Accidental vs. deliberate overdose admissions to the emergency department in Bali's largest hospital - a look into the effects of mental health on Indonesia's substance abuse problem
Keywords:Mental Health, Overdose, Accidental Overdose, Deliberate Overdose, Substance Abuse, Mental Illness
Mental health care in Indonesia is under-resourced, drugs are easily available, and alcohol use is rising, increasing the risk of accidental and deliberate overdose.ÂAims
Identify the demographics of overdose patients presenting to the emergency department. Determine the substances commonly used in overdose; the percentage of accidental vs. deliberate overdoses; the psychiatric history of overdose patients; the reasons behind the overdoses occurring.Methods
22 overdose patients over the age of 18 that had presented to the emergency department at the RSUP Sanglah Hospital in a 1-year period were included in the study. Data were collected from records kept by the hospital on gender, age, nationality, substance(s) used in overdose, presence of psychiatric disorder, whether the overdose was accidental or deliberate, and the reason behind the overdose. Microsoft Excel was used to collect and analyse the data.Results
Overdoses were predominantly carried out by male Indonesians aged 25-34. Alcohol was the most common substance used (n=5, 22.7%). 55.5% (n= 12) of overdoses were accidental and 45.5% (n=10) were deliberate. 3 out of 22 patients had a diagnosed mental disorder. The unknown quantity consumed; unknown content consumed; over-consumption; and spiked drink caused an accidental overdose. Suicidality and family issues caused a deliberate overdose.Conclusions
Overdose rates were lower than expected. Accidental overdoses are likely due to easy access to substances, and a fear of retribution preventing admission to hospital. The high deliberate overdose rate plus low mental disorder rate suggests patients reach a mental-health crisis point before being diagnosed with a mental disorder.Â
Tanra, A. and Roosdy, I. (2017). Challenges and Opportunity of Psychiatric Care in Indonesia. Taiwanese Journal of Psychiatry, [online] 31(3). Available at: http://www.sop.org.tw/sop_journal/Upload_files/31_3/001.pdf [Accessed 6 Feb. 2018].
Global status report on alcohol and health 2018. (2018). [ebook] Geneva: World Health Organization. Available at: https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1 [Accessed 19 Mar. 2019].
gov.uk. (2017). Health matters: preventing drug misuse deaths. [online] Available at: https://www.gov.uk/government/publications/health-matters-preventing-drug-misuse-deaths/health-matters-preventing-drug-misuse-deaths [Accessed 1 Mar. 2019].
drugabuse.gov. (2017). Intentional vs. Unintentional Overdose Deaths. [online] Available at: https://www.drugabuse.gov/related-topics/treatment/intentional-vs-unintentional-overdose-deaths [Accessed 19 Mar. 2019].
Living In Indonesia Editorial Collective. (2019). Living in Indonesia | Illegal Drugs. [online] Livinginindonesia.info. Available at: http://livinginindonesia.info/item/illegal-drugs/ [Accessed 20 Feb. 2019].
jakarta100bars.com. (2019). How Dangerous Is It to Use Drugs in Indonesia?. [online] Available at: http://www.jakarta100bars.com/2016/08/dangerous-drug-use-indonesia.html [Accessed 20 Feb. 2019].
Pols, H. and Wibisono, S. (2017). Psychiatry and Mental Health Care in Indonesia from Colonial to Modern Times. International and Cultural Psychology, pp.205-221.
Park, S.C., Lee, M.S., Hahn, S.W., Si, T.M., Kanba, S., Chong, M.Y., Yoon, C.K., Udomratn, P., Tripathi, A., Sartorius, N. and Shinfuku, N. (2016). Suicidal thoughts/acts and clinical correlates in patients with depressive disorders in Asians: results from the REAP-AD study. Acta neuropsychiatr, 28(6), pp.337-345.
Kurihara, T., Kato, M., Reverger, R. and Tirta, I. (2009). Risk factors for suicide in Bali: a psychological autopsy study. BMC Public Health, 9(1).
Kurihara, T., Kato, M., Reverger, R. and Tirta, I. (2009). Suicide rate in Bali. Psychiatry Clin Neurosci, 63(5), pp.701-701.
Tobin, K.E. and Latkin, C.A. (2003). The relationship between depressive symptoms and nonfatal overdose among a sample of drug users in Baltimore, Maryland. J Urban Health, 80(2), pp.220-229.
Alcohol and health. (2018). [ebook] World Health Organisation. Available at: https://www.who.int/substance_abuse/infographic_alcohol_2018.pdf?ua=1 [Accessed 19 Mar. 2019].
Kanehara, A., Yamana, H., Yasunaga, H., Matsui, H., Ando, S., Okamura, T., Kumakura, Y., Fushimi, K. and Kasai, K. (2015). Psychiatric intervention and repeated admission to emergency centres due to drug overdose. BJPsych Open, [online] 1(02), pp.158-163. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995585/ [Accessed 6 Feb. 2018].
Mental Health Atlas 2011. (2011). [ebook] World Health Organisation. Available at: https://www.who.int/mental_health/evidence/atlas/profiles/idn_mh_profile.pdf [Accessed 5 Feb. 2019].
Irwanto, Wirawan, D., Praptoraharjo, I., Irianto, S. and Mulia, S. (2015). Evidence-informed response to illicit drugs in Indonesia. Lancet, 385(9984), pp.2249-2250.
dataunodc.un.org. (2018). Drug treatment in Asia | Statistics and Data. [online] Available at: https://dataunodc.un.org/drugs/treatment/asia [Accessed 24 Apr. 2019].
Martins, S.S., Sampson, L., CerdÃ¡, M. and Galea, S. (2015). Worldwide prevalence and trends in unintentional drug overdose: a systematic review of the literature. Am J Public Health, 105(11), pp.e29-e49.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5Â®). American Psychiatric Pub.
who.int. (2010). ATLAS of Substance Use Disorders. [online] Available at: https://www.who.int/substance_abuse/publications/atlas_report/profiles/indonesia.pdf [Accessed 24 Apr. 2019].
Wang, G. (2019). Cannabis (marijuana): Acute intoxication. [online] uptodate.com. Available at: https://www.uptodate.com/contents/cannabis-marijuana-acute-intoxication [Accessed 24 Apr. 2019].
Lai, G., Asmin, F. and Birgin, R. (2013). Drug Policy in Indonesia. [ebook] International Drug Policy Consortium, p.1. Available at: http://www.cahrproject.org/wp-content/uploads/2013/01/IDPC-Briefing-Paper-Drug-policy-in-Indonesia.pdf [Accessed 20 Feb. 2019].
Hartini, N., Fardana, N.A., Ariana, A.D. and Wardana, N.D. (2018). Stigma toward people with mental health problems in Indonesia. Psychol Res Behav Manag, 11, p.535.
Bhugra, D., Tse, S., Ng, R. and Takei, N. eds. (2015). Routledge handbook of psychiatry in Asia. Routledge.
Mental Health Innovation Network. (2019). Get Happy Indonesia. [online] Available at: https://www.mhinnovation.net/organisations/get-happy-indonesia-0?mode=List/ [Accessed 21 Feb. 2019].
Mental Health Innovation Network. (2019). Indonesia Mentality Care. [online] Available at: https://www.mhinnovation.net/organisations/indonesia-mentality-care [Accessed 21 Feb. 2019].
globalmentalhealth.org. (2019). Indonesia | Movement for Global Mental Health. [online] Available at: http://globalmentalhealth.org/category/country/indonesia [Accessed 21 Feb. 2019].
Chen, Y., Chien-Chang Wu, K., Yousuf, S. and Yip, P. (2011). Suicide in Asia: Opportunities and Challenges. Epidemiol Rev, 34(1), pp.129-144.