Multicenter study of adolescent suicide attempts by poisoning: social, epidemiological, and clinical characteristics.

Abstract

Objective: To evaluate the social, epidemiological, and clinical characteristics of patients brought to Spanish pediatric emergency departments (EDs) after suicide attempts by poisoning. A secondary objective was to identify risk factors for moderate-severe poisoning.

Methods: Prospective multicenter cohort study. We included patients under the age of 18 years who were brought to 20 Spanish pediatric EDs after attempting suicide between January 2021 and June 2022. Case histories were reviewed and the patients were interviewed. A Poisoning Severity Score of 2 or more was classified as moderate-severe.

Results: A total of 592 episodes were studied; 541 of the patients (91.4%) were girls. The median (P25-P75) age was 14.6 years (13.6-15.7 years). A psychiatric diagnosis had been made in 417 (70.4%), 334 (56.4%) had attempted suicide previously, and 409 (69.1%) had been victims of bullying. Medications were ingested by 584 (98.6%). The most often used were benzodiazepines (used by 222; 37.5%) and paracetamol (by 187; 31.6%). Fifty-three poisonings were classified as moderate-severe. A mental health evaluation was carried out in 585 cases (98.8%). Odds ratios (ORs) indicated that higher risk of moderate-severe poisoning was associated with having an adjustment disorder (OR, 3.2; P25-P75, 1.1-9.0; P = .027), using opioids (OR, 6.4; P25-P75, 1.2-35.4; P = .032), and taking of antidiabetic drugs (OR, 27.6; P25-P75, 1.2-634.9; P = .038). Being a victim of bullying (OR, 0.4; P25-P75, 0.2-0.8; P = .013] and using nonsteroidal anti-inflammatory drugs (OR, 0.3; P25-P75, 0.1-0.8; P = .020) decreased risk.

Conclusions: Pediatric ED visits for suicide attempts by poisoning occur mainly in adolescent girls, and a majority have a medical history of a psychiatric diagnosis, prior suicide attempts, or self-harm behaviors. They have also often experienced bullying. Characteristics that distinguish patients with moderate-severe poisoning are the presence of an adjustment disorder and the use of opioids and antidiabetic drugs, which confer risk for greater severity.