Yaron Finkelstein1,2,3, Erin M Macdonald4, Simon Hollands4, Marco L A Sivilotti5,6, Janine R Hutson2, Muhammad M Mamdani7,8, Gideon Koren2,3, David N Juurlink4,9,10. 1. a Division of Emergency Medicine, Hospital for Sick Children, Faculty of Medicine , University of Toronto , Toronto , Canada ; 2. b Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Faculty of Medicine , University of Toronto , Toronto , Canada ; 3. c Child Health Evaluative Sciences, Research Institute , the Hospital for Sick Children , Toronto , Canada ; 4. d The Institute for Clinical Evaluative Sciences , Toronto , Canada ; 5. e Department of Emergency Medicine , Queen's University , Kingston , Canada ; 6. f Department of Biomedical and Molecular Sciences , Queen's University , Kingston , Canada ; 7. g Applied Health Research Centre (AHRC) , Li Ka Shing Knowledge Institute of St. Michael's Hospital , Toronto , Canada ; 8. h Dalla Lana School of Public Health , University of Toronto , Canada ; 9. i Sunnybrook Hospital , Sunnybrook Research Institute , Toronto , Canada ; 10. j Departments of Medicine, Pediatrics and Health Policy, Management and Evaluation , University of Toronto , Canada.
Abstract
CONTEXT: Intentional overdose is a leading method of self-harm and suicide, and repeat attempts strongly predict eventual death by suicide. OBJECTIVES: To determine the risk of recurrence after a first intentional overdose. Secondary objectives included characterization of the temporal course and potential predictors of repeat overdose, a strong risk factor for death from suicide. DESIGN: Population-based cohort study. SETTING: Ontario, Canada, from 1 April 2002 to 31 March 2013. PARTICIPANTS: All Ontario residents presenting to an emergency department after a first intentional overdose. MAIN OUTCOME MEASURES: The incidence and timing of recurrent overdose. RESULTS: We followed 81,675 patients discharged from hospital after a first intentional overdose. Overall, 13,903 (17.0%) returned with a repeat overdose after a median interval of 288 (inter-quartile range: 62 to 834) days. Of these, 4493 (5.5%) had multiple repeat episodes. Factors associated with repeat self-poisoning included psychiatric care in the preceding year (adjusted hazard ratio [aHR] 1.55; 95% confidence interval [CI] 1.50 to 1.61), alcohol dependence (aHR 1.41; 95% CI 1.35 to 1.46) and documented depression (aHR 1.39; 95% CI 1.34 to 1.44). Female sex, rural residence, lower socioeconomic status, ingestion of psychoactive drugs and younger age were also weakly associated with repeat overdose. DISCUSSION: Hospital presentation for repetition of intentional overdose is common, with recurrent episodes often far removed from the first. While several factors predict overdose repetition, none is particularly strong. CONCLUSION: Secondary prevention initiatives should be implemented for all individuals who present to the emergency department and survive intentional overdose.
CONTEXT: Intentional overdose is a leading method of self-harm and suicide, and repeat attempts strongly predict eventual death by suicide. OBJECTIVES: To determine the risk of recurrence after a first intentional overdose. Secondary objectives included characterization of the temporal course and potential predictors of repeat overdose, a strong risk factor for death from suicide. DESIGN: Population-based cohort study. SETTING: Ontario, Canada, from 1 April 2002 to 31 March 2013. PARTICIPANTS: All Ontario residents presenting to an emergency department after a first intentional overdose. MAIN OUTCOME MEASURES: The incidence and timing of recurrent overdose. RESULTS: We followed 81,675 patients discharged from hospital after a first intentional overdose. Overall, 13,903 (17.0%) returned with a repeat overdose after a median interval of 288 (inter-quartile range: 62 to 834) days. Of these, 4493 (5.5%) had multiple repeat episodes. Factors associated with repeat self-poisoning included psychiatric care in the preceding year (adjusted hazard ratio [aHR] 1.55; 95% confidence interval [CI] 1.50 to 1.61), alcohol dependence (aHR 1.41; 95% CI 1.35 to 1.46) and documented depression (aHR 1.39; 95% CI 1.34 to 1.44). Female sex, rural residence, lower socioeconomic status, ingestion of psychoactive drugs and younger age were also weakly associated with repeat overdose. DISCUSSION: Hospital presentation for repetition of intentional overdose is common, with recurrent episodes often far removed from the first. While several factors predict overdose repetition, none is particularly strong. CONCLUSION: Secondary prevention initiatives should be implemented for all individuals who present to the emergency department and survive intentional overdose.
Authors: Niel Chen; Clifton W Callaway; Francis X Guyette; Jon C Rittenberger; Ankur A Doshi; Cameron Dezfulian; Jonathan Elmer Journal: Resuscitation Date: 2018-06-22 Impact factor: 5.262
Authors: Andrea L Murphy; Randa Ataya; Dani Himmelman; Claire O'Reilly; Alan Rosen; Luis Salvador-Carulla; Ruth Martin-Misener; Fred Burge; Stanley Kutcher; David M Gardner Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2018-06-23 Impact factor: 4.328