Self-poisoning evaluated in the emergency department of a general hospital in the years 2014–2020 and the provision of psychiatric services before and after the index event

Abstract

Background

The recent literature on self-poisoning (SP) has mainly focused on the type of substances used for SP and the associated variables. Few data are available on psychiatric diagnoses, repeated SP, multiple substances SP, contacts with psychiatric services before the event and after a long follow-up.

Methods

A consecutive series of 1.807 subjects evaluated in the emergency department of a large urban university hospital was collected from 2014 to 2020. These subjects were matched with the data of Psyche-Web, a case register collecting all psychiatric contacts of the Lombardia Region, Italy.

Results

The most used drugs were benzodiazepines (37.8 %), cocaine (24.0 %), cannabis (15.2 %), antipsychotics (10.5 %), antidepressants (9.2 %). Alcohol was associated in 27.0 % of the cases. The most frequent psychiatric diagnoses were substance use (28.8 %), personality disorders (24.5 %), and mood disorders (21.7 %). Subjects who repeatedly self-poisoned were younger, more often suffered from a personality disorder and less often from a substance use disorder. In 38.2 % of the sample SP was the first-time presentation to psychiatric evaluation of a mood, personality, or psychotic disorder. At one-year follow-up 63.3 % were not in contact with psychiatric services.

Limitations

This study could not include children and adolescents because Psyche-Web stores data only for the adult population. Psychiatric diagnoses were given by specialists, but in different settings.

Conclusions

A substantial number of subjects with no previous contacts remained out of the reach of psychiatric care after discharge. A subgroup of these patients would probably benefit of a more structured referral.