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Repeated self-poisoning: increasing severity of self-harm as a predictor of subsequent suicide

Faculty of Medicine and Health Services, University of Newcastle, Suicide Prevention Research Unit, Centre for Mental Health Studies, Newcastle, and Department of Consultation–Liaison Psychiatry, Newcastle Mater Misericordiae Hospital, Newcastle, New South Wales, Australia

David M. Reith, MBBS, FRACP, PhD

Discipline of Paediatrics, Dunedin School of Medicine, University of Otago, New Zealand

Ian M. Whyte, MBBS(Hons), FRACP, FRCPE

Discipline of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Newcastle and Department of Clinical Toxicology and Pharmacology, Newcastle Mater Misericordiae Hospital, Newcastle

Michelle McPherson, BSc, BA, MPH

Australian Institute of Health and Welfare, Canberra, Australia

Correspondence: David M. Reith, Discipline of Paediatrics, Dunedin School of Medicine, University of Otago, New Zealand. E-mail: david.reith{at}stonebow.otago.ac.nz

Declaration of interest None.

Background Prediction of suicide risk is difficult in clinical practice.

Aims To identify changes in clinical presentation predictive of suicide in patients treated for repeated episodes of self-poisoning.

Method A nested case–control study used the Hunter Area Toxicology Service database to identify exposure variables and the National Death Index to identify suicide. Cases were patients who had hospital treatment on more than one occasion between 15 January 1987 and 31 December 2000.

Results There were 31 cases, for which 93 controls were selected. Study variables associated with an increased risk of subsequent suicide were an increase in the number of drugs ingested (odds ratio 2.59, 95% CI 1.48–4.51), an increase in the dose ingested (OR 1.33, 95% CI 1.01–1.76), an increase in coma score (OR 1.71, 95% CI 1.11–2.66), a decrease in Glasgow Coma Score (OR 1.21, 95% CI 1.03–1.43) and an increase in drug or alcohol misuse (OR 2.33, 95% CI 1.06–5.10).

Conclusions Patients who have escalating severity of self-poisoning episodes are at high risk of completed suicide.

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