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

Abstract

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.

Self‐harm by single‐ and multi‐agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022

“…To our knowledge, there are no previous reports in literature of the longitudinal prevalence of self‐harm cases involving just one medication, as number of medications involved is not consistently treated as a variable of interest. This is remarkable considering that single‐agent cases are the majority among self‐harm poisonings 2,8 . The increase found here is of clinical relevance in that, as our data show, these cases are usually very mild in severity, with patients mostly asymptomatic, compared with patients with multi‐agent poisonings that usually present signs and symptoms.…”

“…This is remarkable considering that singleagent cases are the majority among self-harm poisonings. 2,8 The increase found here is of clinical relevance in that, as our data show, these cases are usually very mild in severity, with patients mostly asymptomatic, compared with patients with multi-agent poisonings that usually present signs and symptoms. Single-agent type of poisoning usually has a very favorable outcome if the appropriate treatment is promptly initiated, as for acetaminophen poisonings.…”

“…Among the diverse methods of self‐harm, intentional poisoning by medications represents the vast majority of ED hospital presentations, especially in young adolescents 2,3 . Prevalence estimates of these hospital presentations vary greatly between countries, ranging from 3.4 to 2.2/10 000 population, respectively for females and males, in Australia, 4 7.7 and 5.7 in Ireland, 5 10 and 5 in Denmark 6 to up to 38 and 27.3 in the United Kingdom 7 and 40 and 18.6 in the United States 8 . The age group of 15–18 years appears to be particularly prone to the behavior, 1,2,9 and within this age group, females account for 61%–76% of cases 1,2,4,10 .…”

“…2,3 Prevalence estimates of these hospital presentations vary greatly between countries, ranging from 3.4 to 2.2/10 000 population, respectively for females and males, in Australia, 4 7.7 and 5.7 in Ireland, 5 10 and 5 in Denmark 6 to up to 38 and 27.3 in the United Kingdom 7 and 40 and 18.6 in the United States. 8 The age group of 15-18 years appears to be particularly prone to the behavior, 1,2,9 and within this age group, females account for 61%-76% of cases. 1,2,4,10 While other risk factors for self-harm in general are well defined and include sexual orientation, employment, characteristics of family environment as well as psychiatric and psychological disorders, 11 data on risk factors specific for self-harm by medication poisoning is still lacking.…”

“…23 The aim of this study was therefore to describe the occurrence and characteristics of self-harm by medication poisoning from 2018 to the December 31, 2022 through a retrospective analysis of calls to the PCC. Moreover, although the literature suggests that the majority of self-harm cases consist in single-agent exposures, 2,8 very little is known on the relative temporal trends of single-agent versus multiple agents' poisonings. We were therefore interested in querying the database to address this gap.…”