PMID: 27117657 DOI: 10.1016/j.ajem.2016.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/21/2016] [Accepted: 04/01/2016] [Indexed: 12/23/2022] Open
Abstract
CONTEXT Routine biological tests are frequently ordered in self-poisoning patients, but their clinical relevance is poorly studied. MATERIALS AND METHODS This is a prospective multicentric observational study conducted in the emergency departments and intensive care units of 5 university and nonuniversity French hospitals. Adult self-poisoning patients without severely altered vital status on admission were prospectively included. RESULTS Routine biological test (serum electrolytes and creatinine, liver enzymes, bilirubin, blood cell count, prothrombin time) ordering and results were analyzed. A total of 1027 patients were enrolled (age, 40.2 ± 14 years; women, 61.5%); no patient died during the hospital stay. Benzodiazepine was suspected in more than 70% of cases; 65% (range, 48%-80%) of patients had at least 1 routine biological test performed. At least 1 abnormal test was registered in 23% of these patients. Three factors were associated with abnormal test results: age older than 40 years, male sex, and poisoning with a drug known to alter routine tests (ie, acetaminophen, NSAIDs, metformine, lithium). Depending on these factors, abnormal results ranged from 14% to 48%. Unexpected severe life-threatening conditions were recorded in 6 patients. Only 3 patients were referred to the intensive care unit solely because of abnormal test results. CONCLUSION Routine biological tests are commonly prescribed in nonsevere self-poisoning patients. Abnormal results are frequent but their relevance at bedside remains limited.
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Affiliation(s)
- Thomas Reydel
- Angers University, Angers, France; Department of Medical Intensive Care and Hyperbaric Medicine, Angers University Hospital, Angers, France
| | | | - Laurent Verley
- Department of Emergency Medicine, Saint Malo Hospital, Saint Malo, France
| | - Christelle Teiten
- Department of Emergency Medicine, Brest University Hospital, Brest, France
| | - Christophe Andreotti
- Department of Emergency Medicine, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yann Erick Claessens
- Department of Emergency Medicine, Centre Hospitalier Princesse Grace, Principauté de, Monaco
| | - David Missud
- Clinical Research Center, Angers University Hospital, Angers, France
| | - Erwan L'Her
- Department of Emergency Medicine, Brest University Hospital, Brest, France
| | - Gael Le Roux
- Poison Center, Angers University Hospital, Angers, France
| | - Nicolas Lerolle
- Angers University, Angers, France; Department of Medical Intensive Care and Hyperbaric Medicine, Angers University Hospital, Angers, France.
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21
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Sorge M, Weidhase L, Bernhard M, Gries A, Petros S. Self-poisoning in the acute care medicine 2005-2012. Anaesthesist 2016; 64:456-62. [PMID: 25951922 DOI: 10.1007/s00101-015-0030-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the trend of acute self-poisoning in the emergency and intensive care. METHODS Electronic charts of adults who presented to the emergency department of the University Hospital Leipzig with self-poisoning following a suicide attempt (suicide group), intoxication (intoxication group), drug overdose for relief of pain or discomfort (drug overdose group) between 2005 and 2012 were analyzed. RESULTS 3533 adults (62.6% males) were identified, with the yearly admissions increasing from 305 in 2005 to 624 in 2012. The admission rate in relation to the total emergency department admissions also increased, from 1.2% in 2005 to 1.9% in 2012. 31.7% of the patients were younger than 25 years. The reasons for self-poisoning were suicide attempt (18.1%), intoxication (76.8%) and drug overdose (2.9%). The reason could not be clearly classified in 80 patients. Psychotropic drugs were used in 71.6% of suicide attempts, while alcohol was the sole cause of intoxication in 80.1% of cases in the intoxication group. Self-poisoning using at least two substances was observed in 52.0% of the suicide attempts, 10.3% of those with intoxication and 29.7% of those with drug overdose. While alcohol remains the most common cause of intoxication, there was a drastic increase in the consumption of cannabinoids, Crystal Meth and gamma-hydroxybutyrate in the years 2011 and 2012. ICU admission was necessary in 16.6% of the cases. There were 22 deaths (0.6% of the study population), of whom 15 were in the suicide group (2.3%), four (0.15%) in the intoxication group, and three in the not clearly classified group (3.8%). CONCLUSION Acute self-poisoning is an increasing medical issue. Psychotropic drugs remain the most common means of suicide attempt. Although alcohol intoxication is very frequent, intake of illicit drugs as the cause of emergency admission is increasing.
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Affiliation(s)
- M Sorge
- Medical Intensive Care Unit, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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22
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Cobaugh DJ, Miller MJ, Pham TT, Krenzelok EP. Risk of major morbidity and death in older adults with suicidal intent: a cross-sectional analysis from the National Poison Data System, 2000-2009. J Am Geriatr Soc 2015; 63:501-7. [PMID: 25735433 DOI: 10.1111/jgs.13323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe suicide-related exposures in older persons according to sex, age, and substance category reported to U.S. poison control centers (PCCs) and report the crude relative risk (RR) of major effects and death from pharmaceuticals and nonpharmaceutical substances after single- and multiple-substance exposures. DESIGN Cross-sectional analysis of American Association of Poison Control Centers National Poison Data System (NPDS) data. SETTING Calls to U.S. PCCs. PARTICIPANTS NPDS cases involving individuals aged 60 and older with an exposure to a pharmaceutical or nonpharmaceutical substance and suicide as the reason (n=46,494). MEASUREMENTS Major effect and death probabilities for single- and multiple-substance exposures to pharmaceuticals and nonpharmaceuticals were determined. In the NPDS, a major effect is defined as symptoms or signs that are life-threatening or resulted in significant residual disability or disfigurement. Crude RRs of major effects or death were estimated for single and multiple pharmaceutical substances in comparison with nonpharmaceutical substances. RESULTS Single-substance exposures occurred in 53.3% of cases. Overall, 92.3% involved pharmaceuticals and 64.4% involved women. In the total sample, 12.7% (5,895/46,494) of exposures resulted in major effect, and 1.9% (884/46,494) resulted in death. The crude RR of major effects in single-substance pharmaceutical exposures was significantly lower than with nonpharmaceutical exposures (RR=0.54, 95% confidence interval (CI)=0.49-0.59), as was death (RR=0.25, 95% CI=0.20-0.30). For multiple-substance exposures, the crude RR of major effects from pharmaceuticals was similar to that for nonpharmaceuticals (RR=0.92, 95% CI=0.80-1.06), whereas the crude RR of death from pharmaceuticals was significantly lower (RR=0.55, 95% CI=0.40-0.77). CONCLUSION These findings can inform suicide prevention strategies that focus on decreasing at-risk older adults' access to dangerous medications and chemicals in the home.
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Affiliation(s)
- Daniel J Cobaugh
- American Society of Health-System Pharmacists Research and Education Foundation, Bethesda, Maryland
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23
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Oliveira FFS, Suchara EA. [Epidemiological profile of exogenous poisoning in children and adolescents from a municipality in the state of Mato Grosso]. REVISTA PAULISTA DE PEDIATRIA 2014; 32:299-305. [PMID: 25510992 PMCID: PMC4311782 DOI: 10.1016/j.rpped.2014.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/01/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE: To study the epidemiology of exogenous intoxications in children and adolescents
of Barra Garças, Mato Grosso, from January 2008 to September 2013. METHOD: This was a cross-sectional, retrospective, and descriptive epidemiological study.
Data were collected from the Disease Notification System (Sistema de Informação de
Agravos de Notificação [SINAN]) of the municipality, processed using Microsoft
Excel, and evaluated through BIOESTAT statistical software. The variables included
were: sex; age; toxic agent; time and place of service; route of administration;
circumstance; and classification of intoxication. The age range was established
according to the Brazilian Institute of Geography and Statistics, comprising
children aged from 0 to 9 years old and adolescents aged from 10 to 19 years old.
RESULTS: A total of 125 cases of accidental exogenous poisoning was registered, including
77 children and 48 adolescents. Food and beverages (38.4%) and drugs (24.0%) were
the most common groups of toxic agents responsible for the poisoning. The largest
age group affected by intoxication was composed of children aged from 0 to 4 years
old (43.2%) and adolescents aged from 10 to 14 years old (19.7%). Regarding the
circumstances, intoxication occurred due to suicide attempts (16.8%) and
accidental events (23.2%) in adolescents and children, respectively. The study
revealed a higher frequency of poisoning in girls. CONCLUSION: Exogenous intoxications occurred predominantly in children up to 4 years old,
through the accidental consumption of food or drinks. Thus, the adoption of
educational prevention programs for children's family members and caregivers is
necessary.
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Oliveira FFS, Suchara EA. Epidemiological profile of exogenous poisoning in children and adolescents from a municipality in the state of Mato Grosso. REVISTA PAULISTA DE PEDIATRIA 2014. [DOI: 10.1590/s0103-05822014000400004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To study the epidemiology of exogenous intoxications in children and adolescents of Barra Garças, Mato Grosso, from January 2008 to September 2013.METHOD: This was a cross-sectional, retrospective, and descriptive epidemiological study. Data were collected from the Disease Notification System (Sistema de Informação de Agravos de Notificação [SINAN]) of the municipality, processed using Microsoft Excel, and evaluated through BIOESTAT statistical software. The variables included were: sex; age; toxic agent; time and place of service; route of administration; circumstance; and classification of intoxication. The age range was established according to the Brazilian Institute of Geography and Statistics, comprising children aged from 0 to 9 years old and adolescents aged from 10 to 19 years old.RESULTS: A total of 125 cases of accidental exogenous poisoning was registered, including 77 children and 48 adolescents. Food and beverages (38.4%) and drugs (24.0%) were the most common groups of toxic agents responsible for the poisoning. The largest age group affected by intoxication was composed of children aged from 0 to 4 years old (43.2%) and adolescents aged from 10 to 14 years old (19.7%). Regarding the circumstances, intoxication occurred due to suicide attempts (16.8%) and accidental events (23.2%) in adolescents and children, respectively. The study revealed a higher frequency of poisoning in girls.CONCLUSION: Exogenous intoxications occurred predominantly in children up to 4 years old, through the accidental consumption of food or drinks. Thus, the adoption of educational prevention programs for children's family members and caregivers is necessary.
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Pavarin RM, Fioritti A, Fontana F, Marani S, Paparelli A, Boncompagni G. Emergency Department Admission and Mortality Rate for Suicidal Behavior. CRISIS 2014; 35:406-14. [DOI: 10.1027/0227-5910/a000282] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.
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Affiliation(s)
| | - Angelo Fioritti
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Italy
| | | | - Silvia Marani
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Italy
| | | | - Giancarlo Boncompagni
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Italy
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Lee CY, Wu YW, Chen CK, Wang LJ. The Rate of Fatality and Demographic Characteristics Associated With Various Suicide Methods. CRISIS 2014; 35:245-52. [DOI: 10.1027/0227-5910/a000266] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Understanding lethality and risk factors of suicide methods is an initial step in suicide prevention. Aims: To investigate the fatality rate and demographic characteristics of various suicide methods. Method: This study enrolled consecutive individuals with episodes of suicide attempts registered in a surveillance database in a city with a high rate of suicide mortality in Taiwan, from January 1, 2006, to December 31, 2010. In total, 3,089 suicide attempt events (including 2,583 nonfatal suicides and 506 completed suicides) occurred during the study period. Results: Overall, the fatality rate of suicides was 16.4%. Charcoal burning accounted for the most suicide deaths (37.6%), with a fatality rate of 50.1%. Suicide by hanging carried the highest fatality rate (81.2%). Males tended to choose more lethal methods and had higher fatality rates compared with females. Elders and married persons were less likely to attempt suicide by charcoal burning. The case fatality ratio increased along with age among suicide attempts, but not in those using charcoal burning. Conclusion: The choice of suicide methods and lethality might be influenced by one’s demographic characteristics. Results from this study may provide clues for establishing suicide prevention strategies such as restricting access to common lethal suicide methods in the high-risk group.
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Affiliation(s)
- Chun-Yi Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Wen Wu
- Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
- Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Lu CY, Zhang F, Lakoma MD, Madden JM, Rusinak D, Penfold RB, Simon G, Ahmedani BK, Clarke G, Hunkeler EM, Waitzfelder B, Owen-Smith A, Raebel MA, Rossom R, Coleman KJ, Copeland LA, Soumerai SB. Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study. BMJ 2014; 348:g3596. [PMID: 24942789 PMCID: PMC4062705 DOI: 10.1136/bmj.g3596] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate if the widely publicized warnings in 2003 from the US Food and Drug Administration about a possible increased risk of suicidality with antidepressant use in young people were associated with changes in antidepressant use, suicide attempts, and completed suicides among young people. DESIGN Quasi-experimental study assessing changes in outcomes after the warnings, controlling for pre-existing trends. SETTING Automated healthcare claims data (2000-10) derived from the virtual data warehouse of 11 health plans in the US Mental Health Research Network. PARTICIPANTS Study cohorts included adolescents (around 1.1 million), young adults (around 1.4 million), and adults (around 5 million). MAIN OUTCOME MEASURES Rates of antidepressant dispensings, psychotropic drug poisonings (a validated proxy for suicide attempts), and completed suicides. RESULTS Trends in antidepressant use and poisonings changed abruptly after the warnings. In the second year after the warnings, relative changes in antidepressant use were -31.0% (95% confidence interval -33.0% to -29.0%) among adolescents, -24.3% (-25.4% to -23.2%) among young adults, and -14.5% (-16.0% to -12.9%) among adults. These reflected absolute reductions of 696, 1216, and 1621 dispensings per 100,000 people among adolescents, young adults, and adults, respectively. Simultaneously, there were significant, relative increases in psychotropic drug poisonings in adolescents (21.7%, 95% confidence interval 4.9% to 38.5%) and young adults (33.7%, 26.9% to 40.4%) but not among adults (5.2%, -6.5% to 16.9%). These reflected absolute increases of 2 and 4 poisonings per 100,000 people among adolescents and young adults, respectively (approximately 77 additional poisonings in our cohort of 2.5 million young people). Completed suicides did not change for any age group. CONCLUSIONS Safety warnings about antidepressants and widespread media coverage decreased antidepressant use, and there were simultaneous increases in suicide attempts among young people. It is essential to monitor and reduce possible unintended consequences of FDA warnings and media reporting.
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Affiliation(s)
- Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Matthew D Lakoma
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jeanne M Madden
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Donna Rusinak
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Robert B Penfold
- Group Health Research Institute, Seattle, WA, USA Department of Health Services Research, University of Washington, Seattle, WA, USA
| | - Gregory Simon
- Group Health Research Institute, Seattle, WA, USA Mental Health Research Network
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Gregory Clarke
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Enid M Hunkeler
- The Division of Research, Kaiser Permanente Medical Care Program Northern California, Oakland, CA, USA
| | - Beth Waitzfelder
- Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI, USA
| | - Ashli Owen-Smith
- The Center for Health Research Southeast, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Marsha A Raebel
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
| | - Rebecca Rossom
- HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA, USA
| | - Laurel A Copeland
- Center for Applied Health Research, Central Texas Veterans Health Care System jointly with Scott & White Healthcare, Temple, TX, USA
| | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Tran T, Luo W, Phung D, Harvey R, Berk M, Kennedy RL, Venkatesh S. Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments. BMC Psychiatry 2014; 14:76. [PMID: 24628849 PMCID: PMC3984680 DOI: 10.1186/1471-244x-14-76] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To date, our ability to accurately identify patients at high risk from suicidal behaviour, and thus to target interventions, has been fairly limited. This study examined a large pool of factors that are potentially associated with suicide risk from the comprehensive electronic medical record (EMR) and to derive a predictive model for 1-6 month risk. METHODS 7,399 patients undergoing suicide risk assessment were followed up for 180 days. The dataset was divided into a derivation and validation cohorts of 4,911 and 2,488 respectively. Clinicians used an 18-point checklist of known risk factors to divide patients into low, medium, or high risk. Their predictive ability was compared with a risk stratification model derived from the EMR data. The model was based on the continuation-ratio ordinal regression method coupled with lasso (which stands for least absolute shrinkage and selection operator). RESULTS In the year prior to suicide assessment, 66.8% of patients attended the emergency department (ED) and 41.8% had at least one hospital admission. Administrative and demographic data, along with information on prior self-harm episodes, as well as mental and physical health diagnoses were predictive of high-risk suicidal behaviour. Clinicians using the 18-point checklist were relatively poor in predicting patients at high-risk in 3 months (AUC 0.58, 95% CIs: 0.50 - 0.66). The model derived EMR was superior (AUC 0.79, 95% CIs: 0.72 - 0.84). At specificity of 0.72 (95% CIs: 0.70-0.73) the EMR model had sensitivity of 0.70 (95% CIs: 0.56-0.83). CONCLUSION Predictive models applied to data from the EMR could improve risk stratification of patients presenting with potential suicidal behaviour. The predictive factors include known risks for suicide, but also other information relating to general health and health service utilisation.
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Affiliation(s)
- Truyen Tran
- Centre for Pattern Recognition and Data Analytics, Deakin University, Geelong 3220, Australia,Department of Computing, Curtin University, Bentley, Australia
| | - Wei Luo
- Centre for Pattern Recognition and Data Analytics, Deakin University, Geelong 3220, Australia
| | - Dinh Phung
- Centre for Pattern Recognition and Data Analytics, Deakin University, Geelong 3220, Australia
| | - Richard Harvey
- Mental Health Services, Barwon Health, Geelong, Australia,School of Medicine, Deakin University, Geelong, Australia
| | - Michael Berk
- School of Medicine, Deakin University, Geelong, Australia,Barwon Health, Geelong, Australia,Mental Health Research Institute, University of Melbourne, Parkville, Australia,Orygen Youth Health Research Centre, Parkville, Australia
| | - Richard Lee Kennedy
- School of Medicine, Deakin University, Geelong, Australia,Barwon Health, Geelong, Australia
| | - Svetha Venkatesh
- Centre for Pattern Recognition and Data Analytics, Deakin University, Geelong 3220, Australia.
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Caterino JM, Sullivan AF, Betz ME, Espinola JA, Miller I, Camargo CA, Boudreaux ED. Evaluating current patterns of assessment for self-harm in emergency departments: a multicenter study. Acad Emerg Med 2013; 20:807-15. [PMID: 24033624 DOI: 10.1111/acem.12188] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 02/14/2013] [Accepted: 02/16/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was to describe self-harm assessment practices in U.S. emergency departments (EDs) and to identify predictors of being assessed. METHODS This was a prospective observational cohort study of adults presenting to eight U.S. EDs. A convenience sample of adults presenting to the EDs during covered research shifts was entered into a study log. Self-harm assessment was defined as ED documentation of suicide attempt; suicidal ideation; or nonsuicidal self-injury thoughts, behaviors, or both. Institution characteristics were compared relative to percentage assessed. To identify predictive patient characteristics, multivariable generalized linear models were created controlling for weekend presentation, time of presentation, age, sex, and race and ethnicity. RESULTS Among 94,354 charts, self-harm assessment ranged from 3.5% to 31%, except for one outlying site at 95%. Overall, 26% were assessed (11% excluding the outlying site). Current self-harm was present in 2.7% of charts. Sites with specific self-harm assessment policies had higher assessment rates. In the complete model, adjusted risk ratios (aRR) for assessment included age ≥ 65 years (0.56, 95% confidence interval [CI] = 0.35 to 0.92) and male sex (1.17, 95% CI = 1.10 to 1.26). There was an interaction between these variables in the smaller model (excluding outlying site), with males < 65 years of age being more likely to be assessed (aRR = 1.14, 95% CI = 1.02 to 1.37). CONCLUSIONS Emergency department assessment of self-harm was highly variable among institutions. Presence of specific assessment policies was associated with higher assessment rates. Assessment varied based upon patient characteristics. The identification of self-harm in 2.7% of ED patients indicates that a substantial proportion of current risk of self-harm may go unidentified, particularly in certain patient groups.
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Affiliation(s)
- Jeffrey M. Caterino
- Departments of Emergency Medicine and Internal Medicine; The Ohio State University; Columbus; OH
| | - Ashley F. Sullivan
- Department of Emergency Medicine; Massachusetts General Hospital; Boston; MA
| | - Marian E. Betz
- Department of Emergency Medicine; University of Colorado School of Medicine; Aurora; CO
| | - Janice A. Espinola
- Department of Emergency Medicine; Massachusetts General Hospital; Boston; MA
| | - Ivan Miller
- Department of Psychiatry and Human Behavior; Brown University; Providence; RI
| | - Carlos A. Camargo
- Department of Emergency Medicine; Massachusetts General Hospital; Boston; MA
| | - Edwin D. Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences; University of Massachusetts Medical School; Worcester; MA
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Nkansah-Amankra S. Adolescent suicidal trajectories through young adulthood: prospective assessment of religiosity and psychosocial factors among a population-based sample in the United States. Suicide Life Threat Behav 2013; 43:439-59. [PMID: 23601148 PMCID: PMC4140945 DOI: 10.1111/sltb.12029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 02/22/2013] [Indexed: 01/17/2023]
Abstract
The main objective was to identify distinct patterns of suicidal behaviors over the life course from adolescence to young adulthood and to determine influences of religiosity and other contextual factors on subgroup membership. Semiparametric growth mixture models were used to identify distinct clusters of suicide ideation and suicide attempt trajectories, and generalized estimating equations were used to assess individual and contextual characteristics predicting suicidal behaviors in adolescence and in young adulthood. Distinct trajectories of suicide ideation and suicide attempt were identified for the total sample and for the gender groups. Results showed marked gender differences in the trajectory of suicide ideation and attempt patterns. Religiosity effects on suicidality were prominent in adolescence but not in young adulthood. Analysis showed that an important window of opportunity for preventing the escalation of suicidality exists during the early adolescent period, an opportunity that should be emphasized in interventions on adolescence suicide prevention.
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31
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Senarathna L, Jayamanna SF, Kelly PJ, Buckley NA, Dibley MJ, Dawson AH. Changing epidemiologic patterns of deliberate self poisoning in a rural district of Sri Lanka. BMC Public Health 2012; 12:593. [PMID: 22852867 PMCID: PMC3458971 DOI: 10.1186/1471-2458-12-593] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 07/11/2012] [Indexed: 12/01/2022] Open
Abstract
Background Acute poisoning is a major public health issue in many parts of the world. The epidemiology and the mortality rate is higher in low and middle income countries, including Sri Lanka. The aim of this study was to provide details about the epidemiology of acute poisoning in a rural Sri Lankan district and to identify the changing patterns and epidemiology of poisoning. Methods A prospective study was conducted from September 2008 to January 2010 in all hospitals with inpatient facilities in Anuradhapura district of North Central Province of Sri Lanka. Acute poisoning data was extracted from patient charts. Selected data were compared to the data collected from a 2005 study in 28 hospitals. Results There were 3813 poisoned patients admitted to the hospitals in the Anuradhapura district over 17 months. The annual population incidence was 447 poisoning cases per 100,000 population. The total number of male and female patients was approximately similar, but the age distribution differed by gender. There was a very high incidence of poisoning in females aged 15–19, with an estimated cumulative incidence of 6% over these five years. Although, pesticides are still the most common type of poison, medicinal drug poisonings are now 21% of the total and have increased 1.6 fold since 2005. Conclusions Acute poisoning remains a major public health problem in rural Sri Lanka and pesticide poisoning remains the most important poison. However, cases of medicinal drug poisoning have recently dramatically increased. Youth in these rural communities remain very vulnerable to acute poisoning and the problem is so common that school-based primary prevention programs may be worthwhile. Lalith Senarathna, Shaluka F Jayamanna, Patrick J Kelly, Nick A Buckley,michael J Dibley, Andrew H Dawson. These authors contributed equally to this work.
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Affiliation(s)
- Lalith Senarathna
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.
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Hser Y, Kagihara J, Huang D, Evans E, Messina N. Mortality among substance-using mothers in California: a 10-year prospective study. Addiction 2012; 107:215-22. [PMID: 21831178 PMCID: PMC3226896 DOI: 10.1111/j.1360-0443.2011.03613.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To examine mortality rates and causes of death among a cohort of substance-using mothers and to identify risk factors that predict mortality. DESIGN, SETTING, PARTICIPANTS This is a prospective study of a cohort of 4447 substance-using mothers (pregnant or parenting) who were enrolled during 2000-02 in 40 drug abuse treatment programs across California. METHODS All mothers were assessed at baseline using the Addiction Severity Index. Mortality data were obtained from the National Death Index and causes of death were coded using ICD-10. Standardized mortality ratios (SMR) were calculated relative to women in the general population adjusted for age. Proportional hazard (Cox) regression was used to identify risk factors predicting death. RESULTS At the end of 2010, 194 deaths were confirmed, corresponding to a crude mortality rate of 4.47 per 1000 person-years and SMR of 8.4 (95% confidence interval: 7.2-9.6). Drug overdose (28.8%), cardiovascular disease (10%), and alcohol or drug disorders (8.9%) were the leading causes of death. Baseline factors associated with higher mortality included older age, being white (relative to African American or Hispanic), heroin, alcohol, cocaine or marijuana (relative to methamphetamine) as the primary drug problem, drug injection and greater severity of employment, medical/health and psychiatric problems. CONCLUSIONS Substance-using mothers have 8.4 times the mortality than that observed among US women of similar age. Greater severity of employment, medical/health and psychiatric problems contributed to the elevated mortality.
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Affiliation(s)
- Y. Hser
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences
| | - J. Kagihara
- University of Hawaii, John A. Burns School of Medicine
| | - D. Huang
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences
| | - E. Evans
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences
| | - N Messina
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences
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