Risk of Major Morbidity and Death in Older Adults with Suicidal Intent: A Cross-Sectional Analysis from the National Poison Data System, 2000-2009

ObjectivesTo describe suicide-related exposures in older persons according to sex, age, and substance category reported to U.S. poison control centers (PCCs) and report the crude relative risk (RR) of major effects and death from pharmaceuticals and nonpharmaceutical substances after single- and multiple-substance exposures. DesignCross-sectional analysis of American Association of Poison Control Centers National Poison Data System (NPDS) data. SettingCalls to U.S. PCCs. ParticipantsNPDS cases involving individuals aged 60 and older with an exposure to a pharmaceutical or nonpharmaceutical substance and suicide as the reason (n=46,494). MeasurementsMajor effect and death probabilities for single- and multiple-substance exposures to pharmaceuticals and nonpharmaceuticals were determined. In the NPDS, a major effect is defined as symptoms or signs that are life-threatening or resulted in significant residual disability or disfigurement. Crude RRs of major effects or death were estimated for single and multiple pharmaceutical substances in comparison with nonpharmaceutical substances. ResultsSingle-substance exposures occurred in 53.3% of cases. Overall, 92.3% involved pharmaceuticals and 64.4% involved women. In the total sample, 12.7% (5,895/46,494) of exposures resulted in major effect, and 1.9% (884/46,494) resulted in death. The crude RR of major effects in single-substance pharmaceutical exposures was significantly lower than with nonpharmaceutical exposures (RR=0.54, 95% confidence interval (CI)=0.49-0.59), as was death (RR=0.25, 95% CI=0.20-0.30). For multiple-substance exposures, the crude RR of major effects from pharmaceuticals was similar to that for nonpharmaceuticals (RR=0.92, 95% CI=0.80-1.06), whereas the crude RR of death from pharmaceuticals was significantly lower (RR=0.55, 95% CI=0.40-0.77). ConclusionThese findings can inform suicide prevention strategies that focus on decreasing at-risk older adults' access to dangerous medications and chemicals in the home.