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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: Lithium and other mood stabilisers

207 codes in list

Code Coding system Description Entity type List name
03664020 Multilex Priadel 400mg modified-release tablets (DE Pharmaceuticals) drug res41: Lithium and other mood stabilisers
03668020 Multilex Priadel 400mg modified-release tablets (Necessity Supplies Ltd) drug res41: Lithium and other mood stabilisers
04694020 Multilex Carbamazepine 100mg tablets (Phoenix Healthcare Distribution Ltd) drug res41: Lithium and other mood stabilisers
04698020 Multilex Tegretol 200mg tablets (Lexon (UK) Ltd) drug res41: Lithium and other mood stabilisers
04704020 Multilex Carbamazepine 400mg tablets (Sigma Pharmaceuticals Plc) drug res41: Lithium and other mood stabilisers
04705020 Multilex Tegretol 400mg tablets (Lexon (UK) Ltd) drug res41: Lithium and other mood stabilisers
04714020 Multilex Tegretol Prolonged Release 200mg tablets (DE Pharmaceuticals) drug res41: Lithium and other mood stabilisers
04715020 Multilex Tegretol Prolonged Release 200mg tablets (Sigma Pharmaceuticals Plc) drug res41: Lithium and other mood stabilisers
04730020 Multilex Tegretol Prolonged Release 400mg tablets (Stephar (U.K.) Ltd) drug res41: Lithium and other mood stabilisers
04733020 Multilex Tegretol Prolonged Release 400mg tablets (Necessity Supplies Ltd) drug res41: Lithium and other mood stabilisers
04813020 Multilex Epilim Chrono 200 tablets (Lexon (UK) Ltd) drug res41: Lithium and other mood stabilisers
04815020 Multilex Epilim Chrono 200 tablets (DE Pharmaceuticals) drug res41: Lithium and other mood stabilisers
04817020 Multilex Epilim Chrono 300 tablets (Waymade Healthcare Plc) drug res41: Lithium and other mood stabilisers
04819020 Multilex Sodium valproate 300mg modified-release tablets (Sigma Pharmaceuticals Plc) drug res41: Lithium and other mood stabilisers
04822020 Multilex Epilim Chrono 300 tablets (DE Pharmaceuticals) drug res41: Lithium and other mood stabilisers
04823020 Multilex Sodium valproate 500mg modified-release tablets (Alliance Healthcare (Distribution) Ltd) drug res41: Lithium and other mood stabilisers
04827020 Multilex Epilim Chrono 500 tablets (Lexon (UK) Ltd) drug res41: Lithium and other mood stabilisers
04887020 Multilex Lamictal 25mg tablets (DE Pharmaceuticals) drug res41: Lithium and other mood stabilisers
04890020 Multilex Lamotrigine 25mg tablets (Bristol Laboratories Ltd) drug res41: Lithium and other mood stabilisers
04891020 Multilex Lamictal 25mg tablets (Lexon (UK) Ltd) drug res41: Lithium and other mood stabilisers
04913020 Multilex Lamotrigine 25mg dispersible tablets sugar free (Tillomed Laboratories Ltd) drug res41: Lithium and other mood stabilisers
36907020 Multilex Valproic acid 500mg/5ml oral solution drug res41: Lithium and other mood stabilisers
39721020 Multilex Sodium valproate 500mg/5ml oral suspension drug res41: Lithium and other mood stabilisers
39821020 Multilex Lamotrigine 25mg tablets (Accord Healthcare Ltd) drug res41: Lithium and other mood stabilisers
47267020 Multilex Lithium citrate 509mg/5ml oral solution (Cubic Pharmaceuticals Ltd) drug res41: Lithium and other mood stabilisers
48541020 Multilex Camcolit 250 tablets (Norgine Pharmaceuticals Ltd) drug res41: Lithium and other mood stabilisers
48990020 Multilex Carbamazepine 100mg Tablet (Berk Pharmaceuticals Ltd) drug res41: Lithium and other mood stabilisers
48995020 Multilex Carbamazepine 100mg tablets (A A H Pharmaceuticals Ltd) drug res41: Lithium and other mood stabilisers
48996020 Multilex Carbamazepine 200mg tablets (A A H Pharmaceuticals Ltd) drug res41: Lithium and other mood stabilisers
48997020 Multilex Carbamazepine 400mg tablets (A A H Pharmaceuticals Ltd) drug res41: Lithium and other mood stabilisers
50224020 Multilex Liskonum 450mg modified-release tablets (GlaxoSmithKline UK Ltd) drug res41: Lithium and other mood stabilisers
51251020 Multilex Priadel 200mg modified-release tablets (Sanofi) drug res41: Lithium and other mood stabilisers
51252020 Multilex Priadel 400mg modified-release tablets (Sanofi) drug res41: Lithium and other mood stabilisers
52411020 Multilex Sodium valproate 200mg gastro-resistant tablets (A A H Pharmaceuticals Ltd) drug res41: Lithium and other mood stabilisers
52412020 Multilex Sodium valpro