Chitty and colleagues' recent investigation Reference Chitty, Dobbins, Dawson, Isbister and Buckley1 into the association between psychotropic medication use and alcohol consumption during emergency department presentations for self-poisoning raises an interesting perspective on the putative role of psycho-pharmacology in reducing risky alcohol use among those at risk of self-harm and suicide.
Episodes of attempted suicide resulting in hospital presentation may underestimate the true extent of psychotropic medication and alcohol co-ingestion across the community, given recent findings suggesting that just over half of patients treated by ambulance paramedics following an episode of self-harm and/or attempted suicide are transported to hospital. Reference Matsuyama, Kitamura, Kiyohara, Hayashida, Kawamura and Iwami2
Using data from our ongoing study of psychiatric presentations to ambulance services, Reference Lloyd, Gao, Heilbronn and Lubman3 we extracted information on all episodes of non-fatal self-poisoning in the state of Victoria, Australia, from January 2012 to December 2016 (N = 24 726). In contrast to Chitty and colleagues, we found that, overall, use of psychotropic medications was associated with an increased, not decreased, risk of alcohol co-consumption in the self-poisoning episode (odds ratio (OR) = 1.35, 95% CI 1.28–1.42).
While anticonvulsants (OR = 0.74, 95% CI 0.65–0.84), antipsychotics (OR = 0.81, 95% CI 0.75–0.86) and psychostimulants (OR = 0.52, 95% CI 0.32–0.85) were associated with a decreased risk of alcohol co-consumption, in contrast to Chitty and colleagues, we found that benzodiazepines (OR = 1.60, 95% CI 1.52–1.69) were associated with an increased risk of alcohol co-consumption. Additionally, we found no significant association between antidepressant use and risk of alcohol co-consumption for these presentations (OR = 1.04, 95% CI 0.97–1.11).
Importantly, however, we found that medical severity may modify these associations. Specifically, most associations were reduced to non-significance when considering those not requiring hospital treatment following the self-poisoning episode: all psychotropic medication classes (OR = 1.12, 95% CI 0.76–1.65), anticonvulsants (OR = 0.39, 95% CI 0.09–1.80), antidepressants (OR = 1.05, 95% CI 0.63–1.77), antipsychotics (OR = 0.81, 95% CI 0.48–1.36), benzodiazepines (OR = 1.40, 95% CI 0.94–2.07) and psychostimulants (OR = 0.44, 95% CI 0.02–9.21).
This highlights the importance of considering the breadth of services that people who engage in self-harm come into contact with, so as to provide a fuller picture of the treatment needs of this population and how these may vary as a consequence of medical severity.
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