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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: SSRI ADDs
120 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 03837020 | Multilex | Prozac 20mg capsules (Lexon (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 03985020 | Multilex | Citalopram 20mg tablets (Alliance Healthcare (Distribution) Ltd) | drug | res38: SSRI ADDs | |||
| 03997020 | Multilex | Citalopram 20mg tablets (Bristol Laboratories Ltd) | drug | res38: SSRI ADDs | |||
| 04003020 | Multilex | Citalopram 10mg tablets (Kent Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 04004020 | Multilex | Citalopram 10mg tablets (Alliance Healthcare (Distribution) Ltd) | drug | res38: SSRI ADDs | |||
| 04007020 | Multilex | Citalopram 10mg tablets (Arrow Generics Ltd) | drug | res38: SSRI ADDs | |||
| 04011020 | Multilex | Citalopram 10mg tablets (Bristol Laboratories Ltd) | drug | res38: SSRI ADDs | |||
| 20738020 | Multilex | Sertraline 100mg/5ml oral suspension | drug | res38: SSRI ADDs | |||
| 33816020 | Multilex | Sertraline 25mg/5ml oral suspension | drug | res38: SSRI ADDs | |||
| 38526020 | Multilex | Citalopram 20mg tablets (DE Pharmaceuticals) | drug | res38: SSRI ADDs | |||
| 49680020 | Multilex | Felicium 20mg capsules (Opus Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 53823020 | Multilex | Escitalopram 20mg tablets | drug | res38: SSRI ADDs | |||
| 55602020 | Multilex | Cipralex 20mg tablets (Lundbeck Ltd) | drug | res38: SSRI ADDs | |||
| 60735020 | Multilex | Fluvoxamine 100mg tablets (IVAX Pharmaceuticals UK Ltd) | drug | res38: SSRI ADDs | |||
| 61084020 | Multilex | Fluoxetine 20mg capsules (A A H Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 61167020 | Multilex | Fluoxetine 20mg capsules (IVAX Pharmaceuticals UK Ltd) | drug | res38: SSRI ADDs | |||
| 61319020 | Multilex | Fluoxetine 20mg capsules (Teva UK Ltd) | drug | res38: SSRI ADDs | |||
| 61387020 | Multilex | Fluoxetine 20mg capsules (Sandoz Ltd) | drug | res38: SSRI ADDs | |||
| 61409020 | Multilex | Fluoxetine 20mg capsules (Generics (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 61420020 | Multilex | Fluoxetine 20mg capsules (Niche Generics Ltd) | drug | res38: SSRI ADDs | |||
| 61439020 | Multilex | Fluoxetine 20mg capsules (Wockhardt UK Ltd) | drug | res38: SSRI ADDs | |||
| 61452020 | Multilex | Fluoxetine 20mg capsules (Actavis UK Ltd) | drug | res38: SSRI ADDs | |||
| 61455020 | Multilex | Fluoxetine 20mg capsules (Genus Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 61616020 | Multilex | Fluoxetine 20mg capsules (Zentiva) | drug | res38: SSRI ADDs | |||
| 62069020 | Multilex | Fluvoxamine 50mg tablets | drug | res38: SSRI ADDs | |||
| 62070020 | Multilex | Fluvoxamine 100mg tablets | drug | res38: SSRI ADDs | |||
| 62073020 | Multilex | Faverin 50mg tablets (Abbott Healthcare Products Ltd) | drug | res38: SSRI ADDs | |||
| 62074020 | Multilex | Faverin 100mg tablets (Abbott Healthcare Products Ltd) | drug | res38: SSRI ADDs | |||
| 62693020 | Multilex | Fluvoxamine 100mg tablets (Actavis UK Ltd) | drug | res38: SSRI ADDs | |||
| 62975020 | Multilex | Fluoxetine 20mg capsules (Fannin UK Ltd) | drug | res38: SSRI ADDs | |||
| 63016020 | Multilex | Fluoxetine 20mg capsules (Ranbaxy (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 63703020 | Multilex | Paroxetine 20mg tablets (IVAX Pharmaceuticals UK Ltd) | drug | res38: SSRI ADDs | |||
| 64692020 | Multilex | Fluoxetine 20mg/5ml oral solution (Teva UK Ltd) | drug | res38: SSRI ADDs | |||
| 64717020 | Multilex | Fluoxetine 20mg/5ml oral solution (A A H Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 65125020 | Multilex | Citalopram 10mg tablets (Sandoz Ltd) | drug | res38: SSRI ADDs | |||
| 65128020 | Multilex | Citalopram 20mg tablets (Sandoz Ltd) | drug | res38: SSRI ADDs | |||
| 65131020 | Multilex | Citalopram 40mg tablets (Sandoz Ltd) | drug | res38: SSRI ADDs | |||
| 65254020 | Multilex | Citalopram 10mg Tablet (Neo Laboratories Ltd) | drug | res38: SSRI ADDs | |||
| 65257020 | Multilex | Citalopram 20mg Tablet (Neo Laboratories Ltd) | drug | res38: SSRI ADDs | |||
| 65262020 | Multilex | Citalopram 40mg Tablet (Neo Laboratories Ltd) | drug | res38: SSRI ADDs | |||
| 65376020 | Multilex | Citalopram 10mg tablets (A A H Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 65381020 | Multilex | Citalopram 20mg tablets (A A H Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 65386020 | Multilex | Citalopram 40mg tablets (A A H Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 65464020 | Multilex | Fluoxetine 60mg capsules (Generics (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 65578020 | Multilex | Paroxetine 20mg tablets (Actavis UK Ltd) | drug | res38: SSRI ADDs | |||
| 66129020 | Multilex | Fluoxetine 20mg/5ml oral solution (IVAX Pharmaceuticals UK Ltd) | drug | res38: SSRI ADDs | |||
| 66149020 | Multilex | Citalopram 10mg tablets (Zentiva) | drug | res38: SSRI ADDs | |||
| 66152020 | Multilex | Citalopram 20mg tablets (Zentiva) | drug | res38: SSRI ADDs | |||
| 66160020 | Multilex | Citalopram 40mg tablets (Zentiva) | drug | res38: SSRI ADDs | |||
| 66244020 | Multilex | Fluvoxamine 100mg tablets (A A H Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 66273020 | Multilex | Fluoxetine 20mg capsules (Tillomed Laboratories Ltd) | drug | res38: SSRI ADDs | |||
| 66399020 | Multilex | Paroxetine 20mg tablets (Generics (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 66451020 | Multilex | Citalopram 10mg tablets (Generics (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 66454020 | Multilex | Citalopram 20mg tablets (Generics (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 66459020 | Multilex | Citalopram 40mg tablets (Generics (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 66464020 | Multilex | Paroxetine 20mg tablets (A A H Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 66680020 | Multilex | Citalopram 10mg tablets (Niche Generics Ltd) | drug | res38: SSRI ADDs | |||
| 66685020 | Multilex | Citalopram 20mg tablets (Niche Generics Ltd) | drug | res38: SSRI ADDs | |||
| 66688020 | Multilex | Citalopram 40mg tablets (Niche Generics Ltd) | drug | res38: SSRI ADDs | |||
| 67575020 | Multilex | Paroxetine 30mg tablets (Actavis UK Ltd) | drug | res38: SSRI ADDs | |||
| 67650020 | Multilex | Paroxetine 30mg tablets (A A H Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 67890020 | Multilex | Citalopram 10mg tablets (Actavis UK Ltd) | drug | res38: SSRI ADDs | |||
| 67893020 | Multilex | Citalopram 20mg tablets (Actavis UK Ltd) | drug | res38: SSRI ADDs | |||
| 67898020 | Multilex | Citalopram 40mg tablets (Actavis UK Ltd) | drug | res38: SSRI ADDs | |||
| 68042020 | Multilex | Citalopram 10mg tablets (Teva UK Ltd) | drug | res38: SSRI ADDs | |||
| 68045020 | Multilex | Citalopram 20mg tablets (Teva UK Ltd) | drug | res38: SSRI ADDs | |||
| 68049020 | Multilex | Citalopram 40mg tablets (Teva UK Ltd) | drug | res38: SSRI ADDs | |||
| 69506020 | Multilex | Prozac 20mg capsules (Eli Lilly and Company Ltd) | drug | res38: SSRI ADDs | |||
| 69507020 | Multilex | Prozac 20mg/5ml liquid (Eli Lilly and Company Ltd) | drug | res38: SSRI ADDs | |||
| 69508020 | Multilex | Prozac 60mg capsules (Eli Lilly and Company Ltd) | drug | res38: SSRI ADDs | |||
| 69654020 | Multilex | Fluoxetine 20mg capsules | drug | res38: SSRI ADDs | |||
| 69655020 | Multilex | Fluoxetine 20mg/5ml oral solution | drug | res38: SSRI ADDs | |||
| 69656020 | Multilex | Fluoxetine 60mg capsules | drug | res38: SSRI ADDs | |||
| 69754020 | Multilex | Paroxetine 20mg tablets (Genus Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 71214020 | Multilex | Citalopram 10mg tablets (PLIVA Pharma Ltd) | drug | res38: SSRI ADDs | |||
| 71225020 | Multilex | Citalopram 10mg tablets (IVAX Pharmaceuticals UK Ltd) | drug | res38: SSRI ADDs | |||
| 71373020 | Multilex | Citalopram 10mg tablets (Almus Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 71376020 | Multilex | Citalopram 20mg tablets (Almus Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 71725020 | Multilex | Sertraline 50mg tablets (A A H Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 72034020 | Multilex | Sertraline 50mg tablets (Actavis UK Ltd) | drug | res38: SSRI ADDs | |||
| 72095020 | Multilex | Sertraline 100mg tablets (Teva UK Ltd) | drug | res38: SSRI ADDs | |||
| 72932020 | Multilex | Paroxetine 20mg tablets | drug | res38: SSRI ADDs | |||
| 72933020 | Multilex | Paroxetine 30mg tablets | drug | res38: SSRI ADDs | |||
| 72934020 | Multilex | Paroxetine 10mg/5ml oral suspension sugar free | drug | res38: SSRI ADDs | |||
| 72937020 | Multilex | Seroxat 20mg tablets (GlaxoSmithKline UK Ltd) | drug | res38: SSRI ADDs | |||
| 72938020 | Multilex | Seroxat 30mg tablets (GlaxoSmithKline UK Ltd) | drug | res38: SSRI ADDs | |||
| 72939020 | Multilex | Seroxat 20mg/10ml liquid (GlaxoSmithKline UK Ltd) | drug | res38: SSRI ADDs | |||
| 74046020 | Multilex | Lustral 50mg tablets (Pfizer Ltd) | drug | res38: SSRI ADDs | |||
| 74047020 | Multilex | Lustral 100mg tablets (Pfizer Ltd) | drug | res38: SSRI ADDs | |||
| 74050020 | Multilex | Sertraline 50mg tablets | drug | res38: SSRI ADDs | |||
| 74051020 | Multilex | Sertraline 100mg tablets | drug | res38: SSRI ADDs | |||
| 74425020 | Multilex | Fluoxetine 20mg Capsule (Milpharm Ltd) | drug | res38: SSRI ADDs | |||
| 75620020 | Multilex | Sertraline 50mg tablets (Almus Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 77306020 | Multilex | Citalopram 40mg/ml oral drops sugar free | drug | res38: SSRI ADDs | |||
| 77312020 | Multilex | Cipramil 40mg/ml drops (Lundbeck Ltd) | drug | res38: SSRI ADDs | |||
| 78768020 | Multilex | Escitalopram 10mg tablets | drug | res38: SSRI ADDs | |||
| 79420020 | Multilex | Cipramil 20mg tablets (Lundbeck Ltd) | drug | res38: SSRI ADDs | |||
| 79421020 | Multilex | Cipramil 10mg tablets (Lundbeck Ltd) | drug | res38: SSRI ADDs | |||
| 79422020 | Multilex | Cipramil 40mg tablets (Lundbeck Ltd) | drug | res38: SSRI ADDs | |||
| 79462020 | Multilex | Citalopram 20mg tablets | drug | res38: SSRI ADDs | |||
| 79463020 | Multilex | Citalopram 10mg tablets | drug | res38: SSRI ADDs | |||
| 79464020 | Multilex | Citalopram 40mg tablets | drug | res38: SSRI ADDs | |||
| 80679020 | Multilex | Oxactin 20mg capsules (Discovery Pharmaceuticals Ltd) | drug | res38: SSRI ADDs | |||
| 80777020 | Multilex | Prozit 20mg/5ml oral solution (Pinewood Healthcare) | drug | res38: SSRI ADDs | |||
| 82055020 | Multilex | Ranflutin 20mg capsules (Ranbaxy (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 86222020 | Multilex | Cipralex 10mg tablets (Lundbeck Ltd) | drug | res38: SSRI ADDs | |||
| 87524020 | Multilex | Escitalopram 5mg tablets | drug | res38: SSRI ADDs | |||
| 87526020 | Multilex | Cipralex 5mg tablets (Lundbeck Ltd) | drug | res38: SSRI ADDs | |||
| 88346020 | Multilex | Paxoran 10mg Tablet (Ranbaxy (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 88348020 | Multilex | Paxoran 20mg Tablet (Ranbaxy (UK) Ltd) | drug | res38: SSRI ADDs | |||
| 90497020 | Multilex | Sertraline 50mg/5ml oral suspension | drug | res38: SSRI ADDs | |||
| 90871020 | Multilex | Escitalopram 10mg/ml oral drops sugar free | drug | res38: SSRI ADDs | |||
| 90873020 | Multilex | Cipralex 10mg/ml oral drops (Lundbeck Ltd) | drug | res38: SSRI ADDs | |||
| 92043020 | Multilex | Paroxetine 10mg tablets | drug | res38: SSRI ADDs | |||
| 93187020 | Multilex | Seroxat 10mg tablets (GlaxoSmithKline UK Ltd) | drug | res38: SSRI ADDs | |||
| 93918020 | Multilex | Prozep 20mg/5ml oral solution (Chemidex Pharma Ltd) | drug | res38: SSRI ADDs | |||
| 93984020 | Multilex | Fluoxetine 20mg/5ml oral solution sugar free | drug | res38: SSRI ADDs | |||
| 97169020 | Multilex | Escitalopram 20mg/ml oral drops sugar free | drug | res38: SSRI ADDs | |||
| 97171020 | Multilex | Cipralex 20mg/ml oral drops (Lundbeck Ltd) | drug | res38: SSRI ADDs | |||
| 98001020 | Multilex | Fluoxetine 10mg tablets | drug | res38: SSRI ADDs |
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