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Research article:
Suicide risk in primary care patients diagnosed with personality disorder: a nested case control study
Reference:
Michael Doyle; David While; Pearl L.H. Mok; Kirsten Windfuhr; Darren M. Ashcroft; Evangelos Kontopantelis; Carolyn Chew-Graham; Louis Appleby; Jenny Shaw; Roger T. Webb (2015) Suicide risk in primary care patients diagnosed with personality disorder: a nested case control study. BMC Family Practice, doi:
- Link to article
- Abstract
- Background: Personality disorder (PD) is associated with elevated suicide risk, but the level of risk in primary care settings is unknown. We assessed whether PD among primary care patients is linked with a greater elevation in risk as compared with other psychiatric diagnoses, and whether the association is modified by gender, age, type of PD, and comorbid alcohol misuse. Methods: Using data from the UK Clinical Practice Research Datalink, 2384 suicides were matched to 46,899 living controls by gender, age, and registered practice. Prevalence of PD, other mental disorders, and alcohol misuse was calculated for cases and controls separately and conditional logistic regression models were used to estimate exposure odds ratios. We also fitted gender interaction terms and formally tested their significance, and estimated gender age-specific effects. Results: We found a 20-fold increase in suicide risk for patients with PD versus no recorded mental disorder, and a four-fold increase versus all other psychiatric illnesses combined. Comorbid alcohol misuse and borderline PD were associated with a 45- and 37-fold increased risk, respectively, compared with those with no psychiatric disorders. Relative risks were higher for female than for male patients with PD. Significant risks associated with PD diagnosis were identified across all age ranges, although the greatest elevations were in the younger age ranges, 16-49 years. Conclusions: The large elevation in suicide risk among patients diagnosed with PD and comorbid alcohol misuse is a particular concern. Training in PD, alcohol misuse and suicide risk management for GPs and other primary care professionals may enhance the understanding of patients with PD and the interaction between PD traits, alcohol and suicidal behaviour. GPs have a potentially key role to play in intervening with patients diagnosed with PD, particularly in the presence of comorbid alcohol misuse, which may help reduce suicide risk.
- Author for correspondence
- Michael Doyle
- Email for correspondence
- michael.doyle@swyt.nhs.uk
Code list: res32: 340 - res32: Clinically Significant Alcohol Misuse
99 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 1282.00 | Read | fh: alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 1366.00 | Read | Very heavy drinker - >9u/day | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 136Q.00 | Read | Very heavy drinker | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 136T.00 | Read | harmful alcohol use | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 1462.00 | Read | h/o: alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 1B1c.00 | Read | alcohol induced hallucinations | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 66e0.00 | Read | alcohol abuse monitoring | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 7P22100 | Read | delivery of rehabilitation for alcohol addiction | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 8BA8.00 | Read | alcohol detoxification | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 8CAv.00 | Read | advised to contact primary care alcohol worker | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 8G32.00 | Read | aversion therapy - alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 8H35.00 | Read | admitted to alcohol detoxification centre | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 8HkG.00 | Read | referral to specialist alcohol treatment service | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 8IAF.00 | Read | brief intervention for excessive alcohol consumptn declined | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 8IAJ.00 | Read | declined referral to specialist alcohol treatment service | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 8IAt.00 | Read | extended interven for excessive alcohol consumption declined | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 9k1B.00 | Read | extended intervention for excessive alcohol consumptn complt | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| 9NN2.00 | Read | under care of community alcohol team | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| C150500 | Read | alcohol-induced pseudo-cushing's syndrome | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E01..00 | Read | alcoholic psychoses | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E010.00 | Read | alcohol withdrawal delirium | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E011000 | Read | korsakov's alcoholic psychosis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E011100 | Read | korsakov's alcoholic psychosis with peripheral neuritis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E011200 | Read | Wernicke-Korsakov syndrome | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E011z00 | Read | alcohol amnestic syndrome nos | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E012.00 | Read | other alcoholic dementia | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E012000 | Read | chronic alcoholic brain syndrome | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E012.11 | Read | alcoholic dementia nos | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E013.00 | Read | alcohol withdrawal hallucinosis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E014.00 | Read | pathological alcohol intoxication | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E015.00 | Read | alcoholic paranoia | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E01y.00 | Read | other alcoholic psychosis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E01y000 | Read | alcohol withdrawal syndrome | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E01yz00 | Read | other alcoholic psychosis nos | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E01z.00 | Read | alcoholic psychosis nos | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E23..00 | Read | alcohol dependence syndrome | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E230.00 | Read | acute alcoholic intoxication in alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E230000 | Read | acute alcoholic intoxication; unspecified; in alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E230100 | Read | continuous acute alcoholic intoxication in alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E230.11 | Read | alcohol dependence with acute alcoholic intoxication | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E230200 | Read | episodic acute alcoholic intoxication in alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E230300 | Read | acute alcoholic intoxication in remission; in alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E230z00 | Read | acute alcoholic intoxication in alcoholism nos | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E231.00 | Read | chronic alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E231000 | Read | unspecified chronic alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E23..11 | Read | alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E231100 | Read | continuous chronic alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E231200 | Read | episodic chronic alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E231300 | Read | chronic alcoholism in remission | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E231z00 | Read | chronic alcoholism nos | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E23z.00 | Read | alcohol dependence syndrome nos | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| E250300 | Read | nondependent alcohol abuse in remission | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10.00 | Read | [x]mental and behavioural disorders due to use of alcohol | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10100 | Read | [x]mental and behav dis due to use of alcohol: harmful use | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10200 | Read | [x]mental and behav dis due to use alcohol: dependence syndr | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10211 | Read | [x]alcohol addiction | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10212 | Read | [x]chronic alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10300 | Read | [x]mental and behav dis due to use alcohol: withdrawal state | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10400 | Read | [X]Men & behav dis due alcohl: withdrawl state with delirium | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10411 | Read | [x]delirium tremens; alcohol induced | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10500 | Read | [x]mental & behav dis due to use alcohol: psychotic disorder | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10511 | Read | [x]alcoholic hallucinosis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10512 | Read | [x]alcoholic jealousy | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10513 | Read | [x]alcoholic paranoia | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10514 | Read | [x]alcoholic psychosis nos | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10600 | Read | [x]mental and behav dis due to use alcohol: amnesic syndrome | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10611 | Read | [x]korsakov's psychosis; alcohol induced | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10700 | Read | [X]Men & behav dis due alcoh: resid & late-onset psychot dis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10711 | Read | [x]alcoholic dementia nos | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10712 | Read | [x]chronic alcoholic brain syndrome | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10800 | Read | [x]alcohol withdrawal-induced seizure | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10y00 | Read | [x]men & behav dis due to use alcohol: oth men & behav dis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Eu10z00 | Read | [x]ment & behav dis due use alcohol: unsp ment & behav dis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| F11x000 | Read | cerebral degeneration due to alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| F11x011 | Read | alcoholic encephalopathy | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| F144000 | Read | cerebellar ataxia due to alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| F25B.00 | Read | alcohol-induced epilepsy | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| F375.00 | Read | alcoholic polyneuropathy | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| F394100 | Read | alcoholic myopathy | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| G555.00 | Read | alcoholic cardiomyopathy | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| G852300 | Read | oesophageal varices in alcoholic cirrhosis of the liver | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| J610.00 | Read | alcoholic fatty liver | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| J611.00 | Read | acute alcoholic hepatitis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| J612.00 | Read | alcoholic cirrhosis of liver | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| J612000 | Read | alcoholic fibrosis and sclerosis of liver | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| J613.00 | Read | alcoholic liver damage unspecified | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| J613000 | Read | alcoholic hepatic failure | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| J617.00 | Read | alcoholic hepatitis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| J617000 | Read | chronic alcoholic hepatitis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| J671000 | Read | alcohol-induced chronic pancreatitis | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| SLH3.00 | Read | alcohol deterrent poisoning | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| SM00100 | Read | denatured alcohol causing toxic effect | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| U60H300 | Read | [x]alcohol deterrents caus adverse effects in therapeut use | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| U60H311 | Read | [x] adverse reaction to alcohol deterrents | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Z191.00 | Read | alcohol detoxification | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Z191100 | Read | alcohol withdrawal regime | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| Z191211 | Read | alcohol reduction programme | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| ZR1E.11 | Read | ads - alcohol dependence scale | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse | |||
| ZV11300 | Read | [v]personal history of alcoholism | diagnostic | res32: 340 - res32: Clinically Significant Alcohol Misuse |
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