TY - JOUR PY - 2015// TI - Long-term outcomes following self-poisoning in adolescents: a population-based cohort study JO - Lancet psychiatry A1 - Finkelstein, Yaron A1 - Macdonald, Erin M. A1 - Hollands, Simon A1 - Hutson, Janine R. A1 - Sivilotti, Marco L. A. A1 - Mamdani, Muhammad M. A1 - Koren, Gideon A1 - Juurlink, David N. SP - 532 EP - 539 VL - 2 IS - 6 N2 - BACKGROUND: Suicide is the third most common cause of death among adolescents worldwide, and poisoning is the leading method of attempted suicide. Unlike more violent methods, survival after self-poisoning is common, providing an opportunity for secondary prevention. We determined the risk and time course of completed suicide after adolescent self-poisoning, and explored potential risk factors.

METHODS: We did a population-based cohort study using multiple linked health-care databases in Ontario, Canada, from Jan 1, 2001, to Dec 31, 2012. We identified all adolescents aged 10-19 years presenting to hospital after a first self-poisoning episode. Each was matched with 50 population-based reference individuals with no such history, matching on age, sex, and year of cohort entry. The primary outcome was the risk of suicide after a first self-poisoning episode. Secondary analyses explored factors associated with suicide and self-poisoning repetition.

FINDINGS: We identified 20 471 adolescents discharged from hospital after a first self-poisoning episode and 1 023 487 matched reference individuals. Over a median follow-up of 7·2 years (IQR 4·2-9·7), 248 (1%) adolescents discharged after self-poisoning died, 126 (51%) of whom died by suicide. The risk of suicide at 1 year after self-poisoning was greatly increased relative to reference individuals (hazard ratio [HR] 32·1, 95% CI 23·6-43·6), corresponding to a suicide rate of 89·6 (95% CI 75·2-106·7) per 100 000 person-years over the course of follow-up. The median time from hospital discharge to suicide was 3·0 years (IQR 1·1-5·3). Factors associated with suicide included recurrent self-poisoning (adjusted HR 3·5, 95% CI 2·4-5·0), male sex (2·5, 1·8-3·6) and psychiatric care in the preceding year (1·7, 1·1-2·5). Adolescents admitted to hospital for self-poisoning were also more likely to die from accidents (5·2, 4·1-6·6) and from all causes (3·9, 2·8-5·4) during follow-up.

INTERPRETATION: Self-poisoning in adolescence is a strong predictor of suicide and premature death in the ensuing decade, and identifies a high-risk group for targeted secondary prevention. Suicide risk is increased for many years after the index hospital admission, emphasising the importance of sustained prevention efforts. FUNDING: The Canadian Drug Safety and Effectiveness Research Network, Ontario Ministry of Health and Long-Term Care, Paediatric Consultants Partnership.

Language: en

LA - en SN - 2215-0374 UR - http://dx.doi.org/10.1016/S2215-0366(15)00170-4 ID - ref1 ER -