The role of psychiatric and nonsteroidal anti-inflammatory drug overdoses in adolescent suicide atte

Author: Laura Bajāre 1, Katrīna Krieviņa 1, Ieva Šlēziņa 1, Dana Augustova 1, Dace Osīte-Kovaļova 1

Trustee: Ivars Veģeris 2

Institution: 1 Student, Riga Stradins University / 2 Anaesthesiologist/Reanimatologist, Riga Children’s Clinical University Hospital

Editor: Akihiko Ozaki, M.D., Yuki Senoo

Doctors in Latvia face the problem of rising self-harm rates among children. At Riga Children’s Clinical University Hospital, at least a few children are admitted to the emergency room with intentional self-harm every month. According to a recent report, Latvia has 1.9 million citizens in 2018 with the median age of 43.6. Although the proportion of adolescent aged between 15- 29 years old was 9.45% in 2018, which is similar to that of Japan in 2017, 9.64%, the rate of aging population is progressing at much faster rate compared to Japan (Latvia: -1.08%, Japan -0.21% 2017). Therefore, due to the small population with low number of teens and adolescents of our country, even a few cases of adolescent suicide account for a significant proportion. However, available official data on the incidence of and reasons for such cases do not mention why children choose to harm themselves. To address this problem, it is important to understand potential reasons why a high number of self-ham cases are observed in Latvia and why such cases are still rising continuously. The data available in Riga Children’s Clinical University Hospital database indicates that in Latvia, drug overdose is the most common method of self-harm among the others.

These facts lead to questions about the reason for children to end their lives, which medications they use, and more importantly, the procedure of how they get access to the medications.

To emphasise the importance of this topic, the data by Eurostat is useful (link: https://ec.europa.eu/eurostat/documents/3217494/6776245/KS-05-14-031-EN-N.pdf ). This data indicates that intentional self-harm, including suicide, is the second most frequent external cause of death among young people in EU.

Latvia’s suicide rate in general population is among the highest in Europe. It takes second place following Lithuania which is the neighbour country. It is notable to mention that the counties of Baltic states, Lithuania, Latvia and Estonia, occupies the top 5 in the suicide rates in EU according to table “Suicide rate in EU Member States, 2014”, published by Eurostat, year 2017 (link: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/DDN-20170517-1)

Despite of its higher rate of suicide compared to other countries, current Statistic Bureau of Latvia mainly focus on suicides among all age groups or adults and their analysis lacks in-depth. A new study that analyses various factors related to this topic is therefore necessary to tackle the problem. In this paper, the recent pediatric suicide attempts that involve drug intoxication is explored to investigate the adolescent (age 10-18) drug intoxication cases. Our paper also illuminates the different pharmaceutical substance chosen by children who attempted suicide and parasuicide. Furthermore, the relationship between the pharmaceutical substances and patients’ demographic feature and the reason for suicide intention is also investigated.

We conducted a retrospective study of ICD-10 codes in the patient database of the Children’s Clinical University Hospital (Riga, Latvia) during the period from January 2017 to December 2018. [LVT1] In addition, we reviewed regulations published by the State Agency of Medicines, state statistics, and scientific literature on the topic.

From 2017 to 2018, a total of 146 patients with drug intoxication were admitted to the emergency department (ED). Of these, 43 were suicide attempts, and 6 were repeated attempts.

The number of female patients were approximately four times higher than the number of male patients, and the average age of patient was 16 years (min – 11, max – 18).

The types of medications used were as follows: 15 patients used NSAIDs, 21 used psychiatric drugs, and 7 used various drug combinations or other medication types. In cases of NSAID overdose, the average number of pills was higher (48) than in cases involving psychiatric drugs (19).

Figure 1. Main pharmaceutical substance chosen by adolescents in number of cases, 2017-2018

The diagram presented above (Fig.1) shows the average number of pills taken. In some cases, we observed considerably high number of pills taken such as cases with 68 tablets of Truxal, 60 pills of Ibuprofen, and 27 tablets of Amitriptyline.

Motives for the suicide attempts in adolescent patients vary each case: the motive was related to depression in 15 patients, conflict with family, friends or both in 14 patients, schizophrenia was in 3 patients, family violence in 2 patients, behavioral disorders in 2 patients and the motives were unknown in 7 patients.

In particular, the numbers of adolescent suicide attempts involving NSAIDs and psychiatric drugs was remarkable. In all 15 case of the suicide attempts with NSAIDs, the drugs chosen were accessible over the counter without any restrictions or identification check. In the most of cases involving psychiatric drugs, the patients used the medication prescribed by their psychiatrists.

Statistics Bureau of Latvia reported that there have been 93 suicide attempts among children and adolescents in the first 6 months of 2019 and of 4 cases lead to death. Thus, it can be said that there have been significantly rapid increase in self-harm among children in Latvia. The background reasons of the suicide attempt are varied in case to case.

We would like to pose a following problem in the current. There is a severe shortage of pediatric psychiatrists. Because of this, children with severe mental illness are unable to see their psychiatrists regularly. The patients are able to receive their prescribed medication, but there is no one who is checking whether these children are actually taking the medication as prescribed. In 2019, the Latvian government has also changed the education requirements for young pediatric psychiatrists. Until then, physicians had to study for 8 years, but now it is possible to complete their education in 4 years, because it allows to not spend that many years learning adult psychiatry. However, the new changes to facilitate union and teamwork to provide better healthcare is still required to effectively and promptly decrease the number of suicide attempts.