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Research article:

Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary care patients

Reference:

Kirsten Windfuhr, David While, Nav Kapur, Darren M. Ashcroft, Evangelos Kontopantelis, Matthew J. Carr, Jenny Shaw, Louis Appleby, Roger T. Webb (2016) Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary care patients. Psychological Medicine, doi:

Link to article
Abstract
Background: Little is known about the precursors of suicide risk among primary care patients. Objectives: To examine risk of suicide in relation to recent general practice consultation patterns, psychiatric diagnoses and the prescribing of multiple psychotropic drug types. Methods: Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged 16 years and older who died by suicide during 2002-2011 (N=2384) were matched on gender, age and registered practice with up to 20 living control patients (N=46,899). Results: Risk of dying by suicide was raised among general practice non-attenders, and increased sharply with rising number of clinical consultations compared with patients who consulted once only in the year preceding suicide. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types and with having several psychiatric diagnoses, and to a lesser degree risk was also raised among patients living in more socially deprived residential areas. In a multivariable model the confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing clinical consultation frequency. Conclusion: A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-attenders are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties and at elevated risk of suicide.
Author for correspondence
Roger Webb
Email for correspondence
roger.webb@manchester.ac.uk

Code list: res38: Depression

105 codes in list

Code Coding system Description Entity type List name
1B17.00 Read Depressed diagnostic res38: Depression
2257.00 Read O/E - depressed diagnostic res38: Depression
62T1.00 Read Puerperal depression diagnostic res38: Depression
9kQ..00 Read On full dose long term treatment depression - enh serv admin diagnostic res38: Depression
E001300 Read Presenile dementia with depression diagnostic res38: Depression
E002100 Read Senile dementia with depression diagnostic res38: Depression
E004300 Read Arteriosclerotic dementia with depression diagnostic res38: Depression
E11..12 Read Depressive psychoses diagnostic res38: Depression
E112.00 Read Single major depressive episode diagnostic res38: Depression
E112000 Read Single major depressive episode, unspecified diagnostic res38: Depression
E112100 Read Single major depressive episode, mild diagnostic res38: Depression
E112.11 Read Agitated depression diagnostic res38: Depression
E112.12 Read Endogenous depression first episode diagnostic res38: Depression
E112.13 Read Endogenous depression first episode diagnostic res38: Depression
E112.14 Read Endogenous depression diagnostic res38: Depression
E112200 Read Single major depressive episode, moderate diagnostic res38: Depression
E112300 Read Single major depressive episode, severe, without psychosis diagnostic res38: Depression
E112400 Read Single major depressive episode, severe, with psychosis diagnostic res38: Depression
E112z00 Read Single major depressive episode NOS diagnostic res38: Depression
E113.00 Read Recurrent major depressive episode diagnostic res38: Depression
E113000 Read Recurrent major depressive episodes, unspecified diagnostic res38: Depression
E113100 Read Recurrent major depressive episodes, mild diagnostic res38: Depression
E113.11 Read Endogenous depression - recurrent diagnostic res38: Depression
E113200 Read Recurrent major depressive episodes, moderate diagnostic res38: Depression
E113300 Read Recurrent major depressive episodes, severe, no psychosis diagnostic res38: Depression
E113400 Read Recurrent major depressive episodes, severe, with psychosis diagnostic res38: Depression
E113700 Read Recurrent depression diagnostic res38: Depression
E113z00 Read Recurrent major depressive episode NOS diagnostic res38: Depression
E118.00 Read Seasonal affective disorder diagnostic res38: Depression
E11y200 Read Atypical depressive disorder diagnostic res38: Depression
E11z200 Read Masked depression diagnostic res38: Depression
E135.00 Read Agitated depression diagnostic res38: Depression
E200300 Read Anxiety with depression diagnostic res38: Depression
E204.00 Read Neurotic depression reactive type diagnostic res38: Depression
E204.11 Read Postnatal depression diagnostic res38: Depression
E290.00 Read Brief depressive reaction diagnostic res38: Depression
E290z00 Read Brief depressive reaction NOS diagnostic res38: Depression
E291.00 Read Prolonged depressive reaction diagnostic res38: Depression
E2B..00 Read Depressive disorder NEC diagnostic res38: Depression
E2B0.00 Read Postviral depression diagnostic res38: Depression
E2B1.00 Read Chronic depression diagnostic res38: Depression
Eu20400 Read [X]Post-schizophrenic depression diagnostic res38: Depression
Eu32.00 Read [X]Depressive episode diagnostic res38: Depression
Eu32000 Read [X]Mild depressive episode diagnostic res38: Depression
Eu32100 Read [X]Moderate depressive episode diagnostic res38: Depression
Eu32.11 Read [X]Single episode of depressive reaction diagnostic res38: Depression
Eu32.12 Read [X]Single episode of psychogenic depression diagnostic res38: Depression
Eu32.13 Read [X]Single episode of reactive depression diagnostic res38: Depression
Eu32200 Read [X]Severe depressive episode without psychotic symptoms diagnostic res38: Depression
Eu32211 Read [X]Single episode agitated depressn w'out psychotic symptoms diagnostic res38: Depression
Eu32212 Read [X]Single episode major depression w'out psychotic symptoms diagnostic res38: Depression
Eu32213 Read [X]Single episode vital depression w'out psychotic symptoms diagnostic res38: Depression
Eu32300 Read [X]Severe depressive episode with psychotic symptoms diagnostic res38: Depression
Eu32311 Read [X]Single episode of major depression and psychotic symptoms diagnostic res38: Depression
Eu32312 Read [X]Single episode of psychogenic depressive psychosis diagnostic res38: Depression
Eu32313 Read [X]Single episode of psychotic depression diagnostic res38: Depression
Eu32314 Read [X]Single episode of reactive depressive psychosis diagnostic res38: Depression
Eu32400 Read [X]Mild depression diagnostic res38: Depression
Eu32500 Read [X]Major depression, mild diagnostic res38: Depression
Eu32600 Read [X]Major depression, moderately severe diagnostic res38: Depression
Eu32700 Read [X]Major depression, severe without psychotic symptoms diagnostic res38: Depression
Eu32800 Read [X]Major depression, severe with psychotic symptoms diagnostic res38: Depression
Eu32900 Read [X]Single major depr ep, severe with psych, psych in remiss diagnostic res38: Depression
Eu32A00 Read [X]Recurr major depr ep, severe with psych, psych in remiss diagnostic res38: Depression
Eu32y00 Read [X]Other depressive episodes diagnostic res38: Depression
Eu32y11 Read [X]Atypical depression diagnostic res38: Depression
Eu32y12 Read [X]Single episode of masked depression NOS diagnostic res38: Depression
Eu32z00 Read [X]Depressive episode, unspecified diagnostic res38: Depression
Eu32z11 Read [X]Depression NOS diagnostic res38: Depression
Eu32z12 Read [X]Depressive disorder NOS diagnostic res38: Depression
Eu32z13 Read [X]Prolonged single episode of reactive depression diagnostic res38: Depression
Eu32z14 Read [X] Reactive depression NOS diagnostic res38: Depression
Eu33.00 Read [X]Recurrent depressive disorder diagnostic res38: Depression
Eu33000 Read [X]Recurrent depressive disorder, current episode mild diagnostic res38: Depression
Eu33100 Read [X]Recurrent depressive disorder, current episode moderate diagnostic res38: Depression
Eu33.11 Read [X]Recurrent episodes of depressive reaction diagnostic res38: Depression
Eu33.12 Read [X]Recurrent episodes of psychogenic depression diagnostic res38: Depression
Eu33.13 Read [X]Recurrent episodes of reactive depression diagnostic res38: Depression
Eu33.14 Read [X]Seasonal depressive disorder diagnostic res38: Depression
Eu33.15 Read [X]SAD - Seasonal affective disorder diagnostic res38: Depression
Eu33200 Read [X]Recurr depress disorder cur epi severe without psyc sympt diagnostic res38: Depression
Eu33211 Read [X]Endogenous depression without psychotic symptoms diagnostic res38: Depression
Eu33212 Read [X]Major depression, recurrent without psychotic symptoms diagnostic res38: Depression
Eu33214 Read [X]Vital depression, recurrent without psychotic symptoms diagnostic res38: Depression
Eu33300 Read [X]Recurrent depress disorder cur epi severe with psyc symp diagnostic res38: Depression
Eu33311 Read [X]Endogenous depression with psychotic symptoms diagnostic res38: Depression
Eu33312 Read [X]Manic-depress psychosis,depressed type+psychotic symptoms diagnostic res38: Depression
Eu33313 Read [X]Recurr severe episodes/major depression+psychotic symptom diagnostic res38: Depression
Eu33314 Read [X]Recurr severe episodes/psychogenic depressive psychosis diagnostic res38: Depression
Eu33315 Read [X]Recurrent severe episodes of psychotic depression diagnostic res38: Depression
Eu33316 Read [X]Recurrent severe episodes/reactive depressive psychosis diagnostic res38: Depression
Eu33400 Read [X]Recurrent depressive disorder, currently in remission diagnostic res38: Depression
Eu33y00 Read [X]Other recurrent depressive disorders diagnostic res38: Depression
Eu33z00 Read [X]Recurrent depressive disorder, unspecified diagnostic res38: Depression
Eu33z11 Read [X]Monopolar depression NOS diagnostic res38: Depression
Eu34100 Read [X]Dysthymia diagnostic res38: Depression
Eu34111 Read [X]Depressive neurosis diagnostic res38: Depression
Eu34113 Read [X]Neurotic depression diagnostic res38: Depression
Eu34114 Read [X]Persistant anxiety depression diagnostic res38: Depression
Eu3y111 Read [X]Recurrent brief depressive episodes diagnostic res38: Depression
Eu41200 Read [X]Mixed anxiety and depressive disorder diagnostic res38: Depression
Eu41211 Read [X]Mild anxiety depression diagnostic res38: Depression
Eu53011 Read [X]Postnatal depression NOS diagnostic res38: Depression
Eu53012 Read [X]Postpartum depression NOS diagnostic res38: Depression
Eu92000 Read [X]Depressive conduct disorder diagnostic res38: Depression

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