Emergency medicine in the UK is frequently cited by the British media as being like a warzone, and with that in mind I delved back into one my favourite books. It certainly isn’t a modern book and I very much doubt it was written with EM in mind, but there are lessons we can learn […]
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3.5 out of 5 stars
Risk of Suicide Following Deliberate Self-poisoning. Finkelstein Y et al. JAMA Psychiatry 2015 Apr 1 [Epub ahead of print]
The authors primary objective was to determine the risk of subsequent successful suicide in patients discharged from hospital after a first suicide attempt. They used multiple healthcare databases to identify patients hospitalized for first suicide attempt in Ontario, Canada from April 2002 through December 2010. Subjects identified were followed through the end of 2011. For each subject a control patient without history of self-poisoningt was selected, matched for age, gender, and calendar year.
The search identified 65,784 patients discharged from hospital or the emergency department after a first suicide attempt. These patients were followed for a median of 5.3 years. Of these, 976 committed suicide and were over 40 times more likely to do so than controls. Overdose was the method in 41% of subjects who ultimately killed themselves. The median time from initial self-poisoning to completed suicide was 585 days.
Given the immensity of the problem, the (relatively) small percentage of patients who went on to kill themselves during the follow-up period, and the length of time from first attempt to completed suicide, I have my doubts that much can done to approach this problem as a public health issue. However, these results lead to some important considerations for medical toxicologists, emergency medicine practitioners, and psychiatrists. I sometimes find it astounding how often patients who have attempted self-harm with their own particularly dangerous psychiatric medication — drugs such as tricyclics, venlafaxine, and bupropion — are discharged from hospital on that same medication. Certainly any patient who presents with a suicide attempt should have a thorough re-evaluation of his or her drug regimen by a psychiatrist and psychiatric pharmacologist to determine which medications are dangerous, which are essential, and which could be replaced by less risky alternatives.