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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: Bipolar disorder

111 codes in list

Code Coding system Description Entity type List name
146D.00 Read H/O: manic depressive disorder diagnostic res41: Bipolar disorder
1S42.00 Read Manic mood diagnostic res41: Bipolar disorder
6657.00 Read On lithium diagnostic res41: Bipolar disorder
6657.11 Read Lithium monitoring diagnostic res41: Bipolar disorder
6657.12 Read Started lithium diagnostic res41: Bipolar disorder
E11..00 Read Affective psychoses diagnostic res41: Bipolar disorder
E110.00 Read Manic disorder, single episode diagnostic res41: Bipolar disorder
E110000 Read Single manic episode, unspecified diagnostic res41: Bipolar disorder
E110100 Read Single manic episode, mild diagnostic res41: Bipolar disorder
E110.11 Read Hypomanic psychoses diagnostic res41: Bipolar disorder
E110200 Read Single manic episode, moderate diagnostic res41: Bipolar disorder
E110300 Read Single manic episode, severe without mention of psychosis diagnostic res41: Bipolar disorder
E110400 Read Single manic episode, severe, with psychosis diagnostic res41: Bipolar disorder
E110600 Read Single manic episode in full remission diagnostic res41: Bipolar disorder
E110z00 Read Manic disorder, single episode NOS diagnostic res41: Bipolar disorder
E111.00 Read Recurrent manic episodes diagnostic res41: Bipolar disorder
E111000 Read Recurrent manic episodes, unspecified diagnostic res41: Bipolar disorder
E11..11 Read Bipolar psychoses diagnostic res41: Bipolar disorder
E111100 Read Recurrent manic episodes, mild diagnostic res41: Bipolar disorder
E111200 Read Recurrent manic episodes, moderate diagnostic res41: Bipolar disorder
E11..13 Read Manic psychoses diagnostic res41: Bipolar disorder
E111300 Read Recurrent manic episodes, severe without mention psychosis diagnostic res41: Bipolar disorder
E111400 Read Recurrent manic episodes, severe, with psychosis diagnostic res41: Bipolar disorder
E111500 Read Recurrent manic episodes, partial or unspecified remission diagnostic res41: Bipolar disorder
E111600 Read Recurrent manic episodes, in full remission diagnostic res41: Bipolar disorder
E111z00 Read Recurrent manic episode NOS diagnostic res41: Bipolar disorder
E114.00 Read Bipolar affective disorder, currently manic diagnostic res41: Bipolar disorder
E114000 Read Bipolar affective disorder, currently manic, unspecified diagnostic res41: Bipolar disorder
E114100 Read Bipolar affective disorder, currently manic, mild diagnostic res41: Bipolar disorder
E114.11 Read Manic-depressive - now manic diagnostic res41: Bipolar disorder
E114200 Read Bipolar affective disorder, currently manic, moderate diagnostic res41: Bipolar disorder
E114300 Read Bipolar affect disord, currently manic, severe, no psychosis diagnostic res41: Bipolar disorder
E114400 Read Bipolar affect disord, currently manic,severe with psychosis diagnostic res41: Bipolar disorder
E114500 Read Bipolar affect disord,currently manic, part/unspec remission diagnostic res41: Bipolar disorder
E114600 Read Bipolar affective disorder, currently manic, full remission diagnostic res41: Bipolar disorder
E114z00 Read Bipolar affective disorder, currently manic, NOS diagnostic res41: Bipolar disorder
E115.00 Read Bipolar affective disorder, currently depressed diagnostic res41: Bipolar disorder
E115000 Read Bipolar affective disorder, currently depressed, unspecified diagnostic res41: Bipolar disorder
E115100 Read Bipolar affective disorder, currently depressed, mild diagnostic res41: Bipolar disorder
E115.11 Read Manic-depressive - now depressed diagnostic res41: Bipolar disorder
E115200 Read Bipolar affective disorder, currently depressed, moderate diagnostic res41: Bipolar disorder
E115300 Read Bipolar affect disord, now depressed, severe, no psychosis diagnostic res41: Bipolar disorder
E115400 Read Bipolar affect disord, now depressed, severe with psychosis diagnostic res41: Bipolar disorder
E115500 Read Bipolar affect disord, now depressed, part/unspec remission diagnostic res41: Bipolar disorder
E115600 Read Bipolar affective disorder, now depressed, in full remission diagnostic res41: Bipolar disorder
E115z00 Read Bipolar affective disorder, currently depressed, NOS diagnostic res41: Bipolar disorder
E116.00 Read Mixed bipolar affective disorder diagnostic res41: Bipolar disorder
E116000 Read Mixed bipolar affective disorder, unspecified diagnostic res41: Bipolar disorder
E116100 Read Mixed bipolar affective disorder, mild diagnostic res41: Bipolar disorder
E116200 Read Mixed bipolar affective disorder, moderate diagnostic res41: Bipolar disorder
E116300 Read Mixed bipolar affective disorder, severe, without psychosis diagnostic res41: Bipolar disorder
E116400 Read Mixed bipolar affective disorder, severe, with psychosis diagnostic res41: Bipolar disorder
E116500 Read Mixed bipolar affective disorder, partial/unspec remission diagnostic res41: Bipolar disorder
E116600 Read Mixed bipolar affective disorder, in full remission diagnostic res41: Bipolar disorder
E116z00 Read Mixed bipolar affective disorder, NOS diagnostic res41: Bipolar disorder
E117.00 Read Unspecified bipolar affective disorder diagnostic res41: Bipolar disorder
E117000 Read Unspecified bipolar affective disorder, unspecified diagnostic res41: Bipolar disorder
E117100 Read Unspecified bipolar affective disorder, mild diagnostic res41: Bipolar disorder
E117200 Read Unspecified bipolar affective disorder, moderate diagnostic res41: Bipolar disorder
E117300 Read Unspecified bipolar affective disorder, severe, no psychosis diagnostic res41: Bipolar disorder
E117400 Read Unspecified bipolar affective disorder,severe with psychosis diagnostic res41: Bipolar disorder
E117500 Read Unspecified bipolar affect disord, partial/unspec remission diagnostic res41: Bipolar disorder
E117600 Read Unspecified bipolar affective disorder, in full remission diagnostic res41: Bipolar disorder
E117z00 Read Unspecified bipolar affective disorder, NOS diagnostic res41: Bipolar disorder
E11y.00 Read Other and unspecified manic-depressive psychoses diagnostic res41: Bipolar disorder
E11y000 Read Unspecified manic-depressive psychoses diagnostic res41: Bipolar disorder
E11y100 Read Atypical manic disorder diagnostic res41: Bipolar disorder
E11y300 Read Other mixed manic-depressive psychoses diagnostic res41: Bipolar disorder
E11yz00 Read Other and unspecified manic-depressive psychoses NOS diagnostic res41: Bipolar disorder
Eu3..00 Read [X]Mood - affective disorders diagnostic res41: Bipolar disorder
Eu30.00 Read [X]Manic episode diagnostic res41: Bipolar disorder
Eu30000 Read [X]Hypomania diagnostic res41: Bipolar disorder
Eu30100 Read [X]Mania without psychotic symptoms diagnostic res41: Bipolar disorder
Eu30.11 Read [X]Bipolar disorder, single manic episode diagnostic res41: Bipolar disorder
Eu30200 Read [X]Mania with psychotic symptoms diagnostic res41: Bipolar disorder
Eu30211 Read [X]Mania with mood-congruent psychotic symptoms diagnostic res41: Bipolar disorder
Eu30212 Read [X]Mania with mood-incongruent psychotic symptoms diagnostic res41: Bipolar disorder
Eu30y00 Read [X]Other manic episodes diagnostic res41: Bipolar disorder
Eu30z00 Read [X]Manic episode, unspecified diagnostic res41: Bipolar disorder
Eu30z11 Read [X]Mania NOS diagnostic res41: Bipolar disorder
Eu31.00 Read [X]Bipolar affective disorder diagnostic res41: Bipolar disorder
Eu31000 Read [X]Bipolar affective disorder, current episode hypomanic diagnostic res41: Bipolar disorder
Eu31100 Read [X]Bipolar affect disorder cur epi manic wout psychotic symp diagnostic res41: Bipolar disorder
Eu31.11 Read [X]Manic-depressive illness diagnostic res41: Bipolar disorder
Eu31.12 Read [X]Manic-depressive psychosis diagnostic res41: Bipolar disorder
Eu31.13 Read [X]Manic-depressive reaction diagnostic res41: Bipolar disorder
Eu31200 Read [X]Bipolar affect disorder cur epi manic with psychotic symp diagnostic res41: Bipolar disorder
Eu31300 Read [X]Bipolar affect disorder cur epi mild or moderate depressn diagnostic res41: Bipolar disorder
Eu31400 Read [X]Bipol aff disord, curr epis sev depress, no psychot symp diagnostic res41: Bipolar disorder
Eu31500 Read [X]Bipolar affect dis cur epi severe depres with psyc symp diagnostic res41: Bipolar disorder
Eu31600 Read [X]Bipolar affective disorder, current episode mixed diagnostic res41: Bipolar disorder
Eu31700 Read [X]Bipolar affective disorder, currently in remission diagnostic res41: Bipolar disorder
Eu31y00 Read [X]Other bipolar affective disorders diagnostic res41: Bipolar disorder
Eu31y11 Read [X]Bipolar II disorder diagnostic res41: Bipolar disorder
Eu31y12 Read [X]Recurrent manic episodes diagnostic res41: Bipolar disorder
Eu31z00 Read [X]Bipolar affective disorder, unspecified diagnostic res41: Bipolar disorder
Eu33213 Read [X]Manic-depress psychosis,depressd,no psychotic symptoms diagnostic res41: Bipolar disorder
Eu33312 Read [X]Manic-depress psychosis,depressed type+psychotic symptoms diagnostic res41: Bipolar disorder
Eu34.00 Read [X]Persistent mood affective disorders diagnostic res41: Bipolar disorder
Eu34000 Read [X]Cyclothymia diagnostic res41: Bipolar disorder
Eu34y00 Read [X]Other persistent mood affective disorders diagnostic res41: Bipolar disorder
Eu34z00 Read [X]Persistent mood affective disorder, unspecified diagnostic res41: Bipolar disorder
Eu3y.00 Read [X]Other mood affective disorders diagnostic res41: Bipolar disorder
Eu3y000 Read [X]Other single mood affective disorders diagnostic res41: Bipolar disorder
Eu3y011 Read [X]Mixed affective episode diagnostic res41: Bipolar disorder
Eu3y100 Read [X]Other recurrent mood affective disorders diagnostic res41: Bipolar disorder
Eu3yy00 Read [X]Other specified mood affective disorders diagnostic res41: Bipolar disorder
Eu3z.00 Read [X]Unspecified mood affective disorder diagnostic res41: Bipolar disorder
Eu3z.11 Read [X]Affective psychosis NOS diagnostic res41: Bipolar disorder
ZV11111 Read [V]Personal history of manic-depressive psychosis diagnostic res41: Bipolar disorder
ZV11112 Read [V]Personal history of manic-depressive psychosis diagnostic res41: Bipolar disorder

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