Psychosocial Determinants and Toxicological Profile of Deliberate Self-Poisoning: A Hospital-Based Study from Western India.

Abstract

Background: Deliberate self-poisoning is one of the commonest forms of self-harm presenting to emergency and forensic services in India, and pesticide self-poisoning alone accounts for a large share of suicide deaths. Effective prevention requires an understanding of both the agents used and the psychosocial context of the act. Data combining these dimensions from Western India are scarce. Aim: To describe the sociodemographic and toxicological profile, psychosocial determinants, intent and impulsivity, and hospital outcome of deliberate self-poisoning at a tertiary care centre in Western India. Materials and Methods: A prospective, hospital-based observational study was conducted from 1 May 2025 to 31 May 2026 in the Departments of Forensic Medicine and Toxicology and Emergency Medicine of a tertiary care teaching hospital. All consecutive patients aged ≥10 years with deliberate self-poisoning were included after informed consent. A pre-tested structured proforma recorded sociodemographic details, agent category, psychosocial stressors, intent/impulsivity and outcome. Proportions are reported with Wilson 95% confidence intervals (CI); associations were tested with the chi-square or Fisher's exact test (p < 0.05). Results: Of 222 patients (mean age 28.6 years; range 12–72), 77.9% were younger than 40 years and the largest group was 20–29 years (36.0%). Males comprised 52.3% and females 47.7%. Pesticides were the commonest agents (44.1%; 95% CI 37.8–50.7), followed by pharmaceutical agents (32.4%), corrosives (12.6%) and household chemicals (6.8%). Agent choice differed significantly by sex (χ² = 14.99, df = 3, p = 0.002): pesticides predominated in males and pharmaceuticals and corrosives in females. Family/marital conflict (38.7%) and financial stress (28.8%) were the leading determinants; 16.7% had known psychiatric illness. On assessment, 41.4% of acts were clearly impulsive and 21.6% showed clear suicidal intent. Overall case fatality was 12.6% (95% CI 8.9–17.6), highest for pesticides (19.4%) and lowest for pharmaceuticals (4.2%); pesticide ingestion carried three times the odds of death compared with other agents (OR 3.07; 95% CI 1.32–7.14; p = 0.008). Conclusion: Deliberate self-poisoning in this setting mainly affected young adults, was frequently impulsive, and was precipitated chiefly by family conflict and financial stress. Pesticides remained the leading and most lethal agents. Routine psychosocial assessment at presentation, restriction of access to highly hazardous pesticides and corrosives, and family- and community-level interventions are recommended.