1 Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.
2 European Centre for Environment and Human Health, Medical School, University of Exeter, Truro, UK.
Aust N Z J Psychiatry. 2018 Mar;52(3):271-278. doi: 10.1177/0004867417722639. Epub 2017 Aug 1.
Investigating diurnal variation in the timing of suicidal behaviours offers opportunity to better understand its various proximal risk factors. Acute use of alcohol is a potent proximal risk factor for suicidal behaviour, though the nature of this risk is poorly understood. The aim of this study was to compare the diurnal variation in time of poison ingestion between deliberate self-poisonings that involve alcohol versus those that do not.
A retrospective analysis of consecutive presentations to a toxicology service following deliberate self-poisoning, 1996-2016. An independent samples Kolmogorov-Smirnov test was performed to test the null hypothesis that the diurnal distribution of poison ingestion time was equal across self-poisonings that did and did not involve alcohol co-ingestion. Presence of circadian rhythmicity was established using cosinor analysis.
A total of 11,088 deliberate self-poisoning records, for 7467 patients (60.8% females), were included in the analysis. In all, 31.3% of the total records involved alcohol co-ingestion. Distribution of exposure time was significantly different between deliberate self-poisonings that did and did not involve alcohol ( p < 0.001). The alcohol co-ingestion group showed a significantly greater prominent peak with poisoning occurring later in the evening (20:00 hours) compared to poisonings that did not involve alcohol (18:00 hours).
This study exposed the differential diurnal patterns in deliberate self-poisoning according to the presence of alcohol co-ingestion. This analysis adds to the accumulating evidence that suicidal behaviour that involves alcohol co-ingestion represents a distinct subtype, which may be driven by alcohol consumption patterns in society. This also means that this large proportion of deliberate self-poisonings may not otherwise have occurred if it were not for alcohol consumption, underscoring the importance of drug and alcohol services for alcohol-related self-harm.
研究自杀行为发生时间的昼夜变化，为更好地了解其各种近端风险因素提供了机会。急性使用酒精是自杀行为的一个强有力的近端风险因素，但对这种风险的性质知之甚少。本研究旨在比较涉及酒精与不涉及酒精的故意自我中毒时间的昼夜变化。
对 1996 年至 2016 年连续到毒物服务中心就诊的故意自我中毒者进行回顾性分析。采用独立样本 Kolmogorov-Smirnov 检验来检验一个无效假设，即是否涉及酒精共摄入，对摄入毒物时间的昼夜分布是否相等。采用余弦分析确定是否存在昼夜节律性。
共纳入 7467 例（60.8%为女性）11088 例故意自我中毒记录。总记录中有 31.3%涉及酒精共摄入。是否涉及酒精共摄入，暴露时间的分布有显著差异（p<0.001）。酒精共摄入组中毒时间明显较晚（约 20:00 小时），与不涉及酒精组（约 18:00 小时）相比，明显有一个更大的突出高峰。
本研究根据是否存在酒精共摄入，揭示了故意自我中毒的不同昼夜模式。这一分析增加了越来越多的证据，即涉及酒精共摄入的自杀行为代表了一种独特的亚型，这可能是由社会中酒精消费模式驱动的。这也意味着，如果不是因为酒精的消费，这一大部分故意自我中毒本来是不会发生的，这凸显了药物和酒精服务对于与酒精有关的自我伤害的重要性。
