Zahra Khalighi, Naser Abbasi, Elaheh Karimi, Hori Ghaneialvar, Hojjat Sayyadi, Yousef Veisani
Intentional poisoning was associated with distinct demographic patterns and psychiatric vulnerability, particularly a history of previous suicide attempts. These findings support systematic mental health assessment in emergency poisoning care and prevention strategies focused on patients with established self-harm history and access to highly lethal agents.
BACKGROUND AND AIMS: Intentional poisoning is a major public health challenge requiring rapid emergency intervention. This study aimed to identify demographic, psychiatric, and toxicological factors associated with intentional poisoning among patients presenting to a hospital emergency department.
METHODS: We conducted a retrospective cross-sectional analysis of 658 poisoning cases recorded in a hospital emergency department poisoning registry in Ilam, Iran (March 2022-March 2023), with linked medical-record data reviewed after the index encounter. The primary outcome was a final binary classification of intentional versus unintentional poisoning. Categorical associations were examined using Pearson chi-square tests or Fisher exact tests as appropriate. A multivariable logistic regression model included five prespecified clinical/psychiatric variables and estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Analyses used Stata version 11.0 (α = 0.05, two-sided).
RESULTS: Of 658 patients, 367 (55.8%) were classified as intentional poisoning and 291 (44.2%) as unintentional. Intentional poisoning was more frequent among women than men (194/279, 69.5% vs. 173/379, 45.6%; p < 0.001) and among urban than rural residents (295/476, 62.0% vs. 72/182, 39.6%; p < 0.001). In the multivariable clinical model, previous suicide attempt showed the strongest association with intentional poisoning (aOR 4.69, 95% CI 2.55-8.61, p < 0.001), and psychiatric disorder history remained associated (aOR 1.78, 95% CI 1.02-3.12, p = 0.043); current psychiatric disorder did not remain independently associated after mutual adjustment (aOR 0.91, 95% CI 0.59-1.40, p = 0.669). Among specific agents, high intentional-use proportions were observed for aluminum phosphide (17/18, 94.4%), antibiotics (13/15, 86.7%), and acetaminophen (35/43, 81.4%).
CONCLUSIONS: Intentional poisoning was associated with distinct demographic patterns and psychiatric vulnerability, particularly a history of previous suicide attempts. These findings support systematic mental health assessment in emergency poisoning care and prevention strategies focused on patients with established self-harm history and access to highly lethal agents.