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May 12, 2011

Trends in Emergency Department Visits for Drug-Related Suicide Attempts among Females: 2005 and 2009

In Brief
  • Between 2005 and 2009, emergency department (ED) visits for suicide attempts made by females aged 50 or older increased 49 percent (from 11,235 visits in 2005 to 16,754 visits in 2009)
  • ED visits for suicide attempts involving alcohol or illicit drugs remained stable from 2005 to 2009 among females; however, visits involving certain pharmaceutical drugs increased during this time period
  • Among females, ED visits for suicide attempts involving drugs to treat anxiety and insomnia increased 56 percent from 2005 to 2009 (from 32,426 visits to 50,548 visits)
  • ED visits for suicide attempts involving hydrocodone products and oxycodone products increased (67 and 210 percent, respectively) from 2005 to 2009

Suicide ranks 7th in the top 10 leading causes of death for females aged 12 to 65, making suicide prevention among women a public health priority.1 Although men have higher suicide death rates, women are treated for attempted suicide more often than men.1 More than 215,000 emergency department (ED) visits involving intentional self-harm were made by females in 2009,1 and females were involved in 3 out of 5 ED visits for drug-related suicide attempts.2 Because suicide attempts are a risk factor for subsequent suicide attempts,3 the ED may represent a key opportunity for mental health intervention.

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related ED visits in the United States. To be a DAWN case, an ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. DAWN data can be used to examine ED visits for drug-related suicide attempts. Although DAWN includes only suicide attempts that involve drugs, these attempts are not limited to drug overdoses. If there is drug involvement in a suicide attempt by other means (e.g., a patient cuts his or her wrists while smoking marijuana), the case is included as drug related. Excluded are suicide attempts with no drug involvement and suicide-related behaviors other than actual attempts (e.g., suicidal ideation or suicidal thoughts); also excluded are suicide attempts involving just alcohol for patients aged 21 or older. This issue of The DAWN Report describes trends in ED visits for drug-related suicide attempts among females from 2005 to 2009.


Overview

The number of ED visits for drug-related suicide attempts among females was stable each year from 2005 (92,682 visits) to 2009 (120,418 visits) (Figure 1). By age group, only females aged 50 or older had a statistically significant increase in the number of visits. Among that age group, the number of visits increased 49 percent (from 11,235 visits in 2005 to 16,754 visits in 2009). This increase reflects the overall population growth of women aged 50 or older, rather than an increase in the rate of ED visits for drug-related suicide attempts (23.8 ED visits per 100,000 population in 2005 and 32.3 visits per 100,000 population in 2009).

Figure 1. Emergency Department (ED) Visits for Drug-Related Suicide Attempts among Females, by Age Group: 2005 and 2009
This is a bar chart comparing emergency department (ED) visits for drug-related suicide attempts among females, by age group: 2005 and 2009. Accessible table located below this figure.

Figure 1 Table. Emergency Department (ED) Visits for Drug-Related Suicide Attempts among Females, by Age Group: 2005 and 2009
Age Group 2005 2009
Total 92,682 120,418
Aged 12 to 20 23,313   26,801
Aged 21 to 34 28,796   39,802
Aged 35 to 49 29,300   37,034
Aged 50 or Older* 11,235   16,754
*The change from 2005 to 2009 in women aged 50 or older was statistically significant at the .05 level.
Source: 2005 to 2009 estimates from the 2009 SAMHSA Drug Abuse Warning Network (DAWN).


Alcohol and Drug Involvement Trends

The numbers of ED visits for drug-related suicide attempts among females show that across the drugs examined, most showed modest increases, although only a few differences were statistically significant (Table 1). For example, ED visits for suicide attempts involving illicit drugs remained relatively stable between 2005 and 2009 (14,924 and 16,530 visits, respectively), as did visits for suicide attempts involving pharmaceuticals overall (88,527 and 116,201 visits, respectively). However, visits involving several drugs that treat anxiety and insomnia and specific narcotic pain relievers (i.e., hydrocodone products and oxycodone products) increased significantly during this time period. Findings with respect to these particular drugs are discussed in the subsequent sections.

Table 1. Emergency Department (ED) Visits for Drug-Related Suicide Attempts among Females, by Drug Category: 2005 and 2009
Drug Category and Selected Drugs Estimated Number of ED Visits in 2005 Estimated Number of ED Visits in 2009 Percent Increase from 2005 to 2009
Total ED Visits 92,682 120,418   29.9
Pharmaceuticals 88,527 116,201   31.3
Central Nervous System Medications 67,127   90,191   34.4
Drugs That Treat Anxiety and Insomnia* 32,426   50,548   55.9
Benzodiazepines* 21,575   36,093   67.3
Alprazolam   8,298   13,787   66.1
Clonazepam*   6,127   11,277   84.0
Miscellaneous Drugs That Treat Anxiety and Insomnia 11,214   19,561   74.4
Diphenhydramine   4,308     6,296   46.1
Zolpidem*   3,177     8,190 157.8
Pain Relievers 36,563   47,838   30.8
Acetaminophen Products 15,079   15,517     2.9
Narcotic Pain Relievers 10,746   17,348   61.4
Hydrocodone Products*   4,613     7,715   67.2
Oxycodone Products*   1,895     5,875 210.1
Ibuprofen Products   8,170   11,192   37.0
Psychotherapeutic Medications 24,593   32,986   34.1
Antidepressants 18,328   23,483   28.1
Antipsychotics   9,205   14,749   60.2
Alcohol** 28,293   32,464   14.7
Illicit Drugs 14,924   16,530   10.8
*Percent increases are statistically significant at the .05 level.
**Alcohol involvement includes use of alcohol in combination with other drugs for patients of all ages and use of alcohol only for persons aged 20 or younger.
Source: 2005 and 2009 estimates from the 2009 SAMHSA Drug Abuse Warning Network (DAWN).


Trends in Visits Involving Drugs to Treat Anxiety and Insomnia

Among females, ED visits for suicide attempts involving drugs to treat anxiety and insomnia increased 56 percent from 2005 to 2009 (from 32,426 visits to 50,548 visits) (Table 1). Visits involving benzodiazepines—a specific class of drug used to treat anxiety and insomnia—increased 67 percent; visits involving clonazepam, a type of benzodiazepine, increased 84 percent. Statistically significant increases in visits involving clonazepam were seen for two age groups: those aged 21 to 34 and those aged 50 or older (Figure 2).

ED visits for suicide attempts involving zolpidem (e.g., Ambien®)—a drug to treat insomnia—increased 158 percent among females between 2005 and 2009 (from 3,177 visits to 8,190 visits). By age group, statistically significant increases in visits involving this drug were only seen among patients aged 35 to 49 (Figure 2).

Figure 2. Emergency Department (ED) Visits for Female Suicide Attempts Involving Selected Drugs That Treat Anxiety and Insomnia, by Age Group: 2005 and 2009
This is a bar chart comparing emergency department (ED) visits for female suicide attempts involving selected drugs that treat anxiety and insomnia, by age group: 2005 and 2009. Accessible table located below this figure.

Figure 2 Table. Emergency Department (ED) Visits for Female Suicide Attempts Involving Selected Drugs That Treat Anxiety and Insomnia, by Age Group: 2005 and 2009
Selected Drugs Age Group 2005 2009
Clonazepam Aged 12 to 20       **    675
Clonazepam Aged 21 to 34* 1,859 4,248
Clonazepam Aged 35 to 49 3,073 3,576
Clonazepam Aged 50 or Older*    810 2,778
Zolpidem Aged 12 to 20    152    461
Zolpidem Aged 21 to 34    622 2,183
Zolpidem Aged 35 to 49*    978 3,185
Zolpidem Aged 50 or Older 1,423 2,362
*The change from 2005 to 2009 was statistically significant at the .05 level.
**Estimate suppressed because of low statistical precision.
Source: 2005 and 2009 estimates from the 2009 SAMHSA Drug Abuse Warning Network (DAWN).


Trends in Visits Involving Narcotic Pain Relievers

ED visits for suicide attempts involving narcotic pain relievers in general among females did not show any statistically significant differences between 2005 and 2009; however, there were significant increases involving particular types of these drugs during this period (Table 1). Specifically, visits involving hydrocodone products increased 67 percent (from 4,613 visits in 2005 to 7,715 visits in 2009) and visits involving oxycodone products increased 210 percent (from 1,895 visits in 2005 to 5,875 visits in 2009).

By age group, visits involving hydrocodone products increased significantly only among females in the 35 to 49 age group (Figure 3). Statistically significant increases in visits involving oxycodone products occurred only among female patients aged 21 to 34.

Figure 3. Emergency Department (ED) Visits for Female Suicide Attempts Involving Selected Narcotic Pain Relievers, by Age Group: 2005 and 2009
This is a bar chart comparing emergency department (ED) visits for female suicide attempts involving selected narcotic pain relievers, by age group: 2005 and 2009. Accessible table located below this figure.

Figure 3 Table. Emergency Department (ED) Visits for Female Suicide Attempts Involving Selected Narcotic Pain Relievers, by Age Group: 2005 and 2009
Selected Narcotic Pain Relievers Age Group 2005 2009
Hydrocodone products Aged 12 to 20 1,089 1,357
Hydrocodone products Aged 21 to 34 1,850 2,449
Hydrocodone products Aged 35 to 49* 1,173 2,823
Hydrocodone products Aged 50 or Older*    501 1,079
Oxycodone products Aged 12 to 20       **       **
Oxycodone products Aged 21 to 34*    522 2,057
Oxycodone products Aged 35 to 49    609 2,131
Oxycodone products Aged 50 or Older       ** 1,025
*The change from 2005 to 2009 was statistically significant at the .05 level.
**Estimate suppressed because of low statistical precision.
Source: 2005 and 2009 estimates from the 2009 SAMHSA Drug Abuse Warning Network (DAWN).


Discussion

Increased knowledge is necessary to inform prevention and intervention efforts to reduce the underlying suicidal risk factors in women. Primary care and other health providers who prescribe drugs can monitor the frequency of requested refills, assess medical need, and refer to mental health services when indicated. Likewise, increased awareness of these trends among ED personnel can help ensure that patients are referred to appropriate mental health and social services, which may reduce the repetition of suicide attempts and address underlying health issues (e.g., depression, anxiety disorders, and domestic violence).

The mental and physical health needs of women vary across the life span, and older women represent one of the Nation's fastest growing populations.4 Problems such as pain and sleep disorders can lead to increased use of prescription drugs to treat these conditions. Also, older women may experience depression because of health changes or other negative life events. Expanded research on women's aging issues and the potential use of these drugs as a method of, or influence on, suicide attempts is critical.


End Notes
1 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2011). Injury prevention & control: Data & statistics (WISQARS). Retrieved from http://www.cdc.gov/injury/wisqars/index.html
2 Center for Behavioral Health Statistics and Quality. (2010). Drug Abuse Warning Network, 2009: Selected tables of drug-related emergency department visits. Rockville, MD: Substance Abuse and Mental Health Services Administration. [Available at https://dawninfo.samhsa.gov/data/]
3 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2010). Understanding suicide: Fact sheet. Retrieved from http://www.cdc.gov/violenceprevention/pdf/Suicide-FactSheet-a.pdf
4 U.S. Census Bureau. (2010). The elderly population. Retrieved from http://www.census.gov/population/www/pop-profile/elderpop.html


Suggested Citation
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (May 12, 2011). Trends in Emergency Department Visits for Drug-Related Suicide Attempts among Females: 2005 and 2009. Rockville, MD.

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug related morbidity and mortality. DAWN uses a probability sample of hospitals to produce estimates of drug related emergency department (ED) visits for the United States and selected metropolitan areas annually. DAWN also produces annual profiles of drug related deaths reviewed by medical examiners or coroners in selected metropolitan areas and States.

Any ED visit related to recent drug use is included in DAWN. All types of drugs—licit and illicit—are covered. Alcohol involvement is documented for patients of all ages if it occurs with another drug. Alcohol is considered an illicit drug for minors and is documented even if no other drug is involved. The classification of drugs used in DAWN is derived from the Multum Lexicon, copyright 2010 Lexi-Comp, Inc., and/or Cerner Multum, Inc. The Multum Licensing Agreement governing use of the Lexicon can be found at http://dawninfo.samhsa.gov/drug_vocab.

DAWN is one of three major surveys conducted by the Substance Abuse and Mental Health Services Administration's Center for Behavioral Health Statistics and Quality (SAMHSA/CBHSQ). For more information on other CBHSQ surveys, go to http://www.oas.samhsa.gov/. SAMHSA has contracts with Westat (Rockville, MD) and RTI International (Research Triangle Park, NC) to operate the DAWN system and produce publications.

For publications and additional information about DAWN, go to http://DAWNinfo.samhsa.gov/.

The DAWN Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.

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