In the Journals

Pediatric suicide attempts often involve OTC medications

Henry Spiller

Poison control center calls for suspected suicide-related pediatric self-poisonings often involve over-the-counter, or OTC, medications, including analgesics and antihistamines, according to research published in Clinical Toxicology.

Henry Spiller, MS, DABT, director of the Central Ohio Poison Center at Nationwide Children’s Hospital, and colleagues also found that these events occurred more in rural areas and during the school year.

“While most of these cases involved medications, with adolescents, any available medication can be a potential hazard,” Spiller said in a news release. “It’s not so much a matter of substance type, but rather a matter of access to the substance. Any type of medication can be misused and abused in ways that can unfortunately lead to very severe outcomes, including death.”

Spiller and colleagues conducted a retrospective review of suspected suicide self-poisoning cases reported to the National Poison Data system between 2000 and 2018. They collected age-specific data from the United States Census Bureau to compare annual rates.

Pills 
Source: Shutterstock

During the study period, the researchers identified 1,677,435 suspected suicide-related self-poisoning events among patients aged 10 to 25 years. Of these cases, 24.5% had a serious medical outcome. More serious medical events occurred as the patient’s age increased.

According to the researchers, poison control calls for suicide-related self-poisoning increased significantly among children aged 10 to 12 years, 13 to 15 years and 16 to 18 years after 2011. Spiller and colleagues attributed the increase in cases to an increase in self-poisonings among females.

OTC analgesics — including acetaminophen, aspirin and ibuprofen — along with antidepressants, antihistamines and antipsychotics were associated with the highest number of serious medical events. Children aged 10 to 15 years were most likely to use ADHD medication in these events, whereas older age groups most commonly used sedatives and hypnotics.

After 2011, the most serious medical outcomes occurred for self-poisonings involving antidepressants, OTC analgesics, antihistamines and ADHD medications.

“Because medications are so readily available in homes, many families do not take precautions to store them safely. Our findings suggest this is a big problem,” John Ackerman, PhD, a clinical psychologist and suicide prevention coordinator at the Center for Suicide Prevention and Research at Nationwide Children’s Hospital, said in the release. “Medications can be part of effective treatment, but they require an extra layer of care. The answer is not to stop prescribing medications to those who stand to benefit, but rather to emphasize the practice of safe storage and vigilance when administering any kind of medicine, especially when children and teens live in the home.”

Just 7.4% of cases with serious medical outcomes involved opioids, and the number of cases decreased significantly among patients aged 19 to 25 years after 2012.

When the researchers examined geographic trends in self-poisonings, they identified more cases in states with lower population per square mile and a higher number of cases with serious medical outcomes in these states. Further, the researchers noticed a significant decrease in self-poisonings among school-age children when school was not in session (June to August) compared with the school year (September to May).

The latter trend, the researchers wrote, was observed for all cases and all outcomes.

“It should concern us that youth in rural areas are about twice as likely as those living in urban areas to die by suicide. Although we are in dire need of more research to help us understand what places some people at more risk than others, available evidence indicates that include increased social isolation, stigma, access to lethal means and lack of appropriate mental health resources may play a role in this disparity,” Ackerman said.

“It is vital that parents, teachers and other trusted adults start conversations about mental health early, and pay even closer attention during the school year, as rates of anxiety and depression are shown to increase during that time. Warning signs can often be detected, and support is available for young people in crisis.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Henry Spiller

Poison control center calls for suspected suicide-related pediatric self-poisonings often involve over-the-counter, or OTC, medications, including analgesics and antihistamines, according to research published in Clinical Toxicology.

Henry Spiller, MS, DABT, director of the Central Ohio Poison Center at Nationwide Children’s Hospital, and colleagues also found that these events occurred more in rural areas and during the school year.

“While most of these cases involved medications, with adolescents, any available medication can be a potential hazard,” Spiller said in a news release. “It’s not so much a matter of substance type, but rather a matter of access to the substance. Any type of medication can be misused and abused in ways that can unfortunately lead to very severe outcomes, including death.”

Spiller and colleagues conducted a retrospective review of suspected suicide self-poisoning cases reported to the National Poison Data system between 2000 and 2018. They collected age-specific data from the United States Census Bureau to compare annual rates.

Pills 
Source: Shutterstock

During the study period, the researchers identified 1,677,435 suspected suicide-related self-poisoning events among patients aged 10 to 25 years. Of these cases, 24.5% had a serious medical outcome. More serious medical events occurred as the patient’s age increased.

According to the researchers, poison control calls for suicide-related self-poisoning increased significantly among children aged 10 to 12 years, 13 to 15 years and 16 to 18 years after 2011. Spiller and colleagues attributed the increase in cases to an increase in self-poisonings among females.

OTC analgesics — including acetaminophen, aspirin and ibuprofen — along with antidepressants, antihistamines and antipsychotics were associated with the highest number of serious medical events. Children aged 10 to 15 years were most likely to use ADHD medication in these events, whereas older age groups most commonly used sedatives and hypnotics.

After 2011, the most serious medical outcomes occurred for self-poisonings involving antidepressants, OTC analgesics, antihistamines and ADHD medications.

“Because medications are so readily available in homes, many families do not take precautions to store them safely. Our findings suggest this is a big problem,” John Ackerman, PhD, a clinical psychologist and suicide prevention coordinator at the Center for Suicide Prevention and Research at Nationwide Children’s Hospital, said in the release. “Medications can be part of effective treatment, but they require an extra layer of care. The answer is not to stop prescribing medications to those who stand to benefit, but rather to emphasize the practice of safe storage and vigilance when administering any kind of medicine, especially when children and teens live in the home.”

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Just 7.4% of cases with serious medical outcomes involved opioids, and the number of cases decreased significantly among patients aged 19 to 25 years after 2012.

When the researchers examined geographic trends in self-poisonings, they identified more cases in states with lower population per square mile and a higher number of cases with serious medical outcomes in these states. Further, the researchers noticed a significant decrease in self-poisonings among school-age children when school was not in session (June to August) compared with the school year (September to May).

The latter trend, the researchers wrote, was observed for all cases and all outcomes.

“It should concern us that youth in rural areas are about twice as likely as those living in urban areas to die by suicide. Although we are in dire need of more research to help us understand what places some people at more risk than others, available evidence indicates that include increased social isolation, stigma, access to lethal means and lack of appropriate mental health resources may play a role in this disparity,” Ackerman said.

“It is vital that parents, teachers and other trusted adults start conversations about mental health early, and pay even closer attention during the school year, as rates of anxiety and depression are shown to increase during that time. Warning signs can often be detected, and support is available for young people in crisis.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.