The Hospital Management of Fatal Self‐Poisoning in Industrialized Countries: An Opportunity for Suicide Prevention?

Abstract

Suicide by self-poisoning is a prevalent cause of death worldwide. A substantial proportion of individuals who poison themselves come into contact with medical services before they die. Our focus in the current study was the medical management of drug self-poisoning in industrialized countries and its possible contribution to suicide prevention. We reviewed the literature to determine the proportion of self-poisoning suicides who reach hospital alive, the sociodemographic and clinical characteristics of in-hospital overdose deaths, the in-hospital management this group of patients receives, and whether there are specific aspects of pre-hospital care and in-hospital management that have the potential to improve survival. Between 11% and 28% of individuals who died following deliberate ingestion of drugs reached hospital alive. The substances which were most frequently implicated in death were paracetamol (acetaminophen) and paracetamol compounds, tricyclic antidepressants, and benzodiazepines. Most patients received fairly intensive treatment, yet death may have been preventable in a small proportion of cases. Only one intervention (the administration of acetylcysteine) was shown to reduce mortality and this was in a highly selected group of patients (those who had ingested paracetamol and developed fulminant hepatic failure). It is possible that other interventions such as better airway management, the prompt administration of activated charcoal, and improved pre-hospital care may improve outcomes but their potential contribution to suicide prevention needs to be investigated in future studies.

Suicidal intention, psychosocial factors and referral to further treatment: A one-year cross-sectional study of self-poisoning

“…It is unclear whether the morbidity of the substance users treated in emergency departments has been underestimated [10]. The risk of further suicidal behavior in patients reporting suicidal intention has led to psychiatric follow-up of these patients; being referred for specialist follow-up reduces the risk of a repeat attempt [11]. Suicide attempters who suffer from substance use disorders are less likely to receive psychiatric follow-up [12].…”

The Effect of Active Treatment and Visit Compared to Conventional Treatment, on Preventing Recurrent Suicidal Attempts: A Randomized Controlled Clinical Trial

“…In the study conducted by Kapur et al . [4] and Cederke et al . [12] the majority of recurrent suicide attempters had a history of chronic psychiatric disorders.…”

“…[12] Suicide prevention was declared as a basic measure by WHO. [34] Proposer interventions can adjust or eliminate the frequency of suicide. [56] According to WHO estimates, every second a suicide attempt occurs and one dies of suicide every 40 sec.…”

Use of Over-The-Counter Analgesics for Pain and Psychological Distress Among Adolescents: A Mixed Effects Approach in Cross-Sectional Survey Data From Norway

“…Frequent OTCA use for headaches, and other forms of pain, can cause chronic headaches, and frequent use of Ibuprofen, anxiety and depression, and being female are among the factors that increase the risk of OTCA-induced chronic headaches [39,40]. Paracetamol is the most frequently ingested compound in intentional overdosing and causes liver failure [41,42]. Adolescent females are more likely to report deliberate self-poisoning with Paracetamol [43].…”