Non-suicidal deaths following hospital-treated self-poisoning.
OBJECTIVE
To quantify the non-suicidal mortality subsequent to hospital treated self-poisoning, and to identify risk factors for non-suicidal death.


METHODS
A prospective longitudinal cohort design was used, with data-linkage between the Hunter Area Toxicology Service database and the National Death Index. All patients with deliberate self-poisoning for a 10-year period (1991-2000) were studied and the first episode in the period was used as the index episode. The outcomes were: accidental, 'natural' and non-suicidal death, with follow-up for the study duration.


RESULTS
There were 4044 patients studied, and 170 (4.2%) of these had non-suicidal death; 64 were accidental and 106 were 'natural' cause deaths. The standardized mortality ratio (95% CI) for non-suicidal death for males, females and combined were 4.98 (4.08-6.07), 3.78 (3.0-4.75) and 4.20 (3.62-4.88), respectively. The increased mortality was apparent for both males and females, and was more marked in the younger age groups. For non-suicidal death the adjusted hazard ratio (95% CI) for increased risk were: increasing age 1.07 (1.06-1.08), male gender 1.77 (1.24-2.52), psychiatric diagnosis of substance related disorder 1.49 (1.03-2.16), prescription of a respiratory drug 2.69 (1.31-5.55), and prescription of an anti-diabetic drug 1.95 (0.93-4.07), while psychiatric diagnosis of adjustment disorder 0.64 (0.38-1.053) was associated with decreased risk.


CONCLUSIONS
Patients who present with self-poisoning have increased mortality from accidental and 'natural' causes. Long-term treatment goals for these patients need to address non-suicide mortality in addition to suicide mortality.
Carter
Greg
G
Children's Pavillion, Dunedin Public Hospital, Dunedin, New Zealand.
Reith
David M
DM
Whyte
Ian M
IM
McPherson
Michelle
M
D000059:Accidents / Q000401:mortality; D000275:Adjustment Disorders / Q000401:mortality; D000328:Adult; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000401:mortality; D001315:Australia; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000506:poisoning; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D011041:Poisoning / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000401:mortality*; D012737:Sex Factors; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000401:mortality; D013405:Suicide / Q000706:statistics & numerical data
D007004:Hypoglycemic Agents