Overdosing on drugs as a means of adolescent self-harm is a strong predictor of suicide, and understanding the probable triggers can help with prevention strategies.

That is according to a study which aims to highlight a pattern of probable triggers and underlying circumstances that may increase the risk of self-harm.

The authors of ‘Presentations and preceding factors of drug overdose amongst adolescents admitted to a large regional hospital’ said targeted secondary prevention measures are needed in the aftercare management of self-harm as “completed suicide and deliberate self-harm show considerable overlap”.

However, it acknowledges that young people do not always receive the aftercare they need due to “limited manpower and unavailability” of on-call Child and Adolescent Mental Health Services (CAMHS) or the medical social work team.

The study, by staff at the Department of Paediatrics and the Department of Emergency Medicine, Cork University Hospital, and the Department of Emergency Medicine, Galway University Hospital, evaluated the data of 85 adolescents, of whom 69 were female, ranging in age from 11 to 17, who presented to the paediatric ED at CUH for drug overdose from January 2014 to December 2016. It found:

  • More than two in five (44.7%) had a history of deliberate non-drug-related self-harm, including cutting skin, hanging and near drowning;
  • 10 left a suicide note;
  • 33% had been under the care of CAMHS prior to index admission;
  • Paracetamol was the commonest drug used;
  • Depression was the most common cause of mental illness. Preceding factors included unstable family dynamics, family history of mental illness, social problems, bullying, break-ups.

More than four in five patients were reviewed by the CAMHS team before discharge. A medical social worker assessed 11 patients before discharge. Twelve were readmitted for drug overdose, mostly females. Only one patient had no documented preceding factor or medical background that might have accounted for OD.

Six patients were transferred to Éist Linn, a child and adolescent in-patient unit in Cork, and one patient was transferred to intensive care. There were no deaths.

The study, published in the Irish Medical Journal said because 14% presented with OD within a two-year period of the study, “this might be a pointer that a lot still needs to be put in place”.

The study said recent meta-analysis had shown that active interventions among adolescents following an instance of self-harm helped prevent self-harm and suicide.

During the week, the Oireachtas Committee on Future Mental Health Care heard that 70 school children died by suicide in 2017 as mental health professionals begged for more staff.


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