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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: Eating disorder

38 codes in list

Code Coding system Description Entity type List name
1612.00 Read Appetite loss - anorexia diagnostic res41: Eating disorder
1612.11 Read Anorexia symptom diagnostic res41: Eating disorder
1614.00 Read Excessive eating - polyphagia diagnostic res41: Eating disorder
1614.11 Read Hyperalimentation - symptom diagnostic res41: Eating disorder
1614.12 Read Polyphagia symptom diagnostic res41: Eating disorder
8HTN.00 Read Referral to eating disorders clinic diagnostic res41: Eating disorder
9Nk9.00 Read Seen in eating disorder clinic diagnostic res41: Eating disorder
E271.00 Read Anorexia nervosa diagnostic res41: Eating disorder
E275.00 Read Other and unspecified non-organic eating disorders diagnostic res41: Eating disorder
E275000 Read Unspecified non-organic eating disorder diagnostic res41: Eating disorder
E275100 Read Bulimia (non-organic overeating) diagnostic res41: Eating disorder
E275111 Read Compulsive eating disorder diagnostic res41: Eating disorder
E275y00 Read Other specified non-organic eating disorder diagnostic res41: Eating disorder
E275z00 Read Non-organic eating disorder NOS diagnostic res41: Eating disorder
Eu50.00 Read [X]Eating disorders diagnostic res41: Eating disorder
Eu50000 Read [X]Anorexia nervosa diagnostic res41: Eating disorder
Eu50100 Read [X]Atypical anorexia nervosa diagnostic res41: Eating disorder
Eu50200 Read [X]Bulimia nervosa diagnostic res41: Eating disorder
Eu50211 Read [X]Bulimia NOS diagnostic res41: Eating disorder
Eu50212 Read [X]Hyperorexia nervosa diagnostic res41: Eating disorder
Eu50300 Read [X]Atypical bulimia nervosa diagnostic res41: Eating disorder
Eu50400 Read [X]Overeating associated with other psychological disturbncs diagnostic res41: Eating disorder
Eu50411 Read [X]Psychogenic overeating diagnostic res41: Eating disorder
Eu50y00 Read [X]Other eating disorders diagnostic res41: Eating disorder
Eu50y11 Read [X]Pica in adults diagnostic res41: Eating disorder
Eu50z00 Read [X]Eating disorder, unspecified diagnostic res41: Eating disorder
Fy05.00 Read Nocturnal sleep-related eating disorder diagnostic res41: Eating disorder
R030.00 Read [D]Anorexia diagnostic res41: Eating disorder
R030z00 Read [D]Anorexia NOS diagnostic res41: Eating disorder
R036.00 Read [D]Polyphagia diagnostic res41: Eating disorder
R036000 Read [D]Excessive eating diagnostic res41: Eating disorder
R036011 Read [D]Bulimia NOS diagnostic res41: Eating disorder
R036100 Read [D]Hyperalimentation diagnostic res41: Eating disorder
R036z00 Read [D]Polyphagia NOS diagnostic res41: Eating disorder
SN42100 Read Starvation diagnostic res41: Eating disorder
U1B3.11 Read [X]Starvation diagnostic res41: Eating disorder
Z4B5.00 Read Eating disorder counselling diagnostic res41: Eating disorder
ZC2CD00 Read Dietary advice for eating disorder diagnostic res41: Eating disorder

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