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

Self-harm by single- and multi-agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022

PURPOSE

Medication poisoning is the most common method of self-harm. Longitudinal studies incorporating pre- and post-COVID-19 pandemic data are required to describe the phenomenon and to evaluate the long-term impact on mental health.

METHODS

Calls to the Poison Control Center of Policlinico Umberto I Hospital - Sapienza University of Rome, Italy, were analyzed retrospectively for characteristics and clinical presentation of cases of interest from January 2018 to December 2022.

RESULTS

A total of 756 cases of self-harm by medication poisonings were recorded in the study period. A reduction in rate of cases in 2020 was followed by a return to pre-pandemic levels by 2021. When separately analyzing single- and multi-agent cases, occurrence of cases involving just one medication increased since early 2021, with a peak in 2022 (7.8% of total calls, 95% CI 6.2-9.5, from 4.9%, 95% CI 4.1-5.8 in 2018). This increase in the rate of cases, mostly of none or mild severity, was driven by youth aged 12-21, in which the relative proportion of single- versus multi-agent cases showed an increasing trend since 2020 (from 42.6% in 2018 to 78.6% in 2022). Acetaminophen was the medication most frequently involved and benzodiazepines the largest class. A psychiatric background was increasingly seen in 2022, especially in age group 12-21.

CONCLUSION

Single-agent medication self-harm may be an increasingly prevailing phenomenon. Young adolescents with a psychiatric background might be most vulnerable to this behavior in the COVID-19 pandemic aftermath. Healthcare professionals should expect favorable clinical outcome and improve both counseling and psychotherapy supervision in individuals at risk.

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.

The potential of general practice to support young people who self-harm: a narrative review

Background

Self-harm in young people is a growing public health concern. Young people commonly present to their GP for help with self-harm, and thus general practice may be a key setting to support young people who have self-harmed.

Aim

To examine the potential of general practice to support young people aged 10–25 years who have harmed themselves.

Design & setting

A narrative review of published and grey literature.

Method

The Scale for the Assessment of Narrative Review Articles (SANRA) was used to guide a narrative review to examine the potential of general practice to support young people who have self-harmed. The evidence is presented textually.

Results

The included evidence showed that GPs have a key role in supporting young people, and they sometimes relied on gut feeling when handling uncertainty on how to help young people who had self-harmed. Young people described the importance of initial clinician responses after disclosing self-harm, and if they were perceived to be negative, the self-harm could become worse.

Conclusion

In context of the evidence included, this review found that general practice is a key setting for the identification and management of self-harm in young people; but improvements are needed to enhance general practice care for young people to fulfil its potential.

Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales

INTRODUCTION

Mental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine primary care (WLGP) and inpatient admission (PEDW) data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and survival with CC, in children and young people in Wales, UK.

METHODS

A retrospective population-based electronic cohort study using data from the Secure Anonymised Information Linkage (SAIL) Databank. Participants were 958,603 individuals aged 11-25 between 2008 and 2017. We estimated first ever incidence of CC, plotted Kaplan-Meier survival curves and carried out Cox regression to estimate hazard ratios (HR) for risk of death by condition group (CC; MD or SUD only; NC).

RESULTS

Higher incidence of CC in WLGP and PEDW was associated with male sex, older age and greater deprivation. Male to female IRRs (95% CI) were 1.18 (1.12-1.24) in WLGP and 1.17 (1.10-1.24) in PEDW, oldest to youngest IRRs were 24.80 (21.20-29.40) in WLGP and 4.50 (4.08-4.98) in PEDW and most to least deprived IRRs were 3.28 (3.00-3.58) in WLGP and 2.59 (2.36-2.84) in PEDW. Incidence in WLGP significantly decreased between 2008 and 2017 (IRR = 0.88, 95% CI 0.78-0.99); the greatest reduction occurred in the most deprived quintile (IRR 0.67, 95% CI 0.54-0.82). Incidence of hospital admissions remained stable (IRR = 0.95, 95% CI 0.84-1.08). Risk of death was significantly higher for CC compared with NC (HR = 8.7, 95% CI 7.5-10.0).

CONCLUSION

Male sex, older age and greater deprivation were associated with higher CC incidence, although the gap between WIMD quintiles has decreased. CC was associated with greater risk of death. Mental health and substance misuse services should be provided in ways that remove barriers, and are acceptable and accessible to all, particularly those at greatest risk, or who are less likely to engage.

Acute lethal poisonings in children: a 10-year retrospective study of the Moscow Region, Russia

BACKGROUND

Poisoning is a critical public health problem. Toxic substances differ across time, region and age. Little is known about poisoning in Russia, and even less is known about lethal poisoning in children in Russia. We aimed to describe the characteristics of cases of lethal poisoning in children and adolescents.

DESIGN AND METHODS

Our retrospective study was based on autopsy reports from archives of the Moscow Region Bureau of Forensic Medical Examination for the period of 2009 to 2018.

RESULTS

A total of 438 lethal poisoning cases were recorded. The average age of the poisoned children was 11.3 years. Deaths predominantly occurred in boys, mostly due to the higher frequency of poisoning with household and technical chemicals (p<0.01). Accidental deaths were also higher in males (p < 0.01). Therapeutic drug poisoning (p<0.01) and suicide (p < 0.01) were more frequent in females. The leading cause of lethal poisoning in children was exposure to carbon monoxide, especially in children aged 5 to 9 years (p<0.01) and 1 to 4 years (p<0.01). Carbon monoxide poisoning occurred more often in winter (p<0.01). Regarding the structure of poisoning with household and technical chemicals, the most frequent was poisoning by a mixture of utility gases.

CONCLUSION

Our study shows that carbon monoxide poisoning is a serious problem in the region. This may be associated with the ongoing use of individual heating systems. A significant increase in the frequency of fatal poisoning by chemicals, especially by propane-butane gas mixtures while sniffing, has become a disturbing trend.

Analyses of Child and Youth Self-Poisoning Hospitalizations by Substance and Socioeconomic Status

Child and youth self-poisoning is a growing public health issue in many regions of the world, including British Columbia (BC), Canada, where 15–19-year-olds have the highest rates of self-poisoning hospitalizations compared with those of all other ages. The purpose of this study was to identify what substances children and youth commonly used to poison themselves in BC and how socioeconomic status may impact self-poisoning risk. Self-poisoning hospitalization rates among 10–14 and 15–19-year-olds from 1 April 2012 to 31 March 2020 were calculated by substance using ICD-10-CA codes X60-X69 and T36-T65, as well as by socioeconomic status using the Institut National de Santé Publique du Québec’s Deprivation Index. Nonopioid analgesics, antipyretics, and antirheumatics were the most common substances involved, with rates of 27.6 and 74.3 per 100,000 population among 10–14 and 15–19-year-olds, respectively, followed by antiepileptic, sedative–hypnotic, antiparkinsonism, and psychotropic drugs, with rates of 20.2 and 68.1 per 100,000 population among 10–14 and 15–19-year-olds, respectively. In terms of socioeconomic status, rates were highest among 10–19-year-olds living in neighbourhoods with the fewest social connections (243.7 per 100,000 population). These findings can inform poisoning prevention strategies and relevant policies, thereby reducing the number of self-poisoning events among children and youth.

Experiences of general practice care for self-harm: a qualitative study of young people's perspectives

BACKGROUND

Self-harm is a growing concern and rates of self-harm in young people (aged 12-25 years) presenting to general practice are rising. There is, however, little evidence about young people's experiences of GP care and on accessing general practice.

AIM

To explore the help-seeking behaviours, experiences of GP care, and access to general practice of young people who self-harm.

DESIGN AND SETTING

In this qualitative study, semi-structured interviews were conducted with young people aged 16-25 years from England with previous self-harm behaviour.

METHOD

Interviews with 13 young people took place between April and November 2019. Young people were recruited from the community, third-sector organisations, and Twitter. Data were analysed using reflexive thematic analysis with principles of constant comparison. A patient and public involvement advisory group informed recruitment strategies and supported interpretation of findings.

RESULTS

Young people described the avenues of help-seeking they employ and reflected on the mixed experiences of seeing GPs that can influence future help-seeking. Preconceptions and a lack of knowledge about accessing general practice were found to be barriers to help-seeking. GPs who attempt to understand the young person and establish relationship-based care can facilitate young people accessing general practice for self-harm.

CONCLUSION

It is important young people are aware of how to access general practice and that GPs listen, understand, and proactively follow-up young people who self-harm. Supporting young people with self-harm behaviour requires continuity of care.

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.

Suicide attempts by self-poisoning in the United States among 10-25 year olds from 2000 to 2018: substances used, temporal changes and demographics

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.