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The Hospital Management of Fatal Self-Poisoning in Industrialized Countries: An Opportunity for Suicide Prevention?

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  • This study was funded by the UK Department of Health. Views expressed in this paper are those of the authors and not necessarily those of the Department of Health. Keith Hawton is supported by the Oxfordshire Mental Healthcare NHS Trust and Sue Simkin by Oxfordshire Research and Development Consortium Strategic Research Fund. We would like to thank Anita Brock of the Office for National Statistics for providing the general population suicide data used in her published report of suicide in England and Wales (Brock & Griffiths, 2003), Garry Stork for secretarial support, and Michael Eddleston and Andrew Dawson for their comments on the manuscript.

Centre for Suicide Prevention, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, England; E-mail: nav.kapur@manchester.ac.uk

Abstract

Suicide by self-poisoning is a prevalent cause of death worldwide. A substantial proportion of individuals who poison themselves come into contact with medical services before they die. Our focus in the current study was the medical management of drug self-poisoning in industrialized countries and its possible contribution to suicide prevention. We reviewed the literature to determine the proportion of self-poisoning suicides who reach hospital alive, the sociodemographic and clinical characteristics of in-hospital overdose deaths, the in-hospital management this group of patients receives, and whether there are specific aspects of pre-hospital care and in-hospital management that have the potential to improve survival. Between 11% and 28% of individuals who died following deliberate ingestion of drugs reached hospital alive. The substances which were most frequently implicated in death were paracetamol (acetaminophen) and paracetamol compounds, tricyclic antidepressants, and benzodiazepines. Most patients received fairly intensive treatment, yet death may have been preventable in a small proportion of cases. Only one intervention (the administration of acetylcysteine) was shown to reduce mortality and this was in a highly selected group of patients (those who had ingested paracetamol and developed fulminant hepatic failure). It is possible that other interventions such as better airway management, the prompt administration of activated charcoal, and improved pre-hospital care may improve outcomes but their potential contribution to suicide prevention needs to be investigated in future studies.

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