ClinicalCodes.org

An online clinical codes repository to improve validity and reproducibility of medical database research

Research article:

Short- and long-term risk of premature death in a nationally representative cohort of primary care patients with history of self-harm

Reference:

Matthew J. Carr, Darren M. Ashcroft, Evangelos Kontopantelis, David While, Yvonne Awenat, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T. Webb (2016) Short- and long-term risk of premature death in a nationally representative cohort of primary care patients with history of self-harm. BMJ, doi:

Link to article
Abstract
Objectives: To examine premature mortality in a nationally representative cohort of primary care patients who have harmed themselves, and to estimate relative risks versus the general population stratified by follow-up time from first to tenth year. Design: Matched cohort study. Setting: 385 general practices in England contributing data to the Clinical Practice Research Datalink (CPRD) during 2001-2013 with linkage to national mortality records. Population: Index cohort of 30,017 persons aged 15-64 years with a record of self-harm; comparison cohort, sampled from the same population, consisting of 600,258 persons with no record of self-harm and matched to index patients on age (year of birth), gender and registered general practice. Main outcome measures: Hazards ratios for all-cause and cause-specific mortality, including unnatural vs. natural death, suicide, intentional vs. accidental poisoning, and alcohol-related death. Results: We found greatly raised risk of dying prematurely from any cause among members of the self-harm cohort, especially so during the first follow-up year: hazard ratio (HR) 9.9, 95% confidence interval (CI) 8.6 to 11.4. The elevation in suicide risk within a year was especially great (HR 113.9, CI 73.9 to 175.6). Beyond the first follow-up year, suicide risk declined sharply but remained much higher than in the comparison cohort. Large risk elevations throughout the follow-up period were observed for accidental self-poisoning and alcohol-related death. Conclusions: Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by suicide and by other causes, and especially so within a year of the index episode. Relatively frequent general practice attendance by these individuals presents a clear opportunity for preventive action in primary care. National clinical guidelines could provide more specific recommendations for how primary healthcare teams can monitor, intervene and manage risk in these patients more effectively.
Author for correspondence
Matthew J Carr
Email for correspondence
matthew.carr@manchester.ac.uk

Code list: res41: Anxiety

310 codes in list

Code Coding system Description Entity type List name
2258.00 Read O/E - anxious diagnostic res41: Anxiety
225J.00 Read O/E - panic attack diagnostic res41: Anxiety
8G52.00 Read Antiphobic therapy diagnostic res41: Anxiety
8G94.00 Read Anxiety management training diagnostic res41: Anxiety
8HHp.00 Read Referral for guided self-help for anxiety diagnostic res41: Anxiety
E2...00 Read Neurotic, personality and other nonpsychotic disorders diagnostic res41: Anxiety
E20..00 Read Neurotic disorders diagnostic res41: Anxiety
E200.00 Read Anxiety states diagnostic res41: Anxiety
E200000 Read Anxiety state unspecified diagnostic res41: Anxiety
E200100 Read Panic disorder diagnostic res41: Anxiety
E200111 Read Panic attack diagnostic res41: Anxiety
E200200 Read Generalised anxiety disorder diagnostic res41: Anxiety
E200300 Read Anxiety with depression diagnostic res41: Anxiety
E200400 Read Chronic anxiety diagnostic res41: Anxiety
E200500 Read Recurrent anxiety diagnostic res41: Anxiety
E200z00 Read Anxiety state NOS diagnostic res41: Anxiety
E201.00 Read Hysteria diagnostic res41: Anxiety
E201000 Read Hysteria unspecified diagnostic res41: Anxiety
E201100 Read Hysterical blindness diagnostic res41: Anxiety
E201200 Read Hysterical deafness diagnostic res41: Anxiety
E201300 Read Hysterical tremor diagnostic res41: Anxiety
E201400 Read Hysterical paralysis diagnostic res41: Anxiety
E201500 Read Hysterical seizures diagnostic res41: Anxiety
E201511 Read Fit - hysterical diagnostic res41: Anxiety
E201600 Read Other conversion disorder diagnostic res41: Anxiety
E201611 Read Astasia - abasia, hysterical diagnostic res41: Anxiety
E201612 Read Globus hystericus diagnostic res41: Anxiety
E201700 Read Hysterical amnesia diagnostic res41: Anxiety
E201800 Read Hysterical fugue diagnostic res41: Anxiety
E201900 Read Multiple personality diagnostic res41: Anxiety
E201A00 Read Dissociative reaction unspecified diagnostic res41: Anxiety
E201B00 Read Compensation neurosis diagnostic res41: Anxiety
E201C00 Read Phantom pregnancy diagnostic res41: Anxiety
E201z00 Read Hysteria NOS diagnostic res41: Anxiety
E201z11 Read Aphonia - hysterical diagnostic res41: Anxiety
E201z12 Read Ataxia - hysterical diagnostic res41: Anxiety
E201z13 Read Ganser's syndrome - hysterical diagnostic res41: Anxiety
E202.00 Read Phobic disorders diagnostic res41: Anxiety
E202000 Read Phobia unspecified diagnostic res41: Anxiety
E202100 Read Agoraphobia with panic attacks diagnostic res41: Anxiety
E202.11 Read Social phobic disorders diagnostic res41: Anxiety
E202.12 Read Phobic anxiety diagnostic res41: Anxiety
E202200 Read Agoraphobia without mention of panic attacks diagnostic res41: Anxiety
E202300 Read Social phobia, fear of eating in public diagnostic res41: Anxiety
E202400