@article{ref1,
title="Repetition of intentional drug overdose: a population-based study",
journal="Clinical toxicology (Philadelphia, Pa.)",
year="2016",
author="Finkelstein, Yaron and Macdonald, Erin M. and Hollands, Simon and Sivilotti, Marco L. A. and Hutson, Janine R. and Mamdani, Muhammad M. and Koren, Gideon and Juurlink, David N.",
volume="54",
number="7",
pages="585-589",
abstract="CONTEXT: Intentional overdose is a leading method of self-harm and suicide, and repeat attempts strongly predict eventual death by suicide. <br><br>OBJECTIVES: To determine the risk of recurrence after a first intentional overdose. Secondary objectives included characterization of the temporal course and potential predictors of repeat overdose, a strong risk factor for death from suicide. <br><br>METHODS: Design: Population-based cohort study. SETTING: Ontario, Canada, from 1 April 2002 to 31 March 2013. PARTICIPANTS: All Ontario residents presenting to an emergency department after a first intentional overdose. MAIN OUTCOME MEASURES: The incidence and timing of recurrent overdose. <br><br>RESULTS: We followed 81,675 patients discharged from hospital after a first intentional overdose. Overall, 13,903 (17.0%) returned with a repeat overdose after a median interval of 288 (inter-quartile range: 62 to 834) days. Of these, 4493 (5.5%) had multiple repeat episodes. Factors associated with repeat self-poisoning included psychiatric care in the preceding year (adjusted hazard ratio [aHR] 1.55; 95% confidence interval [CI] 1.50 to 1.61), alcohol dependence (aHR 1.41; 95% CI 1.35 to 1.46) and documented depression (aHR 1.39; 95% CI 1.34 to 1.44). Female sex, rural residence, lower socioeconomic status, ingestion of psychoactive drugs and younger age were also weakly associated with repeat overdose. <br><br>DISCUSSION: Hospital presentation for repetition of intentional overdose is common, with recurrent episodes often far removed from the first. While several factors predict overdose repetition, none is particularly strong. <br><br>CONCLUSION: Secondary prevention initiatives should be implemented for all individuals who present to the emergency department and survive intentional overdose.<p /> <p>Language: en</p>",
language="en",
issn="1556-3650",
doi="10.1080/15563650.2016.1177187",
url="http://dx.doi.org/10.1080/15563650.2016.1177187"
}