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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: Personality disorder

78 codes in list

Code Coding system Description Entity type List name
E21..00 Read Personality disorders diagnostic res41: Personality disorder
E210.00 Read Paranoid personality disorder diagnostic res41: Personality disorder
E211.00 Read Affective personality disorder diagnostic res41: Personality disorder
E211000 Read Unspecified affective personality disorder diagnostic res41: Personality disorder
E21..11 Read Neurotic personality disorder diagnostic res41: Personality disorder
E211100 Read Hypomanic personality disorder diagnostic res41: Personality disorder
E211200 Read Depressive personality disorder diagnostic res41: Personality disorder
E211300 Read Cyclothymic personality disorder diagnostic res41: Personality disorder
E211z00 Read Affective personality disorder NOS diagnostic res41: Personality disorder
E212.00 Read Schizoid personality disorder diagnostic res41: Personality disorder
E212000 Read Unspecified schizoid personality disorder diagnostic res41: Personality disorder
E212z00 Read Schizoid personality disorder NOS diagnostic res41: Personality disorder
E213.00 Read Explosive personality disorder diagnostic res41: Personality disorder
E214.00 Read Compulsive personality disorders diagnostic res41: Personality disorder
E214000 Read Anankastic personality diagnostic res41: Personality disorder
E214.11 Read Anancastic personality diagnostic res41: Personality disorder
E214z00 Read Compulsive personality disorder NOS diagnostic res41: Personality disorder
E215.00 Read Histrionic personality disorders diagnostic res41: Personality disorder
E215000 Read Unspecified histrionic personality disorder diagnostic res41: Personality disorder
E215.11 Read Hysterical personality disorders diagnostic res41: Personality disorder
E215z00 Read Histrionic personality disorder NOS diagnostic res41: Personality disorder
E216.00 Read Inadequate personality disorder diagnostic res41: Personality disorder
E217.00 Read Antisocial or sociopathic personality disorder diagnostic res41: Personality disorder
E21y.00 Read Other personality disorders diagnostic res41: Personality disorder
E21y000 Read Narcissistic personality disorder diagnostic res41: Personality disorder
E21y100 Read Avoidant personality disorder diagnostic res41: Personality disorder
E21y200 Read Borderline personality disorder diagnostic res41: Personality disorder
E21y300 Read Passive-aggressive personality disorder diagnostic res41: Personality disorder
E21y400 Read Eccentric personality disorder diagnostic res41: Personality disorder
E21y500 Read Immature personality disorder diagnostic res41: Personality disorder
E21y600 Read Masochistic personality disorder diagnostic res41: Personality disorder
E21y700 Read Psychoneurotic personality disorder diagnostic res41: Personality disorder
E21yz00 Read Other personality disorder NOS diagnostic res41: Personality disorder
E21z.00 Read Personality disorder NOS diagnostic res41: Personality disorder
E21z.11 Read Psychopathic personality diagnostic res41: Personality disorder
Eu06000 Read [X]Organic personality disorder diagnostic res41: Personality disorder
Eu06011 Read [X]Organic pseudopsychopathic personality diagnostic res41: Personality disorder
Eu21.17 Read [X]Pseudopsychopathic schizophrenia diagnostic res41: Personality disorder
Eu21.18 Read [X]Schizotypal personality disorder diagnostic res41: Personality disorder
Eu34011 Read [X]Affective personality disorder diagnostic res41: Personality disorder
Eu34112 Read [X]Depressive personality disorder diagnostic res41: Personality disorder
Eu60.00 Read [X]Specific personality disorders diagnostic res41: Personality disorder
Eu60000 Read [X]Paranoid personality disorder diagnostic res41: Personality disorder
Eu60013 Read [X]Querulant personality disorder diagnostic res41: Personality disorder
Eu60014 Read [X]Sensitive paranoid personality disorder diagnostic res41: Personality disorder
Eu60100 Read [X]Schizoid personality disorder diagnostic res41: Personality disorder
Eu60200 Read [X]Dissocial personality disorder diagnostic res41: Personality disorder
Eu60212 Read [X]Antisocial personality disorder diagnostic res41: Personality disorder
Eu60213 Read [X]Asocial personality disorder diagnostic res41: Personality disorder
Eu60214 Read [X]Psychopathic personality disorder diagnostic res41: Personality disorder
Eu60215 Read [X]Sociopathic personality disorder diagnostic res41: Personality disorder
Eu60300 Read [X]Emotionally unstable personality disorder diagnostic res41: Personality disorder
Eu60311 Read [X]Aggressive personality disorder diagnostic res41: Personality disorder
Eu60312 Read [X]Borderline personality disorder diagnostic res41: Personality disorder
Eu60313 Read [X]Explosive personality disorder diagnostic res41: Personality disorder
Eu60400 Read [X]Histrionic personality disorder diagnostic res41: Personality disorder
Eu60411 Read [X]Hysterical personality disorder diagnostic res41: Personality disorder
Eu60412 Read [X]Psychoinfantile personality disorder diagnostic res41: Personality disorder
Eu60500 Read [X]Anankastic personality disorder diagnostic res41: Personality disorder
Eu60511 Read [X]Compulsive personality disorder diagnostic res41: Personality disorder
Eu60512 Read [X]Obsessional personality disorder diagnostic res41: Personality disorder
Eu60513 Read [X]Obsessive-compulsive personality disorder diagnostic res41: Personality disorder
Eu60600 Read [X]Anxious [avoidant] personality disorder diagnostic res41: Personality disorder
Eu60700 Read [X]Dependent personality disorder diagnostic res41: Personality disorder
Eu60711 Read [X]Asthenic personality disorder diagnostic res41: Personality disorder
Eu60712 Read [X]Inadequate personality disorder diagnostic res41: Personality disorder
Eu60713 Read [X]Passive personality disorder diagnostic res41: Personality disorder
Eu60714 Read [X]Self defeating personality disorder diagnostic res41: Personality disorder
Eu60y00 Read [X]Other specific personality disorders diagnostic res41: Personality disorder
Eu60y11 Read [X]Eccentric personality disorder diagnostic res41: Personality disorder
Eu60y12 Read [X]Haltlose type personality disorder diagnostic res41: Personality disorder
Eu60y13 Read [X]Immature personality disorder diagnostic res41: Personality disorder
Eu60y14 Read [X]Narcissistic personality disorder diagnostic res41: Personality disorder
Eu60y16 Read [X]Psychoneurotic personality disorder diagnostic res41: Personality disorder
Eu60z00 Read [X]Personality disorder, unspecified diagnostic res41: Personality disorder
Eu61.00 Read [X]Mixed and other personality disorders diagnostic res41: Personality disorder
Eu84511 Read [X]Autistic psychopathy diagnostic res41: Personality disorder
Eu94211 Read [X]Affectionless psychopathy diagnostic res41: Personality disorder

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