Association Between Means Restriction of Poison and Method-Specific Suicide Rates

Lim, Jessy S.; Buckley, Nicholas A; Chitty, Kate M.; Moles, Rebekah; Cairns, Rose

doi:10.1001/jamahealthforum.2021.3042

Cited by 27 publications

(28 citation statements)

References 87 publications

(854 reference statements)

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“…Three basic approaches to self-harm prevention are societal means restriction, screening for at-risk individuals and community-based primary prevention. A recent systematic review23 has found means restriction can reduce self-harm attempts and suicides (without subsequent increases in self-harm and suicides by other mechanisms) based on studies of the impact of removing propoxyphene-containing products and barbiturates. However, wholesale means restriction across all the medication categories commonly involved in self-harm ED visits is not feasible.…”

Section: Discussionmentioning

confidence: 99%

National estimates of emergency department visits for medication-related self-harm: United States, 2016–2019

et al. 2022

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BackgroundMedication poisoning is a common form of self-harm injury, and increases in injuries due to self-harm, including suicide attempts, have been reported over the last two decades.MethodsCross-sectional (2016–2019) data from 60 emergency departments (EDs) participating in an active, nationally representative public health surveillance system were analysed and US national estimates of ED visits for medication-related self-harm injuries were calculated.ResultsBased on 18 074 surveillance cases, there were an estimated 269 198 (95% CI 222 059 to 316 337) ED visits for medication-related self-harm injuries annually in 2016–2019 compared with 1 404 090 visits annually from therapeutic use of medications. Population rates of medication-related self-harm ED visits were highest among persons aged 11–19 years (58.5 (95% CI 45.0 to 72.0) per 10 000) and lowest among those aged ≥65 years (6.6 (95% CI 4.4 to 8.8) per 10 000). Among persons aged 11–19 years, the ED visit rate for females was four times that for males (95.4 (95% CI 74.2 to 116.7) vs 23.0 (95% CI 16.4 to 29.6) per 10 000). Medical or psychiatric admission was required for three-quarters (75.1%; 95% CI 70.0% to 80.2%) of visits. Concurrent use of alcohol or illicit substances was documented in 40.2% (95% CI 36.8% to 43.7%) of visits, and multiple medication products were implicated in 38.6% (95% CI 36.8% to 40.4%). The most frequently implicated medication categories varied by patient age.ConclusionsMedication-related self-harm injuries are an important contributor to the overall burden of ED visits and hospitalisations for medication-related harm, with the highest rates among adolescent and young adult females. These findings support continued prevention efforts targeting patients at risk of self-harm.

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Section: Discussionmentioning

confidence: 99%

National estimates of emergency department visits for medication-related self-harm: United States, 2016–2019

et al. 2022

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“…Hanging/suffocation or poisoning may have been used as a substitution of a firearm for some decedents who had disclosed their suicide intent, even though individual-level substitution of methods is difficult to assess ( 36 , 37 ). While means restriction at the population level has strong empirical support as a suicide prevention strategy ( 38 , 39 ), individuals with strong intention to die could have used the next lethal method, hanging/suffocation or poisoning, when they could not access firearms. Reasons for positive associations between intent disclosure and use of hanging/suffocation and poisoning but not firearms need further examination.…”

Section: Discussionmentioning

confidence: 99%

Three leading suicide methods in the United States, 2017–2019: Associations with decedents' demographic and clinical characteristics

Choi

Marti

Choi

2022

Front. Public Health

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Background and aimsThe U.S. suicide data show that use of lethal methods, specifically firearms and hanging/suffocation, has been increasing among young and middle-aged adults of both sexes over the past decades. In this study, we examined demographic and clinical correlates of use of firearms, hanging/suffocation, and poisoning as suicide methods among suicide decedents age 18+.MethodsData came from the 2017-2019 National Violent Death Reporting System (NVDRS; N = 94,454, age ≥ 18 at the time of suicide; 74,042 men and 20,412 women). We fit generalized linear models (GLMs) for a Poisson distribution with a log link to examine (1) changes in four suicide methods (firearms, hanging/suffocation, poisoning, and other) during the study period, controlling for sex and age group; and (2) correlates of firearms, hanging/suffocation, and poisoning use.ResultsIn all age groups, 55% of men and 30% of women used firearms; 28% of men and 29% of women hanging/suffocation; 9% of men and 32% of women poisoning, and 8% of men and 9% of women “other” methods. Men age < 45 had higher likelihood of firearm and/or hanging/suffocation use than those age 45–64. Women age<45 also had higher likelihood of hanging/suffocation than those age 45–64. Prior suicide attempt history was associated with higher likelihood of poisoning in both sexes and hanging/suffocation in men; mental disorders/SUD were associated with higher likelihood of hanging/suffocation and poisoning in both sexes; physical health problems were associated with higher likelihood poisoning in both sexes and firearm use in men; relationship problems were associated with higher likelihood of firearm use; legal problems and job/financial/housing problems were associated with higher likelihood of hanging/suffocation in both sexes; and more crises were associated with higher likelihood of firearm use in both sexes.ImplicationsThe findings call for the following suicide prevention strategies: (1) restricted access to firearms; (2) improved access to mental health/substance use treatment; (3) improved long-term and palliative care services for those (mostly older adults) with physical health problems; (4) financial/housing support policies to mitigate economic hardship; and (5) more research to identify effective strategies to curtail the increasing use of firearm and hanging/suffocation among young and middle-aged adults.

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“…well as reduced risk of suicide death from other causes. 24 The effects of means restriction interventions are strongest where the target is associated with the greatest lethality. Much of the evidence on means restriction of pharmaceutical drugs relates to drugs where limitations have already been introduced, for example, barbiturates, opioids or benzodiazepines, where strict limitations on prescribing are in place.…”

Section: No Presentationsmentioning

confidence: 99%

Premature mortality in young people accessing early intervention youth mental healthcare: data-linkage cohort study

et al. 2023

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Background Understanding premature mortality risk from suicide and other causes in youth mental health cohorts is essential for delivering effective clinical interventions and secondary prevention strategies. Aims To establish premature mortality risk in young people accessing early intervention mental health services and identify predictors of mortality. Method State-wide data registers of emergency departments, hospital admissions and mortality were linked to the Brain and Mind Research Register, a longitudinal cohort of 7081 young people accessing early intervention care, between 2008 and 2020. Outcomes were mortality rates and age-standardised mortality ratios (SMR). Cox regression was used to identify predictors of all-cause mortality and deaths due to suicide or accident. Results There were 60 deaths (male 63.3%) during the study period, 25 (42%) due to suicide, 19 (32%) from accident or injury and eight (13.3%) where cause was under investigation. All-cause SMR was 2.0 (95% CI 1.6–2.6) but higher for males (5.3, 95% CI 3.8–7.0). The mortality rate from suicide and accidental deaths was 101.56 per 100 000 person-years. Poisoning, whether intentional or accidental, was the single greatest primary cause of death (26.7%). Prior emergency department presentation for poisoning (hazard ratio (HR) 4.40, 95% CI 2.13–9.09) and psychiatric admission (HR 4.01, 95% CI 1.81–8.88) were the strongest predictors of mortality. Conclusion Premature mortality in young people accessing early intervention mental health services is greatly increased relative to population. Prior health service use and method of self-harm are useful predictors of future mortality. Enhanced care pathways following emergency department presentations should not be limited to those reporting suicidal ideation or intent.

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Association Between Means Restriction of Poison and Method-Specific Suicide Rates

Cited by 27 publications

References 87 publications

National estimates of emergency department visits for medication-related self-harm: United States, 2016–2019

National estimates of emergency department visits for medication-related self-harm: United States, 2016–2019

Three leading suicide methods in the United States, 2017–2019: Associations with decedents' demographic and clinical characteristics

Premature mortality in young people accessing early intervention youth mental healthcare: data-linkage cohort study

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