Patients Who Attend the Emergency Department Following Medication Overdose: Self-reported Mental Health History and Intended Outcomes of Overdose
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Medication overdose is a common method of non-fatal self-harm. Previous studies have established which mental health disorders are commonly associated with the behaviour (affective, substance use, anxiety and personality disorders) and which medications are most frequently implicated (benzodiazepines, antidepressants, antipsychotics and non-opioid analgesics). However, few studies have explored patient experiences of medication overdose. We address this gap by examining patient stories of a recent medication overdose event, including severity of depression, intended outcomes and patient experiences of emergency medical care, in part to determine the unmet needs of this group of patients. Semi-structured interviews were conducted with 31 patients attending an urban Emergency Department (ED) in Melbourne, Australia, following a medication overdose regarding their mental health history, state of mind at the time of the overdose, circumstances of the overdose, and experiences of emergency medical care. Participants were heterogeneous regarding the severity of depressive symptomatology at the time of overdose. Participant ratings of how accidental or deliberate the overdose was and how strongly they intended to die were also diverse. Stories relating to the overdose usually covered the themes of precipitating events, negative feeling states, and intended outcomes (ambivalent or contradictory). Few problems were identified in relation to the care received in relation to the current overdose. However, histories of extensive mental health problems were commonly reported, along with unsuccessful treatment for these. While mental health problems are common among patients attending the ED following a medication overdose, there is considerable diversity in current levels of distress and intended outcomes, indicating a thorough suicide risk assessment is always warranted. Presentation to the ED for medication overdose should also trigger a mental health treatment review.
KeywordsAustralia Medication overdose Mental health Depression Emergency department
The late Dr Andrew Dent, former Director of the Emergency Department, St Vincent’s Hospital provided exceptional support for the conduct of the project and contributed substantially to the project design, data extraction and interpretation of findings. Grateful acknowledgement is also made of the contribution made by the interview participants and the staff of the Emergency Department, St Vincent’s Hospital. The study was partly funded by beyondblue: The National Depression Initiative and PB was supported by a National Drug Research Institute scholarship. This work was conducted while PB, PD, and AR were all employed at Turning Point Alcohol and Drug Centre, Melbourne, Australia. PD and AR are both currently in receipt of a Career Development Award from the NHMRC.
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