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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: Opioid analgesics

522 codes in list

Code Coding system Description Entity type List name
00078021 Multilex Tramadol 100mg/ml oral drops drug res41: Opioid analgesics
00547021 Multilex Co-dydramol (dihydrocodeine and paracetamol) 10mg with 500mg/5ml oral suspension drug res41: Opioid analgesics
04310020 Multilex Co-codamol 30mg/500mg tablets (Kent Pharmaceuticals Ltd) drug res41: Opioid analgesics
04311020 Multilex Co-codamol 30mg/500mg tablets (Alliance Healthcare (Distribution) Ltd) drug res41: Opioid analgesics
04312020 Multilex Co-codamol 30mg/500mg caplets (Kent Pharmaceuticals Ltd) drug res41: Opioid analgesics
04326020 Multilex Co-codamol 30mg/500mg effervescent tablets (Alliance Healthcare (Distribution) Ltd) drug res41: Opioid analgesics
04328020 Multilex Co-codamol 30mg/500mg effervescent tablets (A A H Pharmaceuticals Ltd) drug res41: Opioid analgesics
04332020 Multilex Co-codamol 30mg/500mg effervescent tablets (Zanza Laboratories Ltd) drug res41: Opioid analgesics
04334020 Multilex Co-codamol 30mg/500mg capsules (Kent Pharmaceuticals Ltd) drug res41: Opioid analgesics
04339020 Multilex Co-codamol 30mg/500mg capsules (Sigma Pharmaceuticals Plc) drug res41: Opioid analgesics
04340020 Multilex Co-codamol 30mg/500mg capsules (AMCo) drug res41: Opioid analgesics
04351020 Multilex Morphine sulfate 10mg/5ml oral solution (A A H Pharmaceuticals Ltd) drug res41: Opioid analgesics
04403020 Multilex Codeine 30mg tablets (Alliance Healthcare (Distribution) Ltd) drug res41: Opioid analgesics
04405020 Multilex Codeine 30mg tablets (Bristol Laboratories Ltd) drug res41: Opioid analgesics
04406020 Multilex Codeine 30mg tablets (Phoenix Healthcare Distribution Ltd) drug res41: Opioid analgesics
04408020 Multilex Codeine 60mg tablets (Alliance Healthcare (Distribution) Ltd) drug res41: Opioid analgesics
04412020 Multilex Codeine 60mg/1ml solution for injection ampoules (A A H Pharmaceuticals Ltd) drug res41: Opioid analgesics
04439020 Multilex Dihydrocodeine 30mg tablets (Kent Pharmaceuticals Ltd) drug res41: Opioid analgesics
04444020 Multilex Dihydrocodeine 30mg tablets (Bristol Laboratories Ltd) drug res41: Opioid analgesics
04490020 Multilex Tramadol 50mg capsules (Bristol Laboratories Ltd) drug res41: Opioid analgesics
04502020 Multilex Marol 100mg modified-release tablets (Teva UK Ltd) drug res41: Opioid analgesics
04512020 Multilex Marol 150mg modified-release tablets (Teva UK Ltd) drug res41: Opioid analgesics
04522020 Multilex Marol 200mg modified-release tablets (Teva UK Ltd) drug res41: Opioid analgesics
04524020 Multilex Tramadol 50mg modified-release capsules (A A H Pharmaceuticals Ltd) drug res41: Opioid analgesics
04527020 Multilex Tramadol 100mg modified-release capsules (Alliance Healthcare (Distribution) Ltd) drug res41: Opioid analgesics
04529020 Multilex Tramadol 100mg modified-release capsules (A A H Pharmaceuticals Ltd) drug res41: Opioid analgesics
04541020 Multilex Zamadol SR 200mg capsules (Lexon (UK) Ltd) drug res41: Opioid analgesics
04549020 Multilex OxyNorm 5mg capsules (Lexon (UK) Ltd) drug res41: Opioid analgesics
04551020 Multilex OxyNorm 5mg capsules (DE Pharmaceuticals) drug res41: Opioid analgesics
04552020 Multilex OxyNorm 10mg capsules (Waymade Healthcare Plc) drug res41: Opioid analgesics
04555020 Multilex OxyNorm 10mg capsules (DE Pharmaceuticals) drug res41: Opioid analgesics
04559020 Multilex OxyNorm 20mg capsules (DE Pharmaceuticals) drug res41: Opioid analgesics
04562020 Multilex OxyContin 10mg modified-release tablets (Lexon (UK) Ltd) drug res41: Opioid analgesics
04563020 Multilex OxyContin 10mg modified-release tablets (Mawdsley-Brooks & Company Ltd) drug res41: Opioid analgesics
04564020 Multilex OxyContin 10mg modified-release tablets (DE Pharmaceuticals) drug res41: Opioid analgesics
04567020 Multilex OxyContin 20mg modified-release tablets (Lexon (UK) Ltd) drug res41: Opioid analgesics
04576020 Multilex OxyContin 80mg modified-release tablets (M