Age–sex differences in medicinal self-poisonings

Rhodes, Anne E.; Bethell, Jennifer; Spence, Julie; Links, Paul S.; Streiner, David L.; Jaakkimainen, R. Liisa

doi:10.1007/s00127-008-0349-6

Cited by 33 publications

(5 citation statements)

References 42 publications

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“…Emergency department data provide more representative information than inpatient admissions; 12 less than half of those who pres-ent to the emergency department for self-harm are admitted and admission is associated with various factors, including method of self-harm. 21 The epidemiology and characteristics of emergency department presentations for self-harm among Ontario youth are quite consistent with those reported from other countries, suggesting generalizability of study results between populations. However, it is unclear whether these findings extend across Canada.…”

Section: Generalizabilitysupporting

confidence: 81%

“…incidence rates are strikingly similar to those in the United States 19 and Ireland. 20 While rates reported from England are considerably higher, 11 each of these international data have consistently found girls outnumber boys; frequency increases with age; and method of self-harm is most often self-poisoning, then self-cutting (in fact, similar to the results from England, a previous study showed Ontario youth most often self-poisoned with analgesics, typically acetaminophen, then antidepressants 21 ). The association with neighbourhood income has also been reported among youth in England, 22 and is thought to involve mechanisms including family (genetic and environmental factors), exposure to violence, lifestyle (e.g., substance abuse) and housing.…”

Section: Discussionmentioning

confidence: 79%

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Emergency Department Presentations for Self-harm Among Ontario Youth

Bethell

Bondy

Lou

et al. 2013

Can J Public Health

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OBJECTIVES: Self-harm is an important public health issue among youth, including as a major risk factor for suicide (a leading cause of death in this age group). This study used population-based emergency department data to describe clinical and demographic characteristics of emergency department presentations for self-harm among youth (12-17 year-olds) in the province of Ontario, Canada. METHODS: Administrative data capturing every emergency department visit in Ontario between April 1, 2002 and March 31, 2009 were used to identify and describe self-harm presentations. RESULTS: Over the 7-year period between 2002/03 and 2008/09, there were 16,835 self-harm presentations by 12,907 youth. Two thirds of self-harm presentations were self-poisonings (almost always with medicinal agents), followed by self-cutting, which accounted for about one quarter. Incidence rates were higher in girls than boys, increased with age, were inversely related to neighbourhood income and were highest in rural areas. Self-harm accounted for about 1 in 100 emergency department presentations by youth, but also a disproportionate number of presentations triaged as high acuity or admitted to hospital (about 1 in 20). CONCLUSION: Self-harm is an important public health issue, requiring a comprehensive approach to prevention. Ontario has useful data with which to study emergency department presentations for self-harm, and the similarities between self-harm presentations among Ontario youth and those reported from the United States and Europe suggest generalizability of results between populations. Further research is needed to address the reasons for the geographic differences in frequency of self-harm.

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Section: Generalizabilitysupporting

confidence: 81%

Section: Discussionmentioning

confidence: 79%

Emergency Department Presentations for Self-harm Among Ontario Youth

Bethell

Bondy

Lou

et al. 2013

Can J Public Health

Self Cite

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“…*Based on previous age categories used in studies of opioid use for pain 39. We will exclude cases where age is reported to be <12 years due to the unclear intention of use in children of this age, consistent with previous research 40 41†The involvement of alcohol is coded as ‘alcohol involved’ and ‘alcohol intoxication’.…”

Section: Methodsmentioning

confidence: 99%

Comparing rates and characteristics of ambulance attendances related to extramedical use of pharmaceutical opioids in Australia: a protocol for a retrospective observational study

et al. 2019

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Introduction and aimsExtramedical use of, and associated harms with pharmaceutical opioids are common. Analysis of coded ambulance clinical records provides a unique opportunity to examine a national population-level indicator of relative harms. This protocol describes an observational study with three aims: (1) to compare supply adjusted rates of pharmaceutical opioid-related ambulance attendances for buprenorphine, codeine, fentanyl, oxycodone, oxycodone-naloxone, morphine, pethidine, tramadol and tapentadol; (2) to compare presentation characteristics for these commonly used pharmaceutical opioids and (3) to describe the context surrounding ambulance presentations related to oxycodone, a widely used opioid with an established abuse liability, and tapentadol, a more recent ‘atypical’ opioid on the Australian market, with fewer studies that have directly examined signals of extramedical use.MethodTrained coders extract data from clinical records for ambulance presentations relating to extramedical use of commonly used pharmaceutical opioids. These data form the basis of a large, national database that captures alcohol-related and drug-related harms. Supply adjusted rates of presentations will be examined using Poisson regression. Multinomial logistic regression will be used to compare severity and other characteristics of attendances relating to different pharmaceutical opioids. Tapentadol-related and oxycodone-related cases will be qualitatively examined to understand the situationally specific contexts of the ambulance attendances outside of the characteristics captured in routinely coded variables.Ethics and disseminationEthics approval related to analysis of ambulance attendance data was obtained from the Eastern Health Human Research Ethics Committee (E122 08–09), with an amendment specific to the qualitative analysis. Findings will be submitted for peer review in 2019. The understanding of risk profiles in real-world settings is of international public health importance. The analysis and publication of findings from this national dataset of clinical records will provide one of the most nuanced analyses to date of relative harms across nine pharmaceutical opioids over a 6-year period.

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“…School-based studies have identified that 7–14 % of 15–16 year olds self-harm with self-cutting being a prominent method [ 17 , 18 ]. However, those presenting to emergency services more commonly present after episodes of self-poisoning or more severe episodes requiring immediate treatment [ 19 , 20 ]. There are approximately 220,000 episodes of self-harm presenting to emergency services each year in the UK, and trends here also indicate a rise in younger age groups [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Young people who self-harm: a prospective 1-year follow-up study

Majid

Tadros

et al. 2015

Soc Psychiatry Psychiatr Epidemiol

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PurposeTo explore repetition, service provision and service engagement following presentation of young people to emergency services with self-harm.Methods969 patients who presented to accident and emergency services after self-harm were followed up prospectively for a period of 1 year. Data on rates, method, clinical history, initial service provision, engagement and repetition (defined as re-presenting to emergency services with further self-harm) were gathered from comprehensive electronic records.ResultsYoung people were less likely to repeat self-harm compared to those aged 25 and above. A psychiatric history and a history of childhood trauma were significant predictors of repetition. Young people were more likely to receive self-help as their initial service provision, and less likely to receive acute psychiatric care or a hospital admission. There were no differences in engagement with services between young people and those aged 25 and above.ConclusionYounger individuals may be less vulnerable to repetition, and are less likely to represent to services with repeated self-harm. All young people who present with self-harm should be screened for mental illness and asked about childhood trauma. Whilst young people are less likely to be referred to psychiatric services, they do attend when referred. This may indicate missed opportunity for intervention.

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Age–sex differences in medicinal self-poisonings

Cited by 33 publications

References 42 publications

Emergency Department Presentations for Self-harm Among Ontario Youth

Emergency Department Presentations for Self-harm Among Ontario Youth

Comparing rates and characteristics of ambulance attendances related to extramedical use of pharmaceutical opioids in Australia: a protocol for a retrospective observational study

Young people who self-harm: a prospective 1-year follow-up study

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