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Hospital admission for non-fatal poisoning with weak analgesics and risk for subsequent suicide: a population study

Published online by Cambridge University Press:  09 April 2009

P. Qin ,
P. Jepsen ,
B. Nørgård ,
E. Agerbo ,
P. B. Mortensen ,
H. Vilstrup  and
H. T. Sørensen
P. Qin*
Affiliation:
National Centre for Register-based Research, University of Aarhus, Denmark
P. Jepsen
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
B. Nørgård
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
E. Agerbo
Affiliation:
National Centre for Register-based Research, University of Aarhus, Denmark
P. B. Mortensen
Affiliation:
National Centre for Register-based Research, University of Aarhus, Denmark
H. Vilstrup
Affiliation:
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
H. T. Sørensen
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
*
*Address for correspondence: P. Qin, M.D., Ph.D., National Centre for Register-based Research, University of Aarhus, Taasingegade 1, DK-8000, Aarhus C, Denmark. (Email: pq@ncrr.dk)
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Abstract

Background

Poisoning with weak analgesics is a major public health problem because of easy accessibility of the compounds; however, few studies have investigated their influence on subsequent suicide in the context of subjects' psychiatric status and other factors.

Method

This nested case-control study was based on the entire Danish population including all 21 169 suicide cases and 423 128 matched population controls. Data on hospital admissions for poisoning and confounding factors were retrieved from national medical and administrative registries. Conditional logistic regression was used to compute relative risk.

Results

A prior hospital admission for poisoning with weak non-opioid analgesics significantly increased the risk of subsequent suicide [crude incidence rate ratio (IRR) 24.7, 95% confidence interval (CI) 22.1–27.6], and the effect of paracetamol poisoning was substantially stronger than that of poisoning with salicylates or non-steriodal anti-inflammatory drugs (NSAIDs). This association could not be explained by confounding from socio-economic or psychiatric factors. The elevated risk was extremely high during the first week following the overdose (adjusted IRR 738.9, 95% CI 173.9–3139.1), then declined over time but still remained significantly high 3 years later (adjusted IRR 4.2, 95% CI 3.5–5.0). Moreover, a history of weak analgesic poisoning significantly interacted with a person's psychiatric history, increasing the risk for subsequent suicide substantially more for persons with no history of psychiatric hospitalization than did it for those with such a history.

Conclusions

A history of non-fatal poisoning with weak analgesics is a strong predictor for subsequent suicide. These results emphasize the importance of intensive psychiatric care of patients following overdose.

Keywords

Non-fatal poisoningpopulation studyrisk factorssuicide completionweak analgesics
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 11 , November 2009 , pp. 1867 - 1873
Copyright
Copyright © Cambridge University Press 2009

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References

Andersen, TF, Madsen, M, Jorgensen, J, Mellemkjoer, L, Olsen, JH (1999). The Danish National Hospital Register. A valuable source of data for modern health sciences. Danish Medical Bulletin 46, 263–268.Google Scholar
Bateman, DN, Gorman, DR, Bain, M, Inglis, JH, House, FR, Murphy, D (2006). Legislation restricting paracetamol sales and patterns of self-harm and death from paracetamol-containing preparations in Scotland. British Journal of Clinical Pharmacology 62, 573–581.CrossRefGoogle ScholarPubMed
Clayton, D, Hills, M (1993). Statistical Models in Epidemiology. Oxford University Press: Oxford.Google Scholar
Clemmesen, JO, Larsen, FS, Ott, P, Hansen, BA (1995). Paracetamol poisoning at a department of hepatology [in Danish]. Ugeskrift for Laeger 157, 877–880.Google Scholar
Conwell, Y, Duberstein, P, Caine, E (2002). Risk factors for suicide in later life. Biological Psychiatry 52, 193–204.CrossRefGoogle ScholarPubMed
Danish Medicines Agency (1999). Medicinal Products Statistics 1994–1998. Schultz Information: Albertslund, Denmark.Google Scholar
Danish Medicines Agency (2003). Medicinal Products Statistics 1998–2002. Schultz Information: Albertslund, Denmark.Google Scholar
Danmarks Statistik (1991). IDA: An Integrated Database for Labour Market Research [in Danish]. Danmarks Statistiks trykkeri: Copenhagen.Google Scholar
Dargan, PI, Wallace, CI, Jones, AL (2002). An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose. Emergercy Medicine Journal 19, 206–209.CrossRefGoogle ScholarPubMed
Gunnell, D, Murray, V, Hawton, K (2000). Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse. Suicide and Life-Threatening Behaviour 30, 313–326.CrossRefGoogle ScholarPubMed
Hawkins, LC, Edwards, JN, Dargan, PI (2007). Impact of restricting paracetamol pack sizes on paracetamol poisoning in the United Kingdom: a review of the literature. Drug Safety 30, 465–479.CrossRefGoogle ScholarPubMed
Hawton, K, Simkin, S, Deeks, J, Cooper, J, Johnston, A, Waters, K, Arundel, M, Bernal, W, Gunson, B, Hudson, M, Suri, D, Simpson, K (2004). UK legislation on analgesic packs: before and after study of long term effect on poisonings. British Medical Journal 329, 1076.Google Scholar
Hawton, K, Zahl, D, Weatherall, R (2003). Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry 182, 537–542.CrossRefGoogle ScholarPubMed
Isometsa, ET, Lonnqvist, JK (1998). Suicide attempts preceding completed suicide. British Journal of Psychiatry 173, 531–535.CrossRefGoogle ScholarPubMed
Jenkins, R, Singh, B (2000). General population strategies of suicide prevention. In The International Handbook of Suicide and Attempted Suicide (ed. Hawton and, K.van Heeringen, K.), pp. 597–625. Wiley: Chichester, UK.Google Scholar
Jepsen, P, Qin, P, Norgard, B, Agerbo, E, Mortensen, PB, Vilstrup, H, Sørensen, HT (2005). The association between admission for poisoning with paracetamol or other weak analgesics and subsequent admission for psychiatric disorder: a Danish nationwide case-control study. Alimentary Pharmacology and Therapeutics 22, 645–651.Google Scholar
Juel, K, Helweg-Larsen, K (1999). The Danish registers of causes of death. Danish Medical Bulletin 46, 354–357.Google Scholar
Moller, LR, Nielsen, GL, Olsen, ML, Thulstrup, AM, Mortensen, JT, Sorensen, HT (2004). Hospital discharges and 30-day case fatality for drug poisoning: a Danish population-based study from 1979 to 2002 with special emphasis on paracetamol. European Journal of Clinical Pharmacology 59, 911–915.Google Scholar
Mortensen, PB, Agerbo, E, Erikson, T, Qin, P, Westergaard-Nielsen, N (2000). Psychiatric illness and risk factors for suicide in Denmark. Lancet 355, 9–12.CrossRefGoogle ScholarPubMed
Munk-Jorgensen, P, Mortensen, PB (1997). The Danish Psychiatric Central Register. Danish Medical Bulletin 44, 82–84.Google ScholarPubMed
Nordentoft, M (2004). Pack sizes of milder over-the-counter analgetic agents [in Danish]. Ugeskrift for Laeger 166, 503–504.Google Scholar
Nordentoft, M, Breum, L, Munck, LK, Nordestgaard, AG, Hunding, A, Laursen Bjaeldager, PA (1993). High mortality by natural and unnatural causes: a 10 year follow up study of patients admitted to a poisoning treatment centre after suicide attempts. British Medical Journal 306, 1637–1641.Google Scholar
Ott, P, Dalhoff, K, Hansen, PB, Loft, S, Poulsen, HE (1990). Consumption, overdose and death from analgesics during a period of over-the-counter availability of paracetamol in Denmark. Journal of Internal Medicine 227, 423–428.CrossRefGoogle ScholarPubMed
Pedersen, CB, Gotzsche, H, Moller, JO, Mortensen, PB (2006). The Danish Civil Registration System. A cohort of eight million persons. Danish Medical Bulletin 53, 441–449.Google ScholarPubMed
Qin, P, Agerbo, E, Mortensen, PB (2003). Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. American Journal of Psychiatry 160, 765–772.Google Scholar
SAS Institute (1999). The PHREG procedure. In SAS/STAT User's Guide, Version 8, pp. 2569–2657. SAS Institute Inc.: Cary, NC.Google Scholar
Skegg, K (2005). Self-harm. Lancet 366, 1471–1483.CrossRefGoogle ScholarPubMed
Sundhedsstyrelsen (1998). Proposal for a national programme for prevention of suicide and suicide attempt in Denmark [in Danish]. Sundhedsstyrelsen (The Danish National Board of Health): Copenhagen.Google Scholar
Sundhedsstyrelsen (2008). Mandatory Contents of General Registration on Hospital Patients 2009 [in Danish]. Sundhedsstyrelsen (The Danish National Board of Health): Copenhagen (www.sst.dk/upload/informatik_og_sundhedsdata/sundhedsstatistik/patientregistrering_obl_dec07/fi%202009.pdf). Accessed 8 January 2009.Google Scholar
Wallace, CI, Dargan, PI, Jones, AL (2002). Paracetamol overdose: an evidence based flowchart to guide management. Emergency Medicine Journal 19, 202–205.CrossRefGoogle ScholarPubMed