title: The impact of rural residence on medically serious medicinal self-poisonings.
abstract: OBJECTIVE
  Suicide rates are often high in rural areas. Despite the strong association between deliberate self-harm (DSH) and suicide, few have studied rural residence and DSH. Self-poisonings dominate DSH hospital presentations. We investigate a previously reported association between rural residence and medical severity (defined as a subsequent medical/surgical inpatient stay) among emergency department presentations for medicinal self-poisoning (SP) to determine whether differences in agents taken, mental health service use or hospital-level resources explain the relationship.
  
  
  METHODS
  A cohort of n=16,294 12-64-year olds presenting with SP to hospital emergency departments in Ontario, Canada, in 2001/2002 was linked to their service records over time.
  
  
  RESULTS
  The rural-medical severity association was best explained by differences in hospital resources; presenting to hospitals providing inpatient psychiatric services appeared to reduce medical/surgical inpatient stays in favor of psychiatric ones. Among those with a recent psychiatric admission, more intensive ambulatory psychiatric contact may be protective of a psychiatric inpatient stay subsequent to the SP presentation. Compared to nonrural residents, deliberate intent was identified less often in rural residents, particularly males.
  
  
  CONCLUSIONS
  The rural-medical severity association was best explained by disparities in the delivery systems serving rural and nonrural residents, important to rural suicide prevention efforts.
authors.affiliation: Suicide Studies Unit, St. Michael's Hospital, Toronto, ON, Canada M5B 1W8. rhodesa@smth.toronto.on.ca
authors.forename: Anne
authors.initials: A
authors.lastname: Rhodes
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bethell
authors.forename: R Liisa
authors.initials: RL
authors.lastname: Jaakkimainen
authors.forename: Julie
authors.initials: J
authors.lastname: Thurlow
authors.forename: Julie
authors.initials: J
authors.lastname: Spence
authors.forename: Paul S
authors.initials: PS
authors.lastname: Links
authors.forename: David L
authors.initials: DL
authors.lastname: Streiner
mesh_terms: D000293:Adolescent; D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology; D000437:Alcoholism / Q000453:epidemiology; D000700:Analgesics / Q000506:poisoning; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D009864:Ontario; D010343:Patient Admission / Q000706:statistics & numerical data; D011041:Poisoning / Q000453:epidemiology*; D055553:Prescription Drugs / Q000506:poisoning*; D012424:Rural Population / Q000706:statistics & numerical data*; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000700:Analgesics; D055553:Prescription Drugs