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Trends in self-poisoning and psychotropic drug use in people aged 5–19 years: a population-based retrospective cohort study in Australia
  1. Rose Cairns1,2,
  2. Emily A Karanges3,
  3. Anselm Wong4,
  4. Jared A Brown1,
  5. Jeff Robinson5,
  6. Sallie-Anne Pearson3,
  7. Andrew H Dawson1,6,
  8. Nicholas A Buckley1,7
  1. 1 NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
  2. 2 Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
  4. 4 Victorian Poisons Information Centre and Austin Toxicology Service, Austin Health, Heidelberg, Victoria, Australia
  5. 5 Victorian Poisons Information Centre, Austin Health, Heidelberg, Victoria, Australia
  6. 6 Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
  7. 7 Pharmacology, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Rose Cairns; rose.cairns{at}health.nsw.gov.au

Abstract

Objectives To characterise trends in self-poisoning and psychotropic medicine use in young Australians.

Design Population-based retrospective cohort study.

Setting Calls taken by the New South Wales and Victorian Poisons Information Centres (2006–2016, accounting for 70% of Australian poisoning calls); medicine dispensings in the 10% sample of Australian Pharmaceutical Benefits Scheme data (July 2012 to June 2016).

Participants People aged 5–19 years.

Main outcome measures Yearly trends in intentional poisoning exposure calls, substances taken in intentional poisonings, a prevalence of psychotropic use (dispensing of antidepressants, antipsychotics, benzodiazepines and medicines for attention deficit hyperactivity disorder (ADHD)).

Results There were 33 501 intentional poisonings in people aged 5–19 years, with an increase of 8.39% per year (95% CI 6.08% to 10.74%, p<0.0001), with a 98% increase overall, 2006–2016. This effect was driven by increased poisonings in those born after 1997, suggesting a birth cohort effect. Females outnumbered males 3:1. Substances most commonly taken in self-poisonings were paracetamol, ibuprofen, fluoxetine, ethanol, quetiapine, paracetamol/opioid combinations, sertraline and escitalopram. Psychotropic dispensing also increased, with selective serotonin reuptake inhibitors (SSRIs) increasing 40% and 35% July 2012 to June 2016 in those aged 5–14 and 15–19, respectively. Fluoxetine was the most dispensed SSRI. Antipsychotics increased by 13% and 10%, while ADHD medication dispensing increased by 16% and 10%, in those aged 5–14 and 15–19, respectively. Conversely, dispensing of benzodiazepines to these age groups decreased by 4% and 5%, respectively.

Conclusions Our results signal a generation that is increasingly engaging in self-harm and is increasingly prescribed psychotropic medications. These findings indicate growing mental distress in this cohort. Since people who self-harm are at increased risk of suicide later in life, these results may foretell future increases in suicide rates in Australia.

  • toxicology
  • clinical pharmacology
  • public health

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Footnotes

  • Patient consent for publication Not required.

  • Contributors RC conducted the literature search, acquired NSWPIC data, analysed PIC data, interpreted data, constructed figures and wrote the draft manuscript. EAK acquired and analysed PBS data, assisted with interpretation of PBS results. AW acquired Victorian PIC data, assisted with analysis and interpretation. JAB assisted with study design, data extraction plan and interpretation of PIC results. JR acquired Victorian PIC data, assisted with analysis and interpretation. S-AP supervised data acquisition, analysis and interpretation of PBS data. AHD assisted with data analysis and interpretation. NAB supervised data analysis and interpretation, construction of figures and writing of the manuscript. All authors were involved in critical revision of the manuscript and have approved the final version.

  • Funding This research was supported by the National Health and Medical Research Council (NHMRC) Translational Australian Clinical Toxicology (TACT) Program, grant (ID 1055176), and the NHMRC Centre of Research Excellence in Medicines and Ageing (ID 1060407).

  • Competing interests RC is an associate investigator on an untied educational grant from Seqirus to study tapentadol misuse. This has no relation to the current study. All other authors declare no conflicts to disclose.

  • Ethics approval This study was approved by The Sydney Children’s Hospitals Network Human Research Ethics Committee (HREC), and the New South Wales Population and Health Services Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement PBS data are available by contacting the Department of Human Services. No further PIC data are available due to privacy concerns.

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