Temporal and geospatial trends of adolescent intentional overdoses with suspected suicidal intent reported to a state...

Background: In the United States, adolescent suicide attempts are increasing. Indiana has the highest rate of adolescent suicidal ideation in the US. Using the National Poison Data System (NPDS), we analyzed Indiana's increase in suicide attempts by poisoning. Methods: Utilizing NPDS and Toxicall data repositories, we selected 10-19 year-old intentional overdose cases with suspected suicidal intent from 2006-2016. Age, sex, outcome, involved substances and case volume by weekday and month were assessed. Geospatial analysis of the proportion of cases by county was also performed. To determine the association between known social determinants of health and adolescent intentional overdose cases with suspected suicidal intent, we correlated county-wide statistics from the County Health Rankings and Roadmaps dataset from 2010-2016 with the proportion of teen suicide cases by county. Results: Over the eleven years, adolescent intentional overdoses with suspected suicidal intent cases significantly increased starting in 2012 (p-value < .001). The majority of cases (73.7%) involved females with an average age of 15.96 ± 0.27 years. Monday and Tuesday had the highest rates and Saturday had the lowest. June and July had the lowest case rate while November had the highest. The most commonly involved agents were over-the-counter analgesics and antidepressants. Geospatial analysis shows an increased number of cases in the northern third of the State. Among county statistics analyzed, only violent crime was associated, albeit intermittently, with the 11-year proportion of adolescent intentional overdoses with suspected suicidal intent by county. Conclusions: Intentional overdoses with suspected suicidal intent involving adolescent females are significantly increasing. These rates correlate with the school schedule with summer months and weekends having a lower frequency of calls. We did not find associations between county wide social determinants of care with the exception of violent crime. Further studies are needed to establish the factors that might better predict adolescents at risk for suicide.