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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: Depot APDs
56 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 48900020 | Multilex | Depixol -conc 100mg/ml Injection (Lundbeck Ltd) | drug | res41: Depot APDs | |||
| 50445020 | Multilex | Modecate 25mg/ml Injection (Sanofi-Synthelabo Ltd) | drug | res41: Depot APDs | |||
| 53027020 | Multilex | Clopixol 200mg/ml Oily injection (Lundbeck Ltd) | drug | res41: Depot APDs | |||
| 53030020 | Multilex | Depixol 20mg/ml Injection (Lundbeck Ltd) | drug | res41: Depot APDs | |||
| 53031020 | Multilex | Depixol 40mg/2ml solution for injection ampoules (Lundbeck Ltd) | drug | res41: Depot APDs | |||
| 53053020 | Multilex | Modecate concentrate 100mg/ml Injection (Sanofi-Synthelabo Ltd) | drug | res41: Depot APDs | |||
| 53586020 | Multilex | Piportil 50mg/ml Depot injection (JHC Healthcare Ltd) | drug | res41: Depot APDs | |||
| 57938020 | Multilex | Depixol Low Volume 200mg/1ml solution for injection ampoules (Lundbeck Ltd) | drug | res41: Depot APDs | |||
| 58509020 | Multilex | Haldol decanoate 50mg/1ml solution for injection ampoules (Janssen-Cilag Ltd) | drug | res41: Depot APDs | |||
| 58510020 | Multilex | Haldol decanoate 100mg/1ml solution for injection ampoules (Janssen-Cilag Ltd) | drug | res41: Depot APDs | |||
| 61027020 | Multilex | Fluphenazine decanoate 25mg/1ml solution for injection ampoules (Hospira UK Ltd) | drug | res41: Depot APDs | |||
| 61511020 | Multilex | Zuclopenthixol decanoate 200mg/ml oily injection | drug | res41: Depot APDs | |||
| 61512020 | Multilex | Zuclopenthixol decanoate 500mg/1ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 62032020 | Multilex | Flupentixol decanoate 20mg/ml Injection | drug | res41: Depot APDs | |||
| 62033020 | Multilex | Flupentixol decanoate 100mg/ml Injection | drug | res41: Depot APDs | |||
| 62034020 | Multilex | Flupentixol 200mg/1ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 62048020 | Multilex | Fluphenazine decanoate 25mg/ml Injection | drug | res41: Depot APDs | |||
| 62049020 | Multilex | Fluphenazine decanoate 100mg/ml Injection | drug | res41: Depot APDs | |||
| 62954020 | Multilex | Fluphenazine decanoate 25mg/ml Injection (Antigen Pharmaceuticals) | drug | res41: Depot APDs | |||
| 63123020 | Multilex | Haloperidol decanoate 50mg/1ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 63124020 | Multilex | Haloperidol decanoate 100mg/1ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 65842020 | Multilex | Pipotiazine palmitate 50mg/ml depot injection | drug | res41: Depot APDs | |||
| 67405020 | Multilex | Clopixol Conc 500mg/1ml solution for injection ampoules (Lundbeck Ltd) | drug | res41: Depot APDs | |||
| 68096020 | Multilex | Flupentixol 40mg/2ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 89970020 | Multilex | Flupentixol 50mg/0.5ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 89972020 | Multilex | Flupentixol 100mg/1ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 89974020 | Multilex | Depixol Conc 50mg/0.5ml solution for injection ampoules (Lundbeck Ltd) | drug | res41: Depot APDs | |||
| 89976020 | Multilex | Depixol Conc 100mg/1ml solution for injection ampoules (Lundbeck Ltd) | drug | res41: Depot APDs | |||
| 91582020 | Multilex | Flupentixol 20mg/1ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 91584020 | Multilex | Depixol 20mg/1ml solution for injection ampoules (Lundbeck Ltd) | drug | res41: Depot APDs | |||
| 91592020 | Multilex | Zuclopenthixol decanoate 200mg/1ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 91596020 | Multilex | Clopixol 200mg/1ml solution for injection ampoules (Lundbeck Ltd) | drug | res41: Depot APDs | |||
| 91981020 | Multilex | Pipotiazine 50mg/1ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 91985020 | Multilex | Pipotiazine 100mg/2ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 91987020 | Multilex | Piportil Depot 50mg/1ml solution for injection ampoules (Sanofi) | drug | res41: Depot APDs | |||
| 91989020 | Multilex | Piportil Depot 100mg/2ml solution for injection ampoules (Sanofi) | drug | res41: Depot APDs | |||
| 92200020 | Multilex | Fluphenazine decanoate 12.5mg/0.5ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 92202020 | Multilex | Fluphenazine decanoate 25mg/1ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 92204020 | Multilex | Fluphenazine decanoate 50mg/2ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 92206020 | Multilex | Modecate 12.5mg/0.5ml solution for injection ampoules (Sanofi) | drug | res41: Depot APDs | |||
| 92208020 | Multilex | Modecate 25mg/1ml solution for injection ampoules (Sanofi) | drug | res41: Depot APDs | |||
| 92210020 | Multilex | Modecate 50mg/2ml solution for injection ampoules (Sanofi) | drug | res41: Depot APDs | |||
| 92212020 | Multilex | Fluphenazine decanoate 50mg/0.5ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 92214020 | Multilex | Fluphenazine decanoate 100mg/1ml solution for injection ampoules | drug | res41: Depot APDs | |||
| 92216020 | Multilex | Modecate Concentrate 50mg/0.5ml solution for injection ampoules (Sanofi) | drug | res41: Depot APDs | |||
| 92218020 | Multilex | Modecate Concentrate 100mg/1ml solution for injection ampoules (Sanofi) | drug | res41: Depot APDs | |||
| 98278020 | Multilex | Olanzapine embonate 210mg powder and solvent for suspension for injection vials | drug | res41: Depot APDs | |||
| 98329020 | Multilex | Olanzapine embonate 300mg powder and solvent for suspension for injection vials | drug | res41: Depot APDs | |||
| 99841020 | Multilex | Paliperidone 50mg/0.5ml suspension for injection pre-filled syringes | drug | res41: Depot APDs | |||
| 99843020 | Multilex | Paliperidone 75mg/0.75ml suspension for injection pre-filled syringes | drug | res41: Depot APDs | |||
| 99845020 | Multilex | Paliperidone 100mg/1ml suspension for injection pre-filled syringes | drug | res41: Depot APDs | |||
| 99847020 | Multilex | Paliperidone 150mg/1.5ml suspension for injection pre-filled syringes | drug | res41: Depot APDs | |||
| 99849020 | Multilex | Xeplion 50mg/0.5ml suspension for injection pre-filled syringes (Janssen-Cilag Ltd) | drug | res41: Depot APDs | |||
| 99851020 | Multilex | Xeplion 75mg/0.75ml suspension for injection pre-filled syringes (Janssen-Cilag Ltd) | drug | res41: Depot APDs | |||
| 99853020 | Multilex | Xeplion 100mg/1ml suspension for injection pre-filled syringes (Janssen-Cilag Ltd) | drug | res41: Depot APDs | |||
| 99855020 | Multilex | Xeplion 150mg/1.5ml suspension for injection pre-filled syringes (Janssen-Cilag Ltd) | drug | res41: Depot APDs |
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