Abstract and Introduction
Introduction: Few studies explore the clinical features of youth suicide by poisoning. The use of both social and clinical features of self-poisoning with suicidal intent could be helpful in enhancing existing and creating new prevention strategies. We sought to characterize self-poisonings with suicide intent in ages 0 to 21 years reported to three regional poison control centers from 2003–2012.
Methods: This study was a blinded retrospective review of intentional self-poisonings by those age 21 or younger captured by the Poison Information Control Network. Age, sex, substance(s) used, medical outcome, management site, clinical effects, and therapies were described using counts and percentages and analyzed using chi-square tests. We analyzed the medical outcome ranging from no effect to death using the Wilcoxon rank-sum test. Serious medical outcome was defined as death or major outcome.
Results: We analyzed a total of 29,737 cases. The majority were females (20,945;70.5%), of whom 274 (1.3%) were pregnant. Most cases were 15–18 year olds (15,520;52.2%). Many experienced no effects (9,068;30.5%) or minor medical outcomes (8,612;29%). Males had more serious medical outcomes (p<0.0001), but females were more likely to be admitted to a critical care unit (p<0.0001). There were 17 deaths (0.06%), most in males (10;p=0.008). Of the 52 substances reported in the death cases, 12 (23.1%) were analgesics. In eight (47.1%) of the deaths, over two substances were used. Overall, drowsiness/lethargy (7,097;19.3%) and single-dose charcoal (8,815;16.3%) were frequently reported. Nearly 20% were admitted to critical care units (5,727;19.3%) and 28.7% went to psychiatric facilities (8,523). Of those admitted to hospitals (8,203), nearly 70% (5,727) required critical care units. Almost half <10 years old were evaluated and released (43;47.2%). Of the 114 reported substances for this population, 22.8% involved psychotropic medications, 15.8% analgesics, and 14% Attention Deficit-Hyperactive Disorder (ADHD) medications. Analgesics (13,539;33.6%) were the most common medication category used by all age groups. Typically only one substance (20,549;69.1%) was used.
Conclusion: Undiagnosed ADHD may be a potential underlying cause for self-harming behaviors in the very young. Gender-specific suicide prevention strategies may be more effective at identifying those at risk than traditional measures alone. Further study into admitting practices by emergency physicians is needed to understand the difference in critical care admission rates based on gender. Once identified to be at-risk for suicidal behavior, access to analgesics and psychotropics should be monitored by care-givers especially in those between the ages of 15–18.
Self-poisoning is a top cause of pediatric injury. The 1997–2002 National Hospital Ambulatory Medical Care Survey found the annual emergency department (ED) rate for self-harm in those aged 7–24 was 225.3 per 100,000. It has been reported across all age groups that for nearly every suicide there are 12–15 self-harm related ED visits. The mean charge for each ED visit related to self-harm was found to be $1,874 ($12,801 for visits resulting in hospital admission) with total U.S. hospitalization charges estimated to be $227.85 million. Early identification and effective prevention strategies may ease the health and financial burden for this preventable situation.
Studies have attempted to identify predictors for pediatric suicide. These include demographic and social factors, such as female gender, history of adoption, gay and lesbian youth, depression, history of previous suicide attempt, drug abuse, and poor social support. However, few studies have characterized the clinical features of youth suicide. The National Electronic Injury Surveillance System All Injury Program found that among the 1,197 nonfatal self-harm injury cases between ages 10–14 years treated in an ED from 2001–2003, nearly half of the cases involved either an over-the-counter (OTC) (28.3%) or prescription drug (21%). This study did not detail the OTC and prescription medication(s) used. A non-United States study identified analgesics as a frequent cause of pediatric poisoning from both accidental and intentional exposures, including misuse, abuse, and suicide.
Most of the pediatric suicide literature focuses on demographic and social characteristics. Few studies explore the clinical features of youth suicide by poisoning. The use of both social and clinical features of self-poisoning with suicidal intent could be helpful in enhancing existing and creating new prevention strategies.