Analysis of emergency adolescent antidepressant poisoning incidence and family psychological environment influencing factors

Table 1 Comparison of basic demographic characteristics between two groups, n (%)

Characteristic	Poisoning group (n = 28)	Normal group (n = 222)	χ2 value	P value
Age group			7.452	0.024
12-14 years	5 (17.9)	72 (32.4)
15-16 years	6 (21.4)	64 (28.8)
17-18 years	17 (60.7)	86 (38.7)
Gender			9.127	0.002
Male	6 (21.4)	114 (51.4)
Female	22 (78.6)	108 (48.6)
Educational level			4.006	0.045
Middle school	9 (32.1)	116 (52.3)
High school	19 (67.9)	106 (47.7)
Specific grade distribution			12.384	0.015
7th grade	2 (7.1)	38 (17.1)
8th grade	3 (10.7)	42 (18.9)
9th grade	4 (14.3)	36 (16.2)
10th grade	6 (21.4)	38 (17.1)
11th grade	8 (28.6)	36 (16.2)
12th grade	5 (17.9)	32 (14.4)

Table 2 Clinical characteristics of antidepressant poisoning in poisoning group, n (%)/mean ± SD

Clinical characteristic	Poisoning group (n = 28)
Drug type
SSRI class	17 (60.7)
SNRI class	7 (25.0)
Tricyclic class	4 (14.3)
Dosage taken
< 3 times therapeutic dose	4 (14.3)
3-5 times therapeutic dose	6 (21.4)
≥ 5 times therapeutic dose	18 (64.3)
Presentation time
< 2 hours	5 (17.9)
2-6 hours	20 (71.4)
> 6 hours	3 (10.7)
Poisoning severity
Mild	16 (57.1)
Moderate	9 (32.1)
Severe	3 (10.7)
Main clinical symptoms
Nausea and vomiting	25 (89.3)
Dizziness and headache	22 (78.6)
Somnolence	19 (67.9)
Palpitations	15 (53.6)
Consciousness disorder	8 (28.6)
Convulsions	3 (10.7)
Treatment regimen
Gastric lavage + activated charcoal	24 (85.7)
Symptomatic supportive treatment	28 (100.0)
Blood purification	3 (10.7)
Mechanical ventilation	2 (7.1)
Cause of poisoning
Suicidal intent	23 (82.1)
Accidental poisoning	3 (10.7)
Drug abuse	2 (7.1)
Past history
Psychiatric disease history	20 (71.4)
Antidepressant medication use history	18 (64.3)
Previous suicide attempt history	7 (25.0)
Other chronic disease history	5 (17.9)
Abnormal laboratory findings
Liver function abnormalities	12 (42.9)
ECG abnormalities	16 (57.1)
Electrolyte disorders	8 (28.6)
Hospital stays (days)	4.3 ± 2.2

SSRI: Selective serotonin reuptake inhibitor; SNRI: Serotonin-norepinephrine reuptake inhibitor; ECG: Electrocardiogram.

Table 3 Comparison of family structure characteristics between two groups (points), mean ± SD

FSCQ dimension	Poisoning group (n = 28)	Normal group (n = 222)	95%CI	t value	P value
Family integrity	8.4 ± 2.8	10.4 ± 2.3	-3.3 to -0.7	-3.942	0.002
Family size	7.1 ± 2.2	8.2 ± 1.7	-1.9 to -0.3	-2.891	0.004
Economic status	9.8 ± 3.2	12.6 ± 2.8	-4.2 to -1.4	-4.862	< 0.001
Living environment	8.9 ± 2.6	11.5 ± 2.2	-3.6 to -1.6	-5.521	< 0.001
Care pattern	10.4 ± 2.9	12.6 ± 2.4	-3.4 to -1.0	-4.289	< 0.001
FSCQ total score	44.6 ± 8.6	55.3 ± 7.4	-14.1 to -7.3	-5.874	< 0.001

FSCQ: Family Structure Characteristics Questionnaire; CI: Confidence interval.

Table 4 Comparison of family function status between two groups (points), mean ± SD

FACES-II dimension	Poisoning group (n = 28)	Normal group (n = 222)	95%CI	t value	P value
Cohesion
Actual feelings	36.7 ± 10.2	49.2 ± 8.6	-16.4 to -8.6	-6.784	< 0.001
Ideal condition	58.7 ± 8.2	62.4 ± 7.8	-7.3 to -0.1	-2.359	0.019
Ideal-actual difference	22.0 ± 8.1	13.2 ± 5.4	4.9-12.7	6.195	< 0.001
Adaptability
Actual feelings	39.4 ± 9.1	46.7 ± 7.9	-10.8 to -3.8	-4.462	< 0.001
Ideal condition	56.2 ± 7.9	58.9 ± 8.1	-5.8 to 0.4	-1.735	0.084
Ideal-actual difference	16.8 ± 7.2	12.2 ± 4.7	2.4-6.8	3.742	< 0.001

FACES-II: Family Adaptability and Cohesion Evaluation Scales-II; CI: Confidence interval.

Table 5 Comparison of parental mental health status between two groups (points), mean ± SD

SCL-90 dimension	Poisoning group (n = 28)	Normal group (n = 222)	95%CI	t value	P value
Somatization	20.1 ± 5.9	16.2 ± 4.5	1.8-6.0	-3.724	< 0.001
Obsessive-compulsive	17.2 ± 5.2	13.6 ± 3.9	1.8-5.4	-3.892	< 0.001
Interpersonal sensitivity	15.1 ± 4.6	11.9 ± 3.4	1.6-4.8	-3.921	< 0.001
Depression	25.4 ± 7.6	18.6 ± 5.4	4.2-9.4	-5.082	< 0.001
Anxiety	21.8 ± 6.9	15.4 ± 4.6	4.1-8.7	-5.421	< 0.001
Hostility	12.4 ± 4.1	9.1 ± 3.1	1.8-4.8	-4.523	< 0.001
Phobia	13.6 ± 4.8	10.6 ± 3.3	1.4-4.6	-3.582	< 0.001
Paranoia	11.2 ± 3.7	8.7 ± 2.8	1.3-3.7	-3.841	< 0.001
Psychoticism	16.1 ± 5.4	13.1 ± 4.2	1.1-4.9	-3.167	0.002
SCL-90 total score	172.5 ± 38.2	132.7 ± 30.2	26.5-53.1	-6.021	< 0.001

SCL-90: Symptom Checklist-90; CI: Confidence interval.

Table 6 Comparison of parental rearing patterns between two groups (points), mean ± SD

EMBU dimension	Poisoning group (n = 28)	Normal group (n = 222)	95%CI	t value	P value
Father version
Emotional warmth and understanding	42.3 ± 9.8	53.1 ± 8.4	-14.4 to -7.2	-6.142	< 0.001
Punishment and strictness	24.8 ± 6.7	18.6 ± 5.4	3.8-8.6	5.128	< 0.001
Excessive interference	28.4 ± 7.2	21.8 ± 6.7	3.9-9.3	4.829	< 0.001
Favoring subjects	14.1 ± 3.9	12.6 ± 3.4	0.1-2.9	2.126	0.035
Rejection and denial	22.7 ± 6.1	16.9 ± 4.9	3.6-8.0	5.284	< 0.001
Overprotection	32.8 ± 7.9	28.4 ± 7.2	1.5-7.3	3.018	0.003
Mother version
Emotional warmth and understanding	46.7 ± 10.1	55.3 ± 8.8	-12.4 to -4.8	-4.721	< 0.001
Excessive interference and overprotection	37.2 ± 8.4	31.6 ± 7.4	2.7-8.5	3.728	< 0.001
Rejection and denial	24.3 ± 6.5	19.2 ± 5.6	2.7-7.5	4.382	< 0.001
Punishment and strictness	20.9 ± 5.8	16.8 ± 4.7	2.0-6.2	3.951	< 0.001
Favoring subjects	13.7 ± 3.8	11.9 ± 3.2	0.7-2.9	2.634	0.009

EMBU: Egna Minnen Betraffande Uppfostran; CI: Confidence interval.

Table 7 Comparison of family stress events and social support between two groups (points), mean ± SD

Scale and dimension	Poisoning group (n = 28)	Normal group (n = 222)	95%CI	t value	P value
LES total score	35.6 ± 11.8	18.9 ± 8.6	12.5-20.9	7.962	< 0.001
LES dimensions
Family life	13.2 ± 4.2	7.2 ± 3.2	4.5-7.5	8.094	< 0.001
Work and study	12.8 ± 3.9	6.8 ± 2.9	4.6-7.4	8.752	< 0.001
Social and others	9.6 ± 3.5	4.9 ± 2.8	3.4-6.0	7.428	< 0.001
SSRS total score	29.4 ± 7.2	41.2 ± 7.9	-15.2 to -8.4	-7.924	< 0.001
SSRS dimensions
Objective support	9.1 ± 3.1	12.6 ± 3.2	-4.7 to -2.3	-5.712	< 0.001
Subjective support	12.4 ± 3.8	16.9 ± 4.1	-6.2 to -2.8	-5.831	< 0.001
Utilization of support	7.9 ± 2.3	11.7 ± 2.6	-4.8 to -2.8	-7.841	< 0.001

LES: Life Events Scale; SSRS: Social Support Rating Scale; CI: Confidence interval.

Table 8 Comparison of adolescent mental health status between two groups, mean ± SD/n (%)

Indicator	Poisoning group (n = 28)	Normal group (n = 222)	95%CI	Statistical value	P value
CES-D score (points)	29.8 ± 8.4	12.8 ± 6.2	13.8-20.2	t = 11.246	< 0.001
SAS standard score (points)	56.3 ± 9.1	38.2 ± 7.6	14.8-21.4	t = 10.928	< 0.001
Depressive symptoms detection	27 (96.4)	32 (14.4)		χ2 = 76.842	< 0.001
Obvious depressive symptoms detection	25 (89.3)	18 (8.1)		χ2 = 103.672	< 0.001
Anxiety symptoms detection	26 (92.9)	28 (12.6)		χ2 = 87.461	< 0.001
Obvious anxiety symptoms detection	22 (78.6)	15 (6.8)		χ2 = 89.527	< 0.001

CES-D: Center for Epidemiologic Studies Depression Scale; SAS: Self-Rating Anxiety Scale; CI: Confidence interval.

Table 9 Comparison of adolescent academic stress and life events between two groups (points), mean ± SD

ALES dimension	Poisoning group (n = 28)	Normal group (n = 222)	95%CI	t value	P value
Academic stress	15.9 ± 4.2	11.2 ± 3.8	3.2-6.2	6.184	< 0.001
Interpersonal relationships	13.8 ± 3.9	9.6 ± 3.2	2.8-5.6	6.024	< 0.001
Punishment	12.1 ± 3.5	8.7 ± 2.9	2.2-4.6	5.428	< 0.001
Loss	10.4 ± 3.0	7.4 ± 2.8	1.9-4.1	5.291	< 0.001
Health adaptation	11.8 ± 3.4	8.2 ± 3.1	2.4-4.8	5.682	< 0.001
Others	12.8 ± 3.8	7.2 ± 2.9	4.2-7.0	8.264	< 0.001
ALES total score	76.8 ± 16.4	52.3 ± 14.6	18.4-30.6	8.129	< 0.001

ALES: Adolescent Life Events Scale; CI: Confidence interval.

Table 10 Comparison of adolescent empathy ability between two groups (points), mean ± SD

IRI dimension	Poisoning group (n = 28)	Normal group (n = 222)	95%CI	t value	P value
Cognitive empathy
Perspective taking	16.8 ± 4.6	19.6 ± 4.2	-4.6 to -1.0	-3.369	0.005
Fantasy	18.6 ± 4.4	18.9 ± 4.3	-1.9 to 1.3	-0.362	0.718
Cognitive empathy total	35.4 ± 7.2	38.5 ± 6.9	-6.1 to -0.1	-2.298	0.043
Emotional empathy
Empathic concern	17.6 ± 4.7	19.4 ± 4.5	-3.7 to 0.1	-2.029	0.103
Personal distress	19.2 ± 4.8	13.7 ± 4.6	3.7-7.3	6.129	< 0.001
Emotional empathy total	36.8 ± 7.9	33.1 ± 7.2	1.6-5.8	2.627	0.021
IRI total score	72.2 ± 11.4	71.6 ± 10.2	-4.0 to 5.2	0.295	0.768

IRI: Interpersonal Reactivity Index; CI: Confidence interval.

Table 11 Comparison of adolescent stress coping patterns between two groups (points), mean ± SD

CSQ dimension	Poisoning group (n = 28)	Normal group (n = 222)	95%CI	t value	P value
Mature coping
Problem solving1	0.52 ± 0.19	0.68 ± 0.22	-0.24 to -0.08	-3.942	0.001
Immature coping
Self-blame	0.61 ± 0.22	0.31 ± 0.19	0.22-0.38	7.584	< 0.001
Fantasy	0.58 ± 0.21	0.34 ± 0.20	0.16-0.32	6.124	< 0.001
Immature coping total	1.19 ± 0.32	0.65 ± 0.28	0.43-0.65	9.284	< 0.001
Negative coping
Withdrawal	0.59 ± 0.24	0.28 ± 0.17	0.23-0.39	7.418	< 0.001
Mixed coping
Help-seeking1	0.39 ± 0.20	0.42 ± 0.18	-0.10 to 0.04	-0.812	0.418
Rationalization	0.46 ± 0.18	0.48 ± 0.21	-0.08 to 0.04	-0.511	0.610
Mixed coping total	0.85 ± 0.27	0.90 ± 0.26	-0.15 to 0.05	-0.993	0.322

¹Indicates this dimension includes reverse-scored items; item 19 in problem solving dimension, items 36, 39, 42 in help-seeking dimension are reverse-scored.

CSQ: Coping Style Questionnaire; CI: Confidence interval.

Table 12 Multivariate logistic regression analysis of influencing factors for adolescent antidepressant poisoning

Influencing factor	B value	SE	Wald value	P value	OR value	95%CI
Gender (female)	1.046	0.522	4.021	0.045	2.847	1.024-7.913
CES-D score	0.117	0.029	16.284	< 0.001	1.124	1.062-1.190
FSCQ total score	-0.068	0.024	7.951	0.005	0.934	0.891-0.979
Parental SCL-90 total score	0.018	0.007	7.442	0.006	1.018	1.005-1.031
SSRS total score	-0.111	0.033	11.285	0.001	0.895	0.839-0.955

Model constant = -4.582, established using forward method; collinearity diagnosis: All variables had variance inflation factors < 3.0; model goodness of fit: Hosmer-Lemeshow test χ²=7.346, P = 0.500; area under receiver operating characteristic curve = 0.823 (95% confidence interval: 0.745-0.901), indicating good model predictive efficacy. CES-D: Center for Epidemiologic Studies Depression Scale; FSCQ: Family Structure Characteristics Questionnaire; SCL-90: Symptom Checklist-90; SSRS: Social Support Rating Scale; OR: Odds ratio; CI: Confidence interval.