Benz Madeline B, Rafferty Neil S, Arias Sarah A, Rabasco Ana, Miller Ivan, Weinstock Lauren M, Boudreaux Edwin D, Camargo Carlos A, Gaudiano Brandon A
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Psychosocial Research Department, Butler Hospital, Providence, Rhode Island, USA.
Acad Emerg Med. 2025 Feb;32(2):147-157. doi: 10.1111/acem.15023. Epub 2024 Sep 20.
Availability and accessibility of a wide range of medications may be a contributing factor to rising medication-related overdose (OD) rates. Treatment for both suicide attempts (SAs) and ODs often occurs in the emergency department (ED), highlighting its potential as a screening and intervention point. The current study aimed to identify sociodemographic and clinical characteristics of individuals who reported SA via medication OD compared to other methods and to examine how these patients' suicide severity and behaviors differed over 12-month post-ED follow-up.
Data were analyzed from Phases 1 and 2 of the Emergency Department Safety Assessment and Follow-up Evaluation multicenter study (N = 1376). Participants with a history of SA (n = 987) were categorized based on whether they indicated a past medication-related SA via OD.
Of participants with history of SA, 62.7% (n = 619) reported medication OD for either their most serious or their most recent SA. Multivariate analyses indicated female birth sex, diagnosis of bipolar disorder, and having some college education were significantly associated with membership in the medication OD attempt group (p <0.05). Of those who attempted suicide over the 12-month follow-up, nearly 60% of participants in the medication OD attempt group reported a subsequent SA via OD over follow-up. However, nearly half (46.5%) of participants with no medication OD at baseline also reported medication OD at follow-up.
Among patients presenting to the ED, females, individuals with bipolar disorder, and patients with a college education, respectively, may be at highest risk for SAs via medication OD. Prospectively, medication OD appears to be a frequent method, even among individuals with no prior attempt via OD, as demonstrated by the high percentage of patients who did not have a medication OD at baseline, but reported a medication OD during follow-up.
广泛可得的各类药物可能是导致与用药相关的过量用药（OD）率上升的一个因素。自杀未遂（SA）和OD的治疗通常在急诊科（ED）进行，这凸显了急诊科作为筛查和干预点的潜力。本研究旨在确定与通过其他方法报告SA的个体相比，通过药物OD报告SA的个体的社会人口学和临床特征，并研究这些患者在急诊科后12个月的随访中自杀严重程度和行为的差异。
对急诊科安全评估和随访评估多中心研究的第1阶段和第2阶段的数据进行分析（N = 1376）。有SA病史的参与者（n = 987）根据他们是否表示过去有过与药物相关的OD自杀未遂进行分类。
在有SA病史的参与者中，62.7%（n = 619）报告其最严重或最近的SA是药物OD。多变量分析表明，女性出生性别、双相情感障碍诊断以及接受过一些大学教育与药物OD未遂组的成员身份显著相关（p < 0.05）。在12个月随访期间自杀未遂的人中，药物OD未遂组中近60%的参与者在随访期间报告随后通过OD自杀未遂。然而，基线时无药物OD的参与者中近一半（46.5%）在随访时也报告了药物OD。
在前往急诊科就诊的患者中，女性、双相情感障碍患者和受过大学教育的患者分别可能是通过药物OD自杀未遂的最高风险人群。前瞻性地看，药物OD似乎是一种常见的方法，即使在之前没有通过OD自杀未遂的个体中也是如此，这一点从基线时没有药物OD但在随访期间报告有药物OD的患者的高比例可以看出。
