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Repetition of intentional drug overdose: a population-based study |
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| Authors: | Yaron Finkelstein Erin M Macdonald Simon Hollands Marco L A Sivilotti Janine R Hutson Muhammad M Mamdani |
| Institution: | 1. Division of Emergency Medicine, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Canada;2. Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Canada;3. Child Health Evaluative Sciences, Research Institute, the Hospital for Sick Children, Toronto, Canada;4. The Institute for Clinical Evaluative Sciences, Toronto, Canada;5. Department of Emergency Medicine, Queen’s University, Kingston, Canada;6. Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Canada;7. Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Canada;8. Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada;9. Dalla Lana School of Public Health, 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. Methods: 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. |
| Keywords: | Recidivism self-poisoning suicide |