Repeat Self-Harm Following Hospital-Presenting Intentional Drug Overdose among Young People—A National Registry Study

Abstract

Background: The incidence of hospital-presenting self-harm peaks among young people, who most often engage in intentional drug overdose (IDO). The risk of self-harm repetition is high among young people and switching methods between self-harm episodes is common. However, little is known about their patterns of repetition and switching following IDO. This study aimed to investigate repeat self-harm and method-switching following hospital-presenting IDO among young people. Methods: Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 10–24 years during 2009–2018 were examined. Cox proportional hazards regression models with associated hazard ratios (HRs), survival curves and Poisson regression models with risk ratios (RRs), were used to examine risk factors for repetition and method-switching. Results: During 2009–2018, 16,800 young people presented following IDO. Within 12 months, 2136 young people repeated self-harm. Factors associated with repetition included being male (HR = 1.13, 95% CI: 1.03–1.24), aged 10–17 years (HR = 1.29, 95% CI: 1.18–1.41), consuming ≥ 50 tablets (HR = 1.27, 95% CI: 1.07–1.49) and taking benzodiazepines (HR = 1.67, 95% CI: 1.40–1.98) or antidepressants (HR = 1.36, 95% CI: 1.18–1.56). The cumulative risk for switching method was 2.4% (95% CI: 2.2–2.7). Method-switching was most likely to occur for males (RR = 1.36; 95% CI: 1.09–1.69) and for those who took illegal drugs (RR = 1.63; 95% CI: 1.19–2.25). Conclusion: Young males are at increased risk of repeat self-harm and method-switching following IDO and the type and quantity of drugs taken are further indicators of risk. Interventions targeting IDO among young people are needed that ensure that mental health assessments are undertaken and which address access to drugs.

Factors Predicting Successful Suicide Among Adolescents:Multiple Attempts And Index Methods, A Retrospective Cohort Study

“…Of the 69 (30.4%) patients connected with the social care service team (of 227 patients total), only 21(30.4%) agreed to follow ups, and only 11 completed case management a total of four times or reconnected to other social care service teams, while others refused or could not participate in postaccident care. Several studies have reported that the mortality and recurrence rate of suicide signi cantly decreased in patients who underwent follow-up care compared with those who did not [17,20]. Thus, because the prospective study design does not include long term output, mortality would increase.…”

“…However, previous studies distinguished between different types of drugs and found that speci c drugs carried higher risks. Additionally, young adults tend to acquire over-the-counter drugs because many other drugs are not easily acquired [20]. Thus, future studies should consider kinds and amounts of drugs based upon adolescents' characteristics.…”

“…One of multiple studies on the recurrence of suicide in young adults [15][16][17]20] states that changes in the self-harm method are highly likely to occur in young male patients with intentional drug overdose, however, its association with mortality is unclear [20]. Thus, there is a shortage of studies focusing on the success rate of suicide that consider its severity with change, irrespective of the rate of recurrence by young adults.…”

Factors predicting meaningful suicide attempts: multiple attempts and index methods

“…However, switching to more lethal methods is a predictor of completed suicide in adults (adjusted hazard ratio, 7.05) 5) . In patients aged 10-24 years with DI, those aged 10-17 years have a 1.3-fold higher risk of repeated self-harm than those aged 18-24 years 6) . Despite the lower severity of suicidal intention and the overuse of over-the-counter medicine in adolescents 7) , their higher rate of repetition of SAs may lead to fatal outcomes.…”

“…Neither changes in the type of drugs in adolescents with DI nor those in the intensity or anatomical region in patients with cutting was regarded as changes in the methods. DI was defined as all types and amounts of potentially lethal drugs whereas previous studies distinguished between different types of drugs and found that specific drugs carried higher risks 6) . The meaningful SA defined above was the primary outcome.…”