Self-reported influence of the COVID-19 pandemic on poisoning presentations to an Australian toxicology service

Dear Sir,

Whilst Australia continues to realise the ongoing ramifications of the COVID-19 pandemic, little is known regarding the impact of lockdowns, border closures and other restrictions on the epidemiology of overdose. These have all lead to widespread personal, social and economic consequences. The state of Victoria has endured some of the toughest and lengthy restrictions, even by global standards. The purpose of this study was to investigate the impact of the COVID-19 pandemic on the motivation behind a medication or substance-related overdose.

This was a prospective study administering a questionnaire to patients presenting with overdose and referred to the Monash Toxicology unit at Monash Health in Victoria, Australia. The study was undertaken from 1 April to 30 November 2020 and encompassed the second COVID-19 wave in Victoria and associated 112-day lockdown period. The study was approved by the Monash Health Research Ethics Committee.

Ninety-one patients were interviewed covering key questions on intent of overdose and influence of the COVID-19 pandemic. Data are summarised in Table 1. The median age was 25 years (IQR 17,43) and the majority of participants were female (n = 64, 70%). All patients (n = 91) survived their drug overdose. The medication most commonly taken in overdose was paracetamol (n = 22, 24%).

Table 1.

Self-reported influence of the COVID-19 pandemic on overdose cases

	Participants, n (%). Total n = 91
Overdose intent - Suicide	59 (65)
– seeking help	19 (21)
– recreational	1 (1)
– unsure	12 (13)
– Employed pre-COVID-19 pandemic	42 (46)
COVID-19 related contributing factors:
– unemployment	19 (21)
– social isolation/loneliness	64 (70)
– cancellation of plans/events	20 (22)
– bereavement	2 (2)
– anxiety	52 (57)
– domestic stressors	25 (27)
– personal illness	12 (13)
– access to mental health services	29 (32)
– depression	66 (73)
Mental health deterioration secondary to COVID-19 pandemic	70 (77)
Pre-COVID-19 pandemic overdose ideation	60 (66)

The most frequent response for how the pandemic impacted individual circumstances was social isolation (n = 64,70%). Nineteen (21%) participants stated job loss due to the pandemic was a contributing factor in their reason to overdose. Fifty-two participants (57%) identified themselves as suffering from anxiety and 66 (73%) with depression. Seventy (77%) felt their mental health had deteriorated as a result of the pandemic. Sixty-five (71%) participants identified the COVID-19 pandemic as a contributing factor in their motivation for deliberate self-poisoning overdose, despite no patients being diagnosed with COVID-19. Thirty-one (34%) participants had not considered self-poisoning prior to the pandemic. The median length of hospital stay for treatment of overdose was one day (IQR 1,2) and the median length of stay if requiring subsequent mental health admission, was an additional one day (IQR 1,2).

In Australia, there have been multiple lockdowns associated with the COVID-19 pandemic. What is less clear is how the motivation for self-poisoning has been influenced by the pandemic situation in many Australians. One study from the US reported an increase in 43% of overdose calls to emergency medical services related to social isolation and stay-at-home orders.¹

In this study, two-thirds of participants stated that suicide was the intention of their overdose. Multiple factors relating to the COVID-19 pandemic influenced the rationale for taking a medication overdose; however, the most common were social isolation, followed by anxiety and mood disorder. Two-thirds of the cohort had a mental health history characterised by thoughts of self-harm prior to the pandemic, but importantly one-third had never previously considered suicide or self-harm by overdose prior to the pandemic.

ORCID iD

Anselm Wong https://orcid.org/0000-0002-6817-7289