Predictors of Recurrent Intentional Self-Poisoning

Intentional self-poisoning is the most common method by which youth attempt suicide, is increasing in frequency, and carries a high risk of morbidity. The objective of this study was to describe pediatric emergency department (ED) encounters for intentional self-poisoning and to identify factors associated with self-poisoning recurrence.

We conducted a retrospective cross-sectional study of patients aged 6 to 17 who presented to a pediatric ED with intentional self-poisoning between March 2020 and March 2023. Encounters with a reason-for-visit or billing code related to an ingestion, overdose, or suicide attempt were included. We extracted demographic data, clinical features of the ingestion, and medical and psychiatric history from the electronic medical record. We calculated descriptive statistics and constructed a multivariable logistic regression model to identify factors associated with self-poisoning recurrence.

Five hundred and thirty-five encounters representing unique patients were included. 70.3% ingested a single toxicant, 58.3% presented within 4 hours of poisoning, 46% required medical intervention in the ED, and 23.7% required admission to an inpatient medical or critical care unit. 68 patients (12.7%) had prior visit(s) for self-poisoning. Existing psychiatric diagnosis (aOR 17.03, 3.92-74.04), history of sexual abuse (aOR 1.96, 1.12-3.42), and history of self-injurious behavior (aOR 3.00, 1.22-7.38) were associated with self-poisoning recurrence.

Intentional self-poisoning was associated with morbidity, with nearly half of the patients requiring medical intervention and nearly one-quarter requiring medical admission. Recurrent visits for intentional self-poisoning were not uncommon, occurring in 1 in 8 patients. We identified risk factors for recurrent intentional self-poisoning. Further study is required to devise targeted approaches for prevention.