@article{ref1,
title="Access to means of lethal overdose among psychiatric patients with co-morbid physical health problems: analysis of national suicide case series data from the United Kingdom",
journal="Journal of affective disorders",
year="2019",
author="Pitman, Alexandra and Tham, Su-Gwan and Hunt, Isabelle M. and Webb, Roger T. and Appleby, Louis and Kapur, Nav",
volume="257",
number="",
pages="173-179",
abstract="BACKGROUND: Many physical health problems are associated with elevated suicide risk whilst also providing access to means of overdose. We aimed to investigate whether psychiatric patients with physical co-morbidities who die by suicide were more likely than those without co-morbidities to self-poison with non-psychotropic medications. <br><br>METHODS: We analysed data on 14,648 psychiatric patients who died by suicide in England & Wales during 2004-2015, as recorded by the National Confidential Inquiry into Suicide and Safety in Mental Health. Using logistic regression models adjusted for age, gender, ethnicity, and primary drug dependence/misuse we compared patients diagnosed with physical co-morbidities versus those without to assess whether a greater proportion of the former had died by overdose, and medication prescribed to treat such disorders (e.g. opioids, insulin). <br><br>RESULTS: 24% (n = 3525) were recorded as having physical co-morbidity. A greater proportion of these individuals died by self-poisoning than those without physical co-morbidity (37% vs. 20%, p < .001; adjusted OR 2.47; 95% CI 2.26-2.70), and they were more likely to have used medications for a physical health disorder in overdose (50% vs. 34%; adjusted OR 2.10; 95% CI 1.80-2.46), particularly opioids (30% vs. 22%; p < .001), paracetamol/opioid compounds (11% vs. 7%, p < .001) and insulin (4% vs. 1%, p < .001). LIMITATIONS: Use of survey data may have resulted in under-reporting of physical health problems and/or overdose medications. <br><br>CONCLUSIONS: Overdose, rather than hanging, is the leading cause of suicide among psychiatric patients with physical co-morbidities, particularly using non-psychotropic medications. There is potential for means restriction in preventing suicide among these patients.<br><br>Copyright © 2019 Elsevier B.V. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0165-0327",
doi="10.1016/j.jad.2019.06.027",
url="http://dx.doi.org/10.1016/j.jad.2019.06.027"
}