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

Risk factors for the need for advanced care among prescription and over-the-counter drug overdose patients

Aim

Prescription drug and over-the-counter (OTC) drug overdose is a major problem in emergency departments in Japan, and some need advanced care which is more than observation. We aimed to identify the prehospital risk factors for the need of advanced care among overdose patients.

Methods

This was a single-center retrospective cohort study. We included overdoses patients of prescription drugs or OTC drugs, who admitted to our hospital between 2016 and 2021. We grouped them into advanced care and non-advanced care. The main outcome was the need for advanced care. We performed a multiple logistic regression analysis, calculated the PAV score (Paracetamol use, Alcohol use, abnormal Vital signs on scene) and performed a receiver operating characteristic (ROC) analysis.

Results

There were 229 subjects. The logistic regression analysis revealed that alcohol, paracetamol, and the abnormal vital signs on scene were associated with advanced care (alcohol-odds ratio [OR]: 2.95; 95% confidence interval [CI]: 1.29-6.75; paracetamol-OR: 5.47; 95% CI: 2.18-13.71; abnormal vital signs-OR: 4.61, 95% CI: 2.07-10.27). The rate of advanced care in the high PAV score (2 and 3) group was statistically higher than that in the low PAV score (0-1) group (p = 0.04). Area under the ROC curve of the PAV score was 0.72 (95% CI, 0.65-0.80).

Conclusion

Alcohol, paracetamol use and abnormal vital signs on scene might be risk factors for advanced care among prescription drugs or OTC drugs overdose patients, and the PAV score may predict the need for advanced care.

Suicide risk assessments: Why are we still relying on these a decade after the evidence showed they perform poorly?

Suicide deaths have a profound impact on whānau and community and are a tragic loss. However, from a statistical point of view, suicide is a relatively rare event. Predicting rare events is difficult, and the implications for suicide prevention were highlighted in an important editorial in this journal more than a decade ago, yet little seems to have changed. Risk assessment that focuses on accurate prediction of suicide in real-world contexts is given a great deal of attention in mental health services, despite the fact that current scientific knowledge and best practice guidelines in this area highlight that it is unlikely to be a good basis on which to provide access to treatment. It is our view that we have a good enough understanding of the common conditions people who struggle with suicidal distress experience and energy is better directed at acting to reduce exposure to these conditions and providing treatment for those who seek it. Blueprints for successful suicide prevention exist. If we lessen the focus on prediction, we will have greater resources to focus on treatment and prevention.

Paracetamol-related intentional drug overdose among young people: a national registry study of characteristics, incidence and trends, 2007-2018

PURPOSE

Incidence rates of hospital-presenting self-harm are highest in people under 25 years and are reportedly increasing in some countries. Intentional drug overdose (IDO) is the most common self-harm method among young people, with paracetamol the drug most frequently used. This study aimed to describe the characteristics, incidence, and temporal trends in paracetamol-related IDO among young people.

METHODS

Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 1024 years during 2007-2018 were examined. Annual IDO rates per 100,000 were calculated by age and gender. Joinpoint regression analyses and incidence rate ratios were used to examine trends in the incidence of paracetamol-related IDO.

RESULTS

During the study, 10,985 paracetamol-related IDOs were recorded. The incidence of paracetamol-related IDO among young people increased by 9% between 2007 and 2018 (IRR 1.09 95% CI 1.00-1.19), with the highest annual percentage change (APC) in females aged 18-24 years (APC 1.2%). Conversely, rates of paracetamol-related IDO among males aged 18-24 years decreased significantly (APC 1.6%). Between 2013 and 2018, excesses of 386 and 151 paracetamol-related IDOs were observed in females aged 10-17 and 18-24 years, respectively, and 42 excess presentations were observed for males aged 10-17 years. There were 107 fewer presentations than expected for males aged 18-24 years.

CONCLUSION

The increase in paracetamol-related IDO among specific groups of young people, particularly young females is an issue of growing concern. Interventions targeting IDO among young people are needed, incorporating measures to address the availability of paracetamol and aftercare following IDO.