Adolescent deliberate self-poisoning in South-East Melbourne

Suicide attempt management among Turkish and American adolescents: A comparison of two pediatric emergency departments

Background/aim

Suicide is one of the leading causes of death among adolescents. This study aimed to compare the characteristics and short-term outcomes of Turkish and American adolescents with suicide attempts and determine the differences in management and resource utilization between two pediatric emergency departments; one in Türkiye and one in the United States of America.

Materials and methods

Adolescents who presented to the emergency departments with a chief complaint of suicide attempt between October 2017 and September 2018 were eligible for including in the study. Characteristics and other information of 217 (131 American and 86 Turkish) suicide attempter adolescents were retrieved from medical records. Outcome was defined as re-admission to the emergency department for another suicide attempt within 3 months of the index visit.

Results

Overall, 78% of adolescents were female. Abuse history (physical/sexual) was more common among American adolescents (p = 0.005), whereas uncontrolled psychiatric diseases were more evident in Turkish cases (p < 0.001). Social worker assessment and hospitalization rates were significantly lower, with shorter mean duration of follow-up in the emergency department among Turkish compared to American adolescents (respectively, p < 0.001, p < 0.001 and p = 0.002). Repeated suicide attempts within three months were significantly higher in the Turkish group compared to the American one (29% vs. 8%, p < 0.001). Receiving a social worker assessment, hospitalization and longer observation in emergency department reduced the incidence of repeated suicide attempts (respectively, p < 0.001, p = 0.003 and p = 0.012).

Conclusion

Turkish adolescents had shorter observation time in the emergency department, received fewer assessment by social workers and were less likely to be hospitalized. These may have contributed to the higher rate of repeat suicide attempts following discharge from the emergency department. Adequate resources are needed to help decrease the burden of suicide among Turkish adolescents.

Trends and Prevalence of Hospital Admissions Related to Deliberate Self-Poisoning and Used Substances in Romanian Adolescents between 2016 and 2022

Rates of self-poisoning are increasing substantially all around the world, with self-poisoning being the most common form of self-harm leading to hospitalization in children and adolescents. This study aims to investigate the trends in the number of deliberate self-poisoning admissions in Romanian adolescents during the period of 2016-2022, as well as the most frequently used substances and the impact of the COVID-19 pandemic on hospital admissions due to self-poisoning and substance use in relation to these episodes. The sample included 178 patients admitted to the Clinic of Pediatric Psychiatry in Cluj-Napoca from 2016 to 2022 due to an episode of self-poisoning. Data were collected on patients' sociodemographic characteristics, psychosocial characteristics, and medical histories. We report a slight overall increase in the self-poisoning admission rate during the studied period. There was a decrease during the initial period of the pandemic, with significantly increasing rates in the second year of the pandemic. The mean prevalence rate of hospital admissions due to self-poisoning episodes during the study period was 3.14% (95% CI 2.72, 3.63). Adolescent girls were identified as the most vulnerable group, with the female-to-male ratio increasing dramatically. In terms of substance use, benzodiazepines; over-the-counter analgesics, including paracetamol; and antidepressants were the most frequently used substances. We emphasize the importance of careful consideration in prescribing psychotropic drugs, as well as the need for regulation of over-the-counter drug dispensation.

Clinical and Social Characteristics of Deliberately Intoxicated Minors Treated in Pediatric Intensive Care

BACKGROUND

The aim of the study was to determine and compare the clinical and social characteristics of minors using alcohol and drugs for inebriation, and the same for those using them for suicide.

METHODS

This study includes an analysis of case histories of adolescents hospitalized in the Pediatric Intensive Care Unit because of acute alcohol or/and drug intoxication in 2015 to 2017. Two groups (group I: inebriation, and group II: suicide) were compared on age, sex, severity of intoxication, used substances, presence of other self-harm evidence, and social status.

RESULTS

A total of 390 cases were registered: 78.21% in Group I and 21.79% in Group II. The Glasgow-Coma-Scale scores showed that patients from Group I were more severely intoxicated, with an average score of 11.47, whereas patients from Group II averaged 13.45 (P < .001). Self-harm was more prominent among minors from Group II, with an incidence of up to 65.09%. The most common substance used to become inebriated was alcohol (72.79%), and for committing suicide was medication (88.24%). Patients who were living in children's care homes composed 13.33% of all cases included into the study, despite the low frequency of these minors in Lithuania (0.8%).

CONCLUSIONS

The substance used for deliberate intoxication was mostly alcohol. Minors experiencing inebriation were hospitalized in worse clinical condition in comparison to those who had attempted suicide. Other signs of self-harm were significantly more common among suicidal minors. Living in children's care homes is a possible risk factor for deliberate intoxication among young people in Lithuania.

Paediatric poisoning presentations reported to a regional toxicology service in Australia

AIM

The aim of this study is to describe the epidemiology and health-care utilisation of paediatric emergency department (ED) presentations due to poisoning.

METHODS

A retrospective review of all ED presentations of paediatric poisoning cases (<18 years) reported to a tertiary toxicology service from 2015 to 2016 was conducted. Cases were classified into three age groups: pre-school (0-6 years), primary school (7-11 years) and adolescent (12-17 years). Outcomes included patient transfer, length of ED stay (LOS) and proportion admitted to a medical ward, mental health unit or intensive care unit (ICU).

RESULTS

From 764 consultations over a 2-year period, 87 were excluded as non-ED presentations. From these, there were 194 (29%; 47% female) pre-school aged, 34 (5%; 41% female) primary school aged and 449 (66%; 77% female) adolescent presentations. Deliberate self-poisoning was most common in 394 of 449 (88%) adolescents. Accidental exposures accounted for 159 (82%) of pre-school presentations and natural toxins occurred in all three age groups. Paracetamol, selective serotonin reuptake inhibitors, antipsychotics and ibuprofen were the most common toxins. Discharge from ED occurred in 147 of 194 (76%) pre-school, 24 of 34 (71%) primary school and 223 of 449 (50%) adolescent presentations. Of the 449 adolescents, 137 (31%) were admitted medically (median LOS 19.9 h), 19 were admitted to ICU (median LOS 71 h) and 70 (16%) admitted to mental health (median LOS 122 h). Five pre-school aged children were admitted to ICU.

CONCLUSIONS

Adolescent deliberate self-poisoning has a significant impact on hospital resources, with mental health problems requiring extended length of stay. There were fewer pre-school accidental poisoning consultations, which were mainly discharged from ED.

Clinical Characteristics, Outcomes, Disposition, and Acute Care of Children and Adolescents Treated for Acetaminophen Toxicity

OBJECTIVE

Acetaminophen is a common cause of intentional and inadvertent overdoses among children and adolescents worldwide. Little is known about characteristics and clinical outcomes of these youths. The primary goal of this naturalistic study was to describe the psychiatric characteristics, medical management, outcomes, and dispositions of children and adolescents evaluated for excessive acetaminophen exposure.

METHODS

The Rochester Epidemiology Project database was searched for all patients ages 0-18 treated for excessive acetaminophen exposure in Olmsted County, Minnesota, during a 7-year period (2004-2010). Demographic factors, overdose intentionality, medical and psychiatric treatment, mental health and addiction history, and disposition from the emergency department (ED) were documented.

RESULTS

Of 110 cases of acetaminophen overdose (89 female patients and 21 male patients), 97 (88%) were intentional and 13 (12%) were unintentional. Fifteen patients (14%) were discharged from the ED, and 69 (63%) required admission to a medical unit. Sixty-four (59%) received N-acetylcysteine. Ninety-eight (89%) were evaluated by psychiatry, and 80 (73%) were admitted for psychiatric hospitalization. Most had at least one psychiatric diagnosis, most commonly depression (55%); 22 (20%) had a prior suicide attempt. Substance use was common, notably alcohol dependence (N=16, 15%), alcohol abuse (N=18, 16%), and cannabis abuse (N=18, 16%). All survived and recovered without liver transplant.

CONCLUSIONS

Among pediatric patients with acetaminophen overdoses, psychiatric comorbidities and substance use were common. Most received both inpatient medical and psychiatric treatment. Interventions that restrict acetaminophen access are needed for this population, as are suicide risk reduction interventions for delivery in emergency settings.

Repeat Self-Harm Following Hospital-Presenting Intentional Drug Overdose among Young People-A National Registry Study

Background: The incidence of hospital-presenting self-harm peaks among young people, who most often engage in intentional drug overdose (IDO). The risk of self-harm repetition is high among young people and switching methods between self-harm episodes is common. However, little is known about their patterns of repetition and switching following IDO. This study aimed to investigate repeat self-harm and method-switching following hospital-presenting IDO among young people. Methods: Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 10–24 years during 2009–2018 were examined. Cox proportional hazards regression models with associated hazard ratios (HRs), survival curves and Poisson regression models with risk ratios (RRs), were used to examine risk factors for repetition and method-switching. Results: During 2009–2018, 16,800 young people presented following IDO. Within 12 months, 2136 young people repeated self-harm. Factors associated with repetition included being male (HR = 1.13, 95% CI: 1.03–1.24), aged 10–17 years (HR = 1.29, 95% CI: 1.18–1.41), consuming ≥ 50 tablets (HR = 1.27, 95% CI: 1.07–1.49) and taking benzodiazepines (HR = 1.67, 95% CI: 1.40–1.98) or antidepressants (HR = 1.36, 95% CI: 1.18–1.56). The cumulative risk for switching method was 2.4% (95% CI: 2.2–2.7). Method-switching was most likely to occur for males (RR = 1.36; 95% CI: 1.09–1.69) and for those who took illegal drugs (RR = 1.63; 95% CI: 1.19–2.25). Conclusion: Young males are at increased risk of repeat self-harm and method-switching following IDO and the type and quantity of drugs taken are further indicators of risk. Interventions targeting IDO among young people are needed that ensure that mental health assessments are undertaken and which address access to drugs.

Adolescent Intentional Ingestions in a Community Hospital

OBJECTIVES

Suicide is the second leading cause of death in the adolescent population, presenting a public health crisis. The goal of this study was to evaluate adolescent intentional ingestions in a community hospital and to identify variables associated with the risk of admission to inpatient medical and psychiatric settings.

METHODS

This study was a retrospective chart review from a hospital system in the Pacific Northwest over 2 years for patients aged 9 to 18 years. Variables examined include age, sex, type of ingestion, emergency department length of stay (LOS), admission to the inpatient setting, LOS of inpatient admission, admission to psychiatry, presence of a therapist, and insurance type.

RESULTS

During the study period, 233 individual intentional ingestions occurred. The most commonly ingested substances were psychiatric medications (30.9%), prescription medications (28.3%), and ibuprofen (24.0%). One-third of patients (33.9%) required admission to a medical hospital, whereas one-quarter (24.9%) required admission to a psychiatric hospital. The following variables were associated with risk of admission to a medical hospital: female sex, shorter emergency department LOS, and ingestion of psychiatric medications, prescription medication, and/or salicylates. Risk of admission to a psychiatric hospital was associated with an inpatient medical admission, an increased duration of medical admission, and an ingestion of a psychiatric medication.

CONCLUSIONS

In this study, we describe important epidemiology on adolescent intentional ingestions in a community setting, providing variables associated with a risk of admission to medical and psychiatric hospitals.

Central nervous system-active drug abused and overdose in children: a worldwide exploratory study using the WHO pharmacovigilance database

Recent epidemiological studies have reported an increase in central nervous system (CNS)-active drug abuse rates in paediatric settings, raising several public health concerns. No study to date has explored this issue worldwide. We performed an extensive analysis of drugs abuse/overdose reported for children in the last decade by using the largest pharmacovigilance database, i.e. the VigiBase, collecting adverse drug reaction reports that involved at least one suspect drug belonging to the Anatomical Therapeutic Chemical code "Nervous System" through the Standardised Medical Dictionary for Drug Regulatory Affairs Queries for Drug abuse. 8.682 reports matched our criteria. An increase in reporting activity was observed, starting from 2014; an intentional overdose was reported more frequently than an accidental one, with a difference between age groups. We retrieved 997 reports with death outcome. These referred more to adolescents (n = 538) than subjects of any other paediatric age group. Paracetamol and opioid analgesics were the most common suspect drugs in deaths across all age groups due to hypoxic-ischaemic encephalopathy, brain death, and cardio-respiratory arrest.Conclusion: The number of reports associated with drug abuse and overdose is increasing (for opioid and paracetamol-containing products) and a considerable number of adverse drug reactions are serious. Data on the patterns of use of such medicines from each country may help in implementing strategies of risk-minimisation and renewing healthcare recommendations worldwide. An increased clinical awareness of drug abuse and overdose is warranted, while continuing to provide effective treatments. What is Known: • The large increase in paediatric prescriptions for CNS-active drugs in the last 20 years has recently raised public health concerns about drug abuse and overdose. • No study to date has examined this issue in paediatric patients worldwide. What is New: • The number of paediatric reports associated with CNS drug abuse and intentional overdose is increasing, including those with fatal outcome; over 4 years; more than 35% of the reports was entered from European countries. • Opioid and paracetamol were most frequently suspected for ADRs with fatal outcome across all age groups, due to hypoxic-ischaemic encephalopathy and cardio-respiratory arrest, suggesting the need to implement strategies of risk-minimisation.

Poisoning substances taken by young people: a population-based cohort study

Background

Globally, poisonings account for most medically-attended self-harm. Recent data on poisoning substances are lacking, but are needed to inform self-harm prevention.

Aim

To assess poisoning substance patterns and trends among 10–24-year-olds across England

Design and setting

Open cohort study of 1 736 527 young people, using linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics mortality data, from 1998 to 2014.

Method

Poisoning substances were identified by ICD-10 or Read Codes. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substances by age, sex, index of multiple deprivation, and calendar year.

Results

In total, 40 333 poisoning episodes were identified, with 57.8% specifying the substances involved. The most common substances were paracetamol (39.8%), alcohol (32.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (11.6%), antidepressants (10.2%), and opioids (7.6%). Poisoning rates were highest at ages 16–18 years for females and 19–24 years for males. Opioid poisonings increased fivefold from 1998–2014 (females: aIRR 5.30, 95% confidence interval (CI) = 4.08 to 6.89; males: aIRR 5.11, 95% CI = 3.37 to 7.76), antidepressant poisonings three-to fourfold (females: aIRR 3.91, 95% CI = 3.18 to 4.80, males: aIRR 2.70, 95% CI = 2.04 to 3.58), aspirin/NSAID poisonings threefold (females: aIRR 2.84, 95% CI = 2.40 to 3.36, males: aIRR 2.76, 95% CI = 2.05 to 3.72) and paracetamol poisonings threefold in females (aIRR 2.87, 95% CI = 2.58 to 3.20). Across all substances poisoning incidence was higher in more disadvantaged groups, with the strongest gradient for opioid poisonings among males (aIRR 3.46, 95% CI = 2.24 to 5.36).

Conclusion

It is important that GPs raise awareness with families of the substances young people use to self-harm, especially the common use of over-the-counter medications. Quantities of medication prescribed to young people at risk of self-harm and their families should be limited, particularly analgesics and antidepressants.

Patterns of poisoning exposure at different ages: the 2015 annual report of the Australian Poisons Information Centres

OBJECTIVES

To characterise the types of calls received by Australian Poisons Information Centres (PICs) in Australia, and to analyse poisoning exposures by age group, circumstances of exposure, and the types of substances involved. Design, setting: Retrospective analysis of call records from all four Australian PICs (national coverage).

MAIN OUTCOME MEASURES

Basic demographic information; exposure circumstances, substance types involved in each age group; recommendations for management (eg, stay at home, go to hospital).

RESULTS

There were 204 906 calls to Australian PICs in 2015, 69.0% from the general public, 27.9% from health professionals; 16.2% of calls originated from hospitals. 170 469 calls (including re-calls about an exposure) related to 164 363 poison exposure events; 64.4% were unintentional, 18.1% were the consequences of medication error, and 10.7% involved deliberate self-poisoning. Most exposures were of 20-74-year-old adults (40.1%) or 1-4-year-old toddlers (36.0%). The PICs advised callers to stay at home for 67.4% of exposures, and to present to hospital for 10.9%. The most common substances involved in exposures overall were household cleaners (10.2%) and paracetamol-containing analgesics (7.3%). Exposures of infants and toddlers were most frequently to household cleaning substances (17.8%, 15.3% respectively) and personal care items (6.6%, 7.3%); callers were usually advised to stay at home (88.5%, 86.4%). Deliberate self-poisoning (49.1%) and hospital referral (23.9%) were most frequent for adolescents. Exposures of adults (20-74 years) frequently involved psychotropic pharmaceuticals (17.8%) or painkillers (15.1%). Exposures in adults over 74 were typically medication errors involving cardiovascular (23.6%), anticoagulant (4.6%), or antidiabetic (4.1%) medications.

CONCLUSIONS

Poisoning is a significant public health problem throughout life, but the nature of the hazards differs markedly between age groups. PIC data could inform strategic public health interventions that target age-specific poisoning hazards.