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National estimates of emergency department visits for medication-related self-harm: United States, 2016–2019
  1. Andrew I Geller1,2,
  2. Daniel C Ehlman3,4,
  3. Maribeth C Lovegrove1,
  4. Daniel S Budnitz1,2
  1. 1Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2US Public Health Service Commissioned Corps, Rockville, Maryland, USA
  3. 3Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  4. 4Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Andrew I Geller, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; wia0{at}cdc.gov

Abstract

Background Medication poisoning is a common form of self-harm injury, and increases in injuries due to self-harm, including suicide attempts, have been reported over the last two decades.

Methods Cross-sectional (2016–2019) data from 60 emergency departments (EDs) participating in an active, nationally representative public health surveillance system were analysed and US national estimates of ED visits for medication-related self-harm injuries were calculated.

Results Based on 18 074 surveillance cases, there were an estimated 269 198 (95% CI 222 059 to 316 337) ED visits for medication-related self-harm injuries annually in 2016–2019 compared with 1 404 090 visits annually from therapeutic use of medications. Population rates of medication-related self-harm ED visits were highest among persons aged 11–19 years (58.5 (95% CI 45.0 to 72.0) per 10 000) and lowest among those aged ≥65 years (6.6 (95% CI 4.4 to 8.8) per 10 000). Among persons aged 11–19 years, the ED visit rate for females was four times that for males (95.4 (95% CI 74.2 to 116.7) vs 23.0 (95% CI 16.4 to 29.6) per 10 000). Medical or psychiatric admission was required for three-quarters (75.1%; 95% CI 70.0% to 80.2%) of visits. Concurrent use of alcohol or illicit substances was documented in 40.2% (95% CI 36.8% to 43.7%) of visits, and multiple medication products were implicated in 38.6% (95% CI 36.8% to 40.4%). The most frequently implicated medication categories varied by patient age.

Conclusions Medication-related self-harm injuries are an important contributor to the overall burden of ED visits and hospitalisations for medication-related harm, with the highest rates among adolescent and young adult females. These findings support continued prevention efforts targeting patients at risk of self-harm.

  • Suicide/Self-Harm
  • Burden Of Disease
  • Mental Health
  • Descriptive Epidemiology

Data availability statement

Data are available upon reasonable request. Some data may not be released due to policy and/or statute.

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Data availability statement

Data are available upon reasonable request. Some data may not be released due to policy and/or statute.

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Footnotes

  • Contributors AG as the corresponding author and data guarantor is responsible for data integrity and data analysis accuracy, and performed the statistical analyses, drafted the manuscript and had full access to all study data. DB supervised the study. MCL led the data acquisition. AG, MCL and DB contributed to study concept and design. All authors critically revised the manuscript for important intellectual content and provided administrative, technical and material support.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The findings and conclusions are those of the authors and do not necessarily represent the official position of the CDC.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.