Summary

Multicenter study of adolescent suicide attempts by poisoning: social, epidemiological, and clinical characteristics

Lorena Algarrada Vico¹, Lidia Martínez-Sánchez^1,2, Irene Baena Olomí³, Consuelo Benito Caldés⁴, Ana Rodríguez Varela⁵, Victoria López-Corominas⁶, Jara Gaitero Tristán⁷, Liliana Mangione Cardarella⁸, Ana Peñalba Cítores⁹, Jose Ángel Muñoz Bernal¹⁰, Beatriz Azkunaga Santibáñez¹¹, Francisco Javier Humayor Yáñez¹², María Dolores Rodríguez Mesa¹³, Nuria Clerigué Arrieta¹⁴, Helvia Benito Pastor¹⁵, Begoña De Miguel Lavisier¹⁶, Neus Pociello Almiñana¹⁷, Anna Pizà Oliveras¹⁸, Pablo Gómez Garrido¹⁹, Teresa Núñez Rebollo²⁰, Paula Vázquez López²¹, en nombre del Grupo de Trabajo de Intoxicaciones de la Sociedad Española de Urgencias de Pediatría.

Affiliation of the authors

¹Área de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain. ²Influencia del entorno en el bienestar del niño y del adolescente. Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain. ³Servicio de Urgencias, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain. ⁴Hospital Universitario Puerta del Hierro, Majadahonda, Madrid, Spain. ⁵Servicio de Urgencias, Hospital Universitario Doctor Peset, Valencia, Spain. ⁶Servicio de Urgencias, Hospital Universitario Son Espases, Palma de Mallorca, Spain. ⁷Servicio de Urgencias, Hospital Universitario Niño Jesús, Madrid, Spain. ⁸Servicio de Urgencias, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain. ⁹Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, Spain. ¹⁰Servicio de Urgencias, Hospital Universitario Donostia, Spain. ¹¹Servicio de Urgencias, Hospital Universitario de Cruces, Barakaldo, Spain. ¹²Servicio de Urgencias, Hospital Universitario de Basurto, Bilbao, Spain. ¹³Servicio de Urgencias, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain. ¹⁴Servicio de Urgencias, Complejo Hospitalario de Navarra, Pamplona, Spain. ¹⁵Servicio de Urgencias, Hospital Universitario Río Hortega, Valladolid, Spain. ¹⁶Servicio de Urgencias, Hospital Universitario La Paz, Madrid, Spain. ¹⁷Servicio de Urgencias, Hospital Arnau de Vilanova, Lleida, Spain. ¹⁸Servicio de Urgencias, Hospital Universitari Mútua Terrassa, Barcelona, Spain. ¹⁹Servicio de Urgencias, Hospital del Tajo, Madrid, Spain. ²⁰Servicio de Urgencias, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain. ²¹Servicio de Urgencias, Hospital Universitario Gregorio Marañón, Madrid, Spain.

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Algarrada Vico L, Martínez-Sánchez L, Baena Olomí I, Benito Caldés C, Rodríguez Varela A, López-Corominas V, et al. Multicenter study of adolescent suicide attempts by poisoning: social, epidemiological, and clinical characteristics. Emergencias. 2024;36:438-46

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Summary

Objectives.

To evaluate the social, epidemiological, and clinical characteristics of patients brought to Spanish pediatric emergency departments (EDs) after suicide attempts by poisoning. A secondary objective was to identify risk factors for moderate-severe poisoning.

Methods.

Prospective multicenter cohort study. We included patients under the age of 18 years who were brought to 20 Spanish pediatric EDs after attempting suicide between January 2021 and June 2022. Case histories were reviewed and the patients were interviewed. A Poisoning Severity Score of 2 or more was classified as moderate-severe.
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Results.

A total of 592 episodes were studied; 541 of the patients (91.4%) were girls. The median (P25-P75) age was 14.6 years (13.6-15.7 years). A psychiatric diagnosis had been made in 417 (70.4%), 334 (56.4%) had attempted suicide previously, and 409 (69.1%) had been victims of bullying. Medications were ingested by 584 (98.6%). The most often used were benzodiazepines (used by 222; 37.5%) and paracetamol (by 187; 31.6%). Fifty-three poisonings were classified as moderate-severe. A mental health evaluation was carried out in 585 cases (98.8%). Odds ratios (ORs) indicated that higher risk of moderate-severe poisoning was associated with having an adjustment disorder (OR, 3.2; P25-P75, 1.1-9.0; P = .027), using opioids (OR, 6.4; P25-P75, 1.2-35.4; P = .032), and taking of antidiabetic drugs (OR, 27.6; P25-P75, 1.2-634.9; P = .038). Being a victim of bullying (OR, 0.4; P25-P75, 0.2-0.8; P = .013] and using nonsteroidal anti-inflammatory drugs (OR, 0.3; P25-P75, 0.1-0.8; P = .020) decreased risk.

Conclusions.

Pediatric ED visits for suicide attempts by poisoning occur mainly in adolescent girls, and a majority have a medical history of a psychiatric diagnosis, prior suicide attempts, or self-harm behaviors. They have also often experienced bullying. Characteristics that distinguish patients with moderate-severe poisoning are the presence of an adjustment disorder and the use of opioids and antidiabetic drugs, which confer risk for greater severity.