Medication-related suicide plans in children and adolescents: findings from crisis conversations

Objectives To identify medications frequently mentioned in suicide plans by texters at a crisis intervention service, and to evaluate age differences. Methods We developed a natural language processing pipeline to extract medications mentioned in suicide plans. In conversations from 5,691 texters, we examined the frequency with which each medication was mentioned in texters under age 18 ( N = 2,332) versus age 18 and older ( N = 3,359). Results The ten most frequently mentioned medications during discussions of planned suicide by overdose were: ibuprofen (16.5% of conversations), acetaminophen (16.1%), alprazolam (9.2%), diphenhydramine (7.3%), insulin (6.0%), melatonin (5.4%), sertraline (3.4%), aspirin (3.1%), fentanyl (3.0%), and trazodone (3.0%). Ibuprofen, acetaminophen, melatonin, and amphetamine were mentioned significantly more often by texters under age 18 than those 18 or older. Conclusions Individuals under age 18 are particularly likely to plan suicide attempts using medications that are available over the counter, including ibuprofen and acetaminophen. In contrast with some prior reports, insulin and melatonin were frequently mentioned. The importance of public health measures including access restriction is emphasized.