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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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