Pattern of deliberate self-poisoning in central Kerala - a five-year retrospective study

Background: There's a change in pattern of suicide observed globally with a substantial decline in pesticide suicide in recent years. Materials and methods: A retrospective analysis of case records of patients admitted with DSP in medical wards in a tertiary care center from January 2010 to December 2014 was done to find out the various agents used for deliberate self-poisoning (DSP), their case fatality (CF) and to assess the pattern of DSP over the 5 years. Results: There were 2214 males and 1693 females in the study population. Mean age was 34.94±15.7 years. Majority of patients consumed pesticides (n=2011), particularly cholinergic pesticides (n=890). Higher CF was seen for corrosives(19.7%) and pesticides(18.4%) whereas plant poisons(5%) and drugs(2.03%) showed low CF. There was reduction in number of pesticide, increase in plant and drug poisoning in each year. 394(10.2%) patients expired, with a mortality of 13.8%, 11.4%, 8.1%, 9.3%, and 8.6% in each year respectively. Majority of death occurred in pesticide group than in non-pesticide group (n=312, OR 4.06, 95% CI 3.16–5.23, p<0.0001). Among the pesticides, death was higher in cholinergic pesticide group than non-cholinergic pesticides (n=204, OR 2.8, 95% CI 2.2- 3.6, p<0.0001). Conclusion: Pesticides, especially cholinergic pesticides were the commonest group of agents used for deliberate self-poisoning in the study. There was a reduction in overall mortality each year due to self-poisoning over the study period with a reduction in pesticide related admissions each year. Regulation of pesticide use should be considered while planning prevention strategies of suicide.