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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: Atypical APDs

173 codes in list

Code Coding system Description Entity type List name
00209021 Multilex Quetiapine 12.5mg/5ml oral solution drug res41: Atypical APDs
00337021 Multilex Asenapine 5mg sublingual tablets sugar free drug res41: Atypical APDs
00341021 Multilex Asenapine 10mg sublingual tablets sugar free drug res41: Atypical APDs
00411021 Multilex Amisulpride 25mg/5ml oral solution drug res41: Atypical APDs
00447021 Multilex Quetiapine 12.5mg/5ml oral suspension drug res41: Atypical APDs
00589021 Multilex Zalasta 5mg orodispersible tablets (Consilient Health Ltd) drug res41: Atypical APDs
00709021 Multilex Olanzapine 5mg orodispersible tablets sugar free drug res41: Atypical APDs
00711021 Multilex Olanzapine 5mg orodispersible tablets drug res41: Atypical APDs
00713021 Multilex Olanzapine 5mg oral lyophilisates sugar free drug res41: Atypical APDs
00715021 Multilex Olanzapine 10mg orodispersible tablets sugar free drug res41: Atypical APDs
00717021 Multilex Olanzapine 10mg orodispersible tablets drug res41: Atypical APDs
00719021 Multilex Olanzapine 10mg oral lyophilisates sugar free drug res41: Atypical APDs
00723021 Multilex Olanzapine 15mg orodispersible tablets sugar free drug res41: Atypical APDs
00725021 Multilex Olanzapine 15mg orodispersible tablets drug res41: Atypical APDs
00727021 Multilex Olanzapine 15mg oral lyophilisates sugar free drug res41: Atypical APDs
00729021 Multilex Olanzapine 20mg orodispersible tablets sugar free drug res41: Atypical APDs
00731021 Multilex Olanzapine 20mg orodispersible tablets drug res41: Atypical APDs
00733021 Multilex Olanzapine 20mg oral lyophilisates sugar free drug res41: Atypical APDs
03580020 Multilex Olanzapine 2.5mg tablets (Aspire Pharma Ltd) drug res41: Atypical APDs
10469020 Multilex Abilify 5mg tablets (Sigma Pharmaceuticals Plc) drug res41: Atypical APDs
13768020 Multilex Risperdal Consta 50mg powder and solvent for suspension for injection vials (Waymade Healthcare Plc) drug res41: Atypical APDs
33610020 Multilex Quetiapine 25mg/5ml oral solution drug res41: Atypical APDs
35008020 Multilex Amisulpride 12.5mg/5ml oral solution drug res41: Atypical APDs
35010020 Multilex Amisulpride 12.5mg/5ml oral suspension drug res41: Atypical APDs
36328020 Multilex Quetiapine 50mg/5ml oral suspension drug res41: Atypical APDs
36905020 Multilex Risperidone 125micrograms/5ml oral solution drug res41: Atypical APDs
42176020 Multilex Quetiapine 25mg tablets (Zentiva) drug res41: Atypical APDs
49437020 Multilex Risperdal 1mg tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
49438020 Multilex Risperdal 2mg tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
49439020 Multilex Risperdal 3mg tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
49489020 Multilex Risperidone 4mg tablets drug res41: Atypical APDs
49490020 Multilex Risperidone 1mg/ml oral solution sugar free drug res41: Atypical APDs
49491020 Multilex Risperidone 6mg tablets drug res41: Atypical APDs
50780020 Multilex Zotepine 25mg tablets drug res41: Atypical APDs
50781020 Multilex Zotepine 50mg tablets drug res41: Atypical APDs
50782020 Multilex Zotepine 100mg tablets drug res41: Atypical APDs
53727020 Multilex Risperidone 1mg tablets drug res41: Atypical APDs
53728020 Multilex Risperidone 2mg tablets drug res41: Atypical APDs
53729020 Multilex Risperidone 3mg tablets drug res41: Atypical APDs
55209020 Multilex Zoleptil 25 tablets (Movianto UK Ltd) drug res41: Atypical APDs
55210020 Multilex Zoleptil 50 tablets (Movianto UK Ltd) drug res41: Atypical APDs
55972020 Multilex Olanzapine 15mg Orodispersible tablet drug res41: Atypical APDs
58203020 Multilex Zyprexa 15mg tablets (Eli Lilly and Company Ltd) drug res41: Atypical APDs
59434020 Multilex Olanzapine 15mg tablets drug res41: Atypical APDs
65788020 Multilex Risperidone 50mg powder and solvent for suspension for injection vials drug res41: Atypical APDs
68217020 Multilex Amisulpride 50mg tablets (Zentiva) drug res41: Atypical APDs
68222020 Multilex Amisulpride 100mg tablets (Zentiva) drug res41: Atypical APDs
68224020 Multilex Amisulpride 200mg tablets (Zentiva) drug res41: Atypical APDs
69302020 Multilex Amisulpride 200mg tablets (A A H Pharmaceuticals Ltd) drug res41: Atypical APDs
72576020 Multilex Clozaril 25mg tablets (Novartis Pharmaceuticals UK Ltd) drug res41: Atypical APDs
72577020 Multilex Clozaril 100mg tablets (Novartis Pharmaceuticals UK Ltd) drug res41: Atypical APDs
72580020 Multilex Clozapine 25mg tablets drug res41: Atypical APDs
72581020 Multilex Clozapine 100mg tablets drug res41: Atypical APDs
73439020 Multilex Remoxipride 150mg capsule drug res41: Atypical APDs
73440020 Multilex Remoxipride 300mg capsule drug res41: Atypical APDs
73441020 Multilex Remoxipride 75mg capsule drug res41: Atypical APDs
73474020 Multilex Roxiam 150mg Capsule (AstraZeneca UK Ltd) drug res41: Atypical APDs
73475020 Multilex Roxiam 300mg Capsule (AstraZeneca UK Ltd) drug res41: Atypical APDs
73798020 Multilex Risperdal 4mg tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
73799020 Multilex Risperdal 1mg/ml liquid (Janssen-Cilag Ltd) drug res41: Atypical APDs
73800020 Multilex Risperdal 6mg tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
74786020 Multilex Risperidone 500microgram tablets (Actavis UK Ltd) drug res41: Atypical APDs
74841020 Multilex Risperidone 1mg tablets (Teva UK Ltd) drug res41: Atypical APDs
74927020 Multilex Risperidone 500microgram tablets (A A H Pharmaceuticals Ltd) drug res41: Atypical APDs
77501020 Multilex Risperdal Quicklet 2mg orodispersible tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
77550020 Multilex Risperdal Consta 37.5mg powder and solvent for suspension for injection vials (Janssen-Cilag Ltd) drug res41: Atypical APDs
77749020 Multilex Risperdal 500microgram tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
77912020 Multilex Risperidone 500microgram tablets drug res41: Atypical APDs
78753020 Multilex Risperdal Consta 25mg powder and solvent for suspension for injection vials (Janssen-Cilag Ltd) drug res41: Atypical APDs
78912020 Multilex Zyprexa 5mg Velotabs (Eli Lilly and Company Ltd) drug res41: Atypical APDs
78913020 Multilex Zyprexa 10mg Velotabs (Eli Lilly and Company Ltd) drug res41: Atypical APDs
79348020 Multilex Solian 100mg/ml oral solution (Sanofi) drug res41: Atypical APDs
79476020 Multilex Risperidone 1mg orodispersible tablets sugar free drug res41: Atypical APDs
79499020 Multilex Zyprexa 15mg Velotabs (Eli Lilly and Company Ltd) drug res41: Atypical APDs
80139020 Multilex Amisulpride 100mg tablets drug res41: Atypical APDs
80154020 Multilex Solian 100 tablets (Sanofi) drug res41: Atypical APDs
81008020 Multilex Zyprexa 2.5mg tablets (Eli Lilly and Company Ltd) drug res41: Atypical APDs
81014020 Multilex Olanzapine 2.5mg tablets drug res41: Atypical APDs
81015020 Multilex Olanzapine 5mg Orodispersible tablet drug res41: Atypical APDs
81016020 Multilex Olanzapine 10mg Orodispersible tablet drug res41: Atypical APDs
81543020 Multilex Risperidone 2mg orodispersible tablets sugar free drug res41: Atypical APDs
81545020 Multilex Risperdal Quicklet 1mg orodispersible tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
81945020 Multilex Amisulpride 100mg/ml oral solution sugar free drug res41: Atypical APDs
82616020 Multilex Risperdal Consta 50mg powder and solvent for suspension for injection vials (Janssen-Cilag Ltd) drug res41: Atypical APDs
82827020 Multilex Sertindole 4mg tablets drug res41: Atypical APDs
82828020 Multilex Sertindole 12mg tablets drug res41: Atypical APDs
82829020 Multilex Sertindole 16mg tablets drug res41: Atypical APDs
82831020 Multilex Sertindole 20mg tablets drug res41: Atypical APDs
82835020 Multilex Serdolect 4mg tablets (Lundbeck Ltd) drug res41: Atypical APDs
82836020 Multilex Serdolect 12mg tablets (Lundbeck Ltd) drug res41: Atypical APDs
82837020 Multilex Serdolect 16mg tablets (Lundbeck Ltd) drug res41: Atypical APDs
83397020 Multilex Zyprexa 5mg tablets (Eli Lilly and Company Ltd) drug res41: Atypical APDs
83398020 Multilex Zyprexa 7.5mg tablets (Eli Lilly and Company Ltd) drug res41: Atypical APDs
83399020 Multilex Zyprexa 10mg tablets (Eli Lilly and Company Ltd) drug res41: Atypical APDs
83403020 Multilex Olanzapine 5mg tablets drug res41: Atypical APDs
83404020 Multilex Olanzapine 7.5mg tablets drug res41: Atypical APDs
83405020 Multilex Olanzapine 10mg tablets drug res41: Atypical APDs
84528020 Multilex Roxiam ir 75mg Capsule (AstraZeneca UK Ltd) drug res41: Atypical APDs
85202020 Multilex Quetiapine Starter Pack drug res41: Atypical APDs
85203020 Multilex Quetiapine 25mg tablets drug res41: Atypical APDs
85204020 Multilex Quetiapine 100mg tablets drug res41: Atypical APDs
85206020 Multilex Quetiapine 200mg tablets drug res41: Atypical APDs
85207020 Multilex Quetiapine 150mg tablets drug res41: Atypical APDs
85212020 Multilex Seroquel 25mg tablets (AstraZeneca UK Ltd) drug res41: Atypical APDs
85213020 Multilex Seroquel 100mg tablets (AstraZeneca UK Ltd) drug res41: Atypical APDs
85215020 Multilex Seroquel 200mg tablets (AstraZeneca UK Ltd) drug res41: Atypical APDs
85216020 Multilex Seroquel 150mg tablets (AstraZeneca UK Ltd) drug res41: Atypical APDs
85992020 Multilex Amisulpride 50mg tablets drug res41: Atypical APDs
85993020 Multilex Amisulpride 200mg tablets drug res41: Atypical APDs
85994020 Multilex Amisulpride 400mg tablets drug res41: Atypical APDs
85999020 Multilex Solian 50 tablets (Sanofi) drug res41: Atypical APDs
86000020 Multilex Solian 200 tablets (Sanofi) drug res41: Atypical APDs
86001020 Multilex Solian 400 tablets (Sanofi) drug res41: Atypical APDs
86494020 Multilex Risperidone 25mg powder and solvent for suspension for injection vials drug res41: Atypical APDs
86496020 Multilex Risperidone 37.5mg powder and solvent for suspension for injection vials drug res41: Atypical APDs
87045020 Multilex Quetiapine 300mg tablets drug res41: Atypical APDs
87047020 Multilex Seroquel 300mg tablets (AstraZeneca UK Ltd) drug res41: Atypical APDs
87556020 Multilex Olanzapine 10mg powder for solution for injection vials drug res41: Atypical APDs
87558020 Multilex Zyprexa 10mg powder for solution for injection vials (Eli Lilly and Company Ltd) drug res41: Atypical APDs
87944020 Multilex Aripiprazole 10mg tablets drug res41: Atypical APDs
87946020 Multilex Aripiprazole 15mg tablets drug res41: Atypical APDs
87948020 Multilex Aripiprazole 30mg tablets drug res41: Atypical APDs
87950020 Multilex Abilify 10mg tablets (Otsuka Pharmaceuticals (U.K.) Ltd) drug res41: Atypical APDs
87952020 Multilex Abilify 15mg tablets (Otsuka Pharmaceuticals (U.K.) Ltd) drug res41: Atypical APDs
87954020 Multilex Abilify 30mg tablets (Otsuka Pharmaceuticals (U.K.) Ltd) drug res41: Atypical APDs
88167020 Multilex Denzapine 25mg tablets (Britannia Pharmaceuticals Ltd) drug res41: Atypical APDs
88169020 Multilex Denzapine 100mg tablets (Britannia Pharmaceuticals Ltd) drug res41: Atypical APDs
88666020 Multilex Aripiprazole 5mg tablets drug res41: Atypical APDs
88668020 Multilex Abilify 5mg tablets (Otsuka Pharmaceuticals (U.K.) Ltd) drug res41: Atypical APDs
88804020 Multilex Zaponex 25mg tablets (Teva UK Ltd) drug res41: Atypical APDs
88806020 Multilex Zaponex 100mg tablets (Teva UK Ltd) drug res41: Atypical APDs
88875020 Multilex Risperidone 500microgram orodispersible tablets sugar free drug res41: Atypical APDs
88877020 Multilex Risperdal Quicklet 500microgram orodispersible tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
89950020 Multilex Amisulpride 25mg/5ml oral suspension drug res41: Atypical APDs
90165020 Multilex Olanzapine 20mg Orodispersible tablet drug res41: Atypical APDs
90167020 Multilex Zyprexa 20mg Velotabs (Eli Lilly and Company Ltd) drug res41: Atypical APDs
91139020 Multilex Aripiprazole 10mg orodispersible tablets sugar free drug res41: Atypical APDs
91141020 Multilex Aripiprazole 15mg orodispersible tablets sugar free drug res41: Atypical APDs
91143020 Multilex Aripiprazole 1mg/ml oral solution drug res41: Atypical APDs
91145020 Multilex Abilify 10mg orodispersible tablets (Otsuka Pharmaceuticals (U.K.) Ltd) drug res41: Atypical APDs
91147020 Multilex Abilify 15mg orodispersible tablets (Otsuka Pharmaceuticals (U.K.) Ltd) drug res41: Atypical APDs
91149020 Multilex Abilify 1mg/ml oral solution (Otsuka Pharmaceuticals (U.K.) Ltd) drug res41: Atypical APDs
92053020 Multilex Olanzapine 20mg tablets drug res41: Atypical APDs
92055020 Multilex Zyprexa 20mg tablets (Eli Lilly and Company Ltd) drug res41: Atypical APDs
92717020 Multilex Risperidone 3mg orodispersible tablets sugar free drug res41: Atypical APDs
92721020 Multilex Risperidone 4mg orodispersible tablets sugar free drug res41: Atypical APDs
92723020 Multilex Risperdal Quicklet 3mg orodispersible tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
92725020 Multilex Risperdal Quicklet 4mg orodispersible tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
93739020 Multilex Paliperidone 3mg modified-release tablets drug res41: Atypical APDs
93741020 Multilex Paliperidone 6mg modified-release tablets drug res41: Atypical APDs
93743020 Multilex Paliperidone 9mg modified-release tablets drug res41: Atypical APDs
93747020 Multilex Invega 6mg modified-release tablets (Janssen-Cilag Ltd) drug res41: Atypical APDs
94787020 Multilex Quetiapine 50mg modified-release tablets drug res41: Atypical APDs
94789020 Multilex Quetiapine 200mg modified-release tablets drug res41: Atypical APDs
94791020 Multilex Quetiapine 300mg modified-release tablets drug res41: Atypical APDs
94793020 Multilex Quetiapine 400mg modified-release tablets drug res41: Atypical APDs
94971020 Multilex Aripiprazole 9.75mg/1.3ml solution for injection vials drug res41: Atypical APDs
94973020 Multilex Abilify 9.75mg/1.3ml solution for injection vials (Otsuka Pharmaceuticals (U.K.) Ltd) drug res41: Atypical APDs
95787020 Multilex Seroquel XL 50mg tablets (AstraZeneca UK Ltd) drug res41: Atypical APDs
95789020 Multilex Seroquel XL 200mg tablets (AstraZeneca UK Ltd) drug res41: Atypical APDs
95791020 Multilex Seroquel XL 300mg tablets (AstraZeneca UK Ltd) drug res41: Atypical APDs
95793020 Multilex Seroquel XL 400mg tablets (AstraZeneca UK Ltd) drug res41: Atypical APDs
97145020 Multilex Clozapine 50mg tablets drug res41: Atypical APDs
97147020 Multilex Denzapine 50mg tablets (Britannia Pharmaceuticals Ltd) drug res41: Atypical APDs
97149020 Multilex Clozapine 200mg tablets drug res41: Atypical APDs
97151020 Multilex Denzapine 200mg tablets (Britannia Pharmaceuticals Ltd) drug res41: Atypical APDs
97153020 Multilex Clozapine 50mg/ml oral suspension sugar free drug res41: Atypical APDs
97155020 Multilex Denzapine 50mg/ml oral suspension (Britannia Pharmaceuticals Ltd) drug res41: Atypical APDs
97203020 Multilex Quetiapine 100mg/5ml oral solution drug res41: Atypical APDs
97205020 Multilex Quetiapine 100mg/5ml oral suspension drug res41: Atypical APDs
98873020 Multilex Quetiapine 150mg modified-release tablets drug res41: Atypical APDs
98875020 Multilex Seroquel XL 150mg tablets (AstraZeneca UK Ltd) drug res41: Atypical APDs
99745020 Multilex Quetiapine 25mg/5ml oral suspension drug res41: Atypical APDs

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