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Research article:

Clinical management following self-harm in a UK-wide primary care cohort

Reference:

Matthew J Carr, Darren M Ashcroft, Evan Kontopantelis, David While, Yvonne Awenat, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T Webb(2016) Clinical management following self-harm in a UK-wide primary care cohort. Journal of Affective Disorders, doi:

Link to article
Abstract
Background: Little is known about the clinical management of patients in primary care following self-harm. Methods: A descriptive cohort study using data from 684 UK general practices that contributed to the Clinical Practice Research Datalink (CPRD) during 2001-2013. We identified 49,970 patients with a self-harm episode, 41,500 of whom had one complete year of follow-up. Results: Among those with complete follow-up, 26,065 (62.8%, 62.3-63.3) were prescribed psychotropic medication and 6,318 (15.2%, 14.9-15.6) were referred to mental health services; 4,105 (9.9%, CI 9.6-10.2) were medicated without an antecedent psychiatric diagnosis or referral, and 4,506 (10.9%, CI 10.6-11.2) had a diagnosis but were not subsequently medicated or referred. Patients registered at practices in the most deprived localities were 27.1% (CI 21.5-32.2) less likely to be referred than those in the least deprived. Despite a specifically flagged NICE ‘Do not do’ recommendation in 2011 against prescribing tricyclic antidepressants following self-harm because of their potentially lethal toxicity in overdose, 8.8% (CI 7.8-9.8) of individuals were issued a prescription in the subsequent year. The percentage prescribed Citalopram, an SSRI antidepressant with higher toxicity in overdose, fell sharply during 2012/2013 in the aftermath of a Medicines and Healthcare products Regulatory Agency (MHRA) safety alert issued in 2011. Conclusions: A relatively small percentage of these vulnerable patients are referred to mental health services, and reduced likelihood of referral in more deprived localities reflects a marked health inequality. National clinical guidelines have not yet been effective in reducing rates of tricyclic antidepressant prescribing for this high-risk group.
Author for correspondence
Matthew J Carr
Email for correspondence
matthew.carr@manchester.ac.uk

Code list: res36: Depression

105 codes in list

Code Coding system Description Entity type List name
1B17.00 Read Depressed diagnostic res36: Depression
2257.00 Read O/E - depressed diagnostic res36: Depression
62T1.00 Read Puerperal depression diagnostic res36: Depression
9kQ..00 Read On full dose long term treatment depression - enh serv admin diagnostic res36: Depression
E001300 Read Presenile dementia with depression diagnostic res36: Depression
E002100 Read Senile dementia with depression diagnostic res36: Depression
E004300 Read Arteriosclerotic dementia with depression diagnostic res36: Depression
E11..12 Read Depressive psychoses diagnostic res36: Depression
E112.00 Read Single major depressive episode diagnostic res36: Depression
E112000 Read Single major depressive episode, unspecified diagnostic res36: Depression
E112100 Read Single major depressive episode, mild diagnostic res36: Depression
E112.11 Read Agitated depression diagnostic res36: Depression
E112.12 Read Endogenous depression first episode diagnostic res36: Depression
E112.13 Read Endogenous depression first episode diagnostic res36: Depression
E112.14 Read Endogenous depression diagnostic res36: Depression
E112200 Read Single major depressive episode, moderate diagnostic res36: Depression
E112300 Read Single major depressive episode, severe, without psychosis diagnostic res36: Depression
E112400 Read Single major depressive episode, severe, with psychosis diagnostic res36: Depression
E112z00 Read Single major depressive episode NOS diagnostic res36: Depression
E113.00 Read Recurrent major depressive episode diagnostic res36: Depression
E113000 Read Recurrent major depressive episodes, unspecified diagnostic res36: Depression
E113100 Read Recurrent major depressive episodes, mild diagnostic res36: Depression
E113.11 Read Endogenous depression - recurrent diagnostic res36: Depression
E113200 Read Recurrent major depressive episodes, moderate diagnostic res36: Depression
E113300 Read Recurrent major depressive episodes, severe, no psychosis diagnostic res36: Depression
E113400 Read Recurrent major depressive episodes, severe, with psychosis diagnostic res36: Depression
E113700 Read Recurrent depression diagnostic res36: Depression
E113z00 Read Recurrent major depressive episode NOS diagnostic res36: Depression
E118.00 Read Seasonal affective disorder diagnostic res36: Depression
E11y200 Read Atypical depressive disorder diagnostic res36: Depression
E11z200 Read Masked depression diagnostic res36: Depression
E135.00 Read Agitated depression diagnostic res36: Depression
E200300 Read Anxiety with depression diagnostic res36: Depression
E204.00 Read Neurotic depression reactive type diagnostic res36: Depression
E204.11 Read Postnatal depression diagnostic res36: Depression
E290.00 Read Brief depressive reaction diagnostic res36: Depression
E290z00 Read Brief depressive reaction NOS diagnostic res36: Depression
E291.00 Read Prolonged depressive reaction diagnostic res36: Depression
E2B..00 Read Depressive disorder NEC diagnostic res36: Depression
E2B0.00 Read Postviral depression diagnostic res36: Depression
E2B1.00 Read Chronic depression diagnostic res36: Depression
Eu20400 Read [X]Post-schizophrenic depression diagnostic res36: Depression
Eu32.00 Read [X]Depressive episode diagnostic res36: Depression
Eu32000 Read [X]Mild depressive episode diagnostic res36: Depression
Eu32100 Read [X]Moderate depressive episode diagnostic res36: Depression
Eu32.11 Read [X]Single episode of depressive reaction diagnostic res36: Depression
Eu32.12 Read [X]Single episode of psychogenic depression diagnostic res36: Depression
Eu32.13 Read [X]Single episode of reactive depression diagnostic res36: Depression
Eu32200 Read [X]Severe depressive episode without psychotic symptoms diagnostic res36: Depression
Eu32211 Read [X]Single episode agitated depressn w'out psychotic symptoms diagnostic res36: Depression
Eu32212 Read [X]Single episode major depression w'out psychotic symptoms diagnostic res36: Depression
Eu32213 Read [X]Single episode vital depression w'out psychotic symptoms diagnostic res36: Depression
Eu32300 Read [X]Severe depressive episode with psychotic symptoms diagnostic res36: Depression
Eu32311 Read [X]Single episode of major depression and psychotic symptoms diagnostic res36: Depression
Eu32312 Read [X]Single episode of psychogenic depressive psychosis diagnostic res36: Depression
Eu32313 Read [X]Single episode of psychotic depression diagnostic res36: Depression
Eu32314 Read [X]Single episode of reactive depressive psychosis diagnostic res36: Depression
Eu32400 Read [X]Mild depression diagnostic res36: Depression
Eu32500 Read [X]Major depression, mild diagnostic res36: Depression
Eu32600 Read [X]Major depression, moderately severe diagnostic res36: Depression
Eu32700 Read [X]Major depression, severe without psychotic symptoms diagnostic res36: Depression
Eu32800 Read [X]Major depression, severe with psychotic symptoms diagnostic res36: Depression
Eu32900 Read [X]Single major depr ep, severe with psych, psych in remiss diagnostic res36: Depression
Eu32A00 Read [X]Recurr major depr ep, severe with psych, psych in remiss diagnostic res36: Depression
Eu32y00 Read [X]Other depressive episodes diagnostic res36: Depression
Eu32y11 Read [X]Atypical depression diagnostic res36: Depression
Eu32y12 Read [X]Single episode of masked depression NOS diagnostic res36: Depression
Eu32z00 Read [X]Depressive episode, unspecified diagnostic res36: Depression
Eu32z11 Read [X]Depression NOS diagnostic res36: Depression
Eu32z12 Read [X]Depressive disorder NOS diagnostic res36: Depression
Eu32z13 Read [X]Prolonged single episode of reactive depression diagnostic res36: Depression
Eu32z14 Read [X] Reactive depression NOS diagnostic res36: Depression
Eu33.00 Read [X]Recurrent depressive disorder diagnostic res36: Depression
Eu33000 Read [X]Recurrent depressive disorder, current episode mild diagnostic res36: Depression
Eu33100 Read [X]Recurrent depressive disorder, current episode moderate diagnostic res36: Depression
Eu33.11 Read [X]Recurrent episodes of depressive reaction diagnostic res36: Depression
Eu33.12 Read [X]Recurrent episodes of psychogenic depression diagnostic res36: Depression
Eu33.13 Read [X]Recurrent episodes of reactive depression diagnostic res36: Depression
Eu33.14 Read [X]Seasonal depressive disorder diagnostic res36: Depression
Eu33.15 Read [X]SAD - Seasonal affective disorder diagnostic res36: Depression
Eu33200 Read [X]Recurr depress disorder cur epi severe without psyc sympt diagnostic res36: Depression
Eu33211 Read [X]Endogenous depression without psychotic symptoms diagnostic res36: Depression
Eu33212 Read [X]Major depression, recurrent without psychotic symptoms diagnostic res36: Depression
Eu33214 Read [X]Vital depression, recurrent without psychotic symptoms diagnostic res36: Depression
Eu33300 Read [X]Recurrent depress disorder cur epi severe with psyc symp diagnostic res36: Depression
Eu33311 Read [X]Endogenous depression with psychotic symptoms diagnostic res36: Depression
Eu33312 Read [X]Manic-depress psychosis,depressed type+psychotic symptoms diagnostic res36: Depression
Eu33313 Read [X]Recurr severe episodes/major depression+psychotic symptom diagnostic res36: Depression
Eu33314 Read [X]Recurr severe episodes/psychogenic depressive psychosis diagnostic res36: Depression
Eu33315 Read [X]Recurrent severe episodes of psychotic depression diagnostic res36: Depression
Eu33316 Read [X]Recurrent severe episodes/reactive depressive psychosis diagnostic res36: Depression
Eu33400 Read [X]Recurrent depressive disorder, currently in remission diagnostic res36: Depression
Eu33y00 Read [X]Other recurrent depressive disorders diagnostic res36: Depression
Eu33z00 Read [X]Recurrent depressive disorder, unspecified diagnostic res36: Depression
Eu33z11 Read [X]Monopolar depression NOS diagnostic res36: Depression
Eu34100 Read [X]Dysthymia diagnostic res36: Depression
Eu34111 Read [X]Depressive neurosis diagnostic res36: Depression
Eu34113 Read [X]Neurotic depression diagnostic res36: Depression
Eu34114 Read [X]Persistant anxiety depression diagnostic res36: Depression
Eu3y111 Read [X]Recurrent brief depressive episodes diagnostic res36: Depression
Eu41200 Read [X]Mixed anxiety and depressive disorder diagnostic res36: Depression
Eu41211 Read [X]Mild anxiety depression diagnostic res36: Depression
Eu53011 Read [X]Postnatal depression NOS diagnostic res36: Depression
Eu53012 Read [X]Postpartum depression NOS diagnostic res36: Depression
Eu92000 Read [X]Depressive conduct disorder diagnostic res36: Depression

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