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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: Eating disorder

38 codes in list

Code Coding system Description Entity type List name
1612.00 Read Appetite loss - anorexia diagnostic res38: Eating disorder
1612.11 Read Anorexia symptom diagnostic res38: Eating disorder
1614.00 Read Excessive eating - polyphagia diagnostic res38: Eating disorder
1614.11 Read Hyperalimentation - symptom diagnostic res38: Eating disorder
1614.12 Read Polyphagia symptom diagnostic res38: Eating disorder
8HTN.00 Read Referral to eating disorders clinic diagnostic res38: Eating disorder
9Nk9.00 Read Seen in eating disorder clinic diagnostic res38: Eating disorder
E271.00 Read Anorexia nervosa diagnostic res38: Eating disorder
E275.00 Read Other and unspecified non-organic eating disorders diagnostic res38: Eating disorder
E275000 Read Unspecified non-organic eating disorder diagnostic res38: Eating disorder
E275100 Read Bulimia (non-organic overeating) diagnostic res38: Eating disorder
E275111 Read Compulsive eating disorder diagnostic res38: Eating disorder
E275y00 Read Other specified non-organic eating disorder diagnostic res38: Eating disorder
E275z00 Read Non-organic eating disorder NOS diagnostic res38: Eating disorder
Eu50.00 Read [X]Eating disorders diagnostic res38: Eating disorder
Eu50000 Read [X]Anorexia nervosa diagnostic res38: Eating disorder
Eu50100 Read [X]Atypical anorexia nervosa diagnostic res38: Eating disorder
Eu50200 Read [X]Bulimia nervosa diagnostic res38: Eating disorder
Eu50211 Read [X]Bulimia NOS diagnostic res38: Eating disorder
Eu50212 Read [X]Hyperorexia nervosa diagnostic res38: Eating disorder
Eu50300 Read [X]Atypical bulimia nervosa diagnostic res38: Eating disorder
Eu50400 Read [X]Overeating associated with other psychological disturbncs diagnostic res38: Eating disorder
Eu50411 Read [X]Psychogenic overeating diagnostic res38: Eating disorder
Eu50y00 Read [X]Other eating disorders diagnostic res38: Eating disorder
Eu50y11 Read [X]Pica in adults diagnostic res38: Eating disorder
Eu50z00 Read [X]Eating disorder, unspecified diagnostic res38: Eating disorder
Fy05.00 Read Nocturnal sleep-related eating disorder diagnostic res38: Eating disorder
R030.00 Read [D]Anorexia diagnostic res38: Eating disorder
R030z00 Read [D]Anorexia NOS diagnostic res38: Eating disorder
R036.00 Read [D]Polyphagia diagnostic res38: Eating disorder
R036000 Read [D]Excessive eating diagnostic res38: Eating disorder
R036011 Read [D]Bulimia NOS diagnostic res38: Eating disorder
R036100 Read [D]Hyperalimentation diagnostic res38: Eating disorder
R036z00 Read [D]Polyphagia NOS diagnostic res38: Eating disorder
SN42100 Read Starvation diagnostic res38: Eating disorder
U1B3.11 Read [X]Starvation diagnostic res38: Eating disorder
Z4B5.00 Read Eating disorder counselling diagnostic res38: Eating disorder
ZC2CD00 Read Dietary advice for eating disorder diagnostic res38: Eating disorder

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