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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: Schizophrenia spectrum

194 codes in list

Code Coding system Description Entity type List name
1464.00 Read H/O: schizophrenia diagnostic res41: Schizophrenia spectrum
146H.00 Read H/O: psychosis diagnostic res41: Schizophrenia spectrum
1BH..00 Read Delusions diagnostic res41: Schizophrenia spectrum
1BH0.00 Read Delusion of persecution diagnostic res41: Schizophrenia spectrum
1BH1.00 Read Grandiose delusions diagnostic res41: Schizophrenia spectrum
1BH..11 Read Delusion diagnostic res41: Schizophrenia spectrum
1BH2.00 Read Ideas of reference diagnostic res41: Schizophrenia spectrum
1BH3.00 Read Paranoid ideation diagnostic res41: Schizophrenia spectrum
225E.00 Read O/E - paranoid delusions diagnostic res41: Schizophrenia spectrum
225F.00 Read O/E - delusion of persecution diagnostic res41: Schizophrenia spectrum
285..11 Read Psychotic condition, insight present diagnostic res41: Schizophrenia spectrum
286..11 Read Poor insight into psychotic condition diagnostic res41: Schizophrenia spectrum
665E.00 Read Injectable neuroleptic given diagnostic res41: Schizophrenia spectrum
665F.00 Read On injectable neuroleptic diagnostic res41: Schizophrenia spectrum
E1...00 Read Non-organic psychoses diagnostic res41: Schizophrenia spectrum
E10..00 Read Schizophrenic disorders diagnostic res41: Schizophrenia spectrum
E100.00 Read Simple schizophrenia diagnostic res41: Schizophrenia spectrum
E100000 Read Unspecified schizophrenia diagnostic res41: Schizophrenia spectrum
E100100 Read Subchronic schizophrenia diagnostic res41: Schizophrenia spectrum
E100.11 Read Schizophrenia simplex diagnostic res41: Schizophrenia spectrum
E100200 Read Chronic schizophrenic diagnostic res41: Schizophrenia spectrum
E100300 Read Acute exacerbation of subchronic schizophrenia diagnostic res41: Schizophrenia spectrum
E100400 Read Acute exacerbation of chronic schizophrenia diagnostic res41: Schizophrenia spectrum
E100500 Read Schizophrenia in remission diagnostic res41: Schizophrenia spectrum
E100z00 Read Simple schizophrenia NOS diagnostic res41: Schizophrenia spectrum
E101.00 Read Hebephrenic schizophrenia diagnostic res41: Schizophrenia spectrum
E101000 Read Unspecified hebephrenic schizophrenia diagnostic res41: Schizophrenia spectrum
E101400 Read Acute exacerbation of chronic hebephrenic schizophrenia diagnostic res41: Schizophrenia spectrum
E101500 Read Hebephrenic schizophrenia in remission diagnostic res41: Schizophrenia spectrum
E101z00 Read Hebephrenic schizophrenia NOS diagnostic res41: Schizophrenia spectrum
E102.00 Read Catatonic schizophrenia diagnostic res41: Schizophrenia spectrum
E102000 Read Unspecified catatonic schizophrenia diagnostic res41: Schizophrenia spectrum
E102100 Read Subchronic catatonic schizophrenia diagnostic res41: Schizophrenia spectrum
E102500 Read Catatonic schizophrenia in remission diagnostic res41: Schizophrenia spectrum
E102z00 Read Catatonic schizophrenia NOS diagnostic res41: Schizophrenia spectrum
E103.00 Read Paranoid schizophrenia diagnostic res41: Schizophrenia spectrum
E103000 Read Unspecified paranoid schizophrenia diagnostic res41: Schizophrenia spectrum
E103200 Read Chronic paranoid schizophrenia diagnostic res41: Schizophrenia spectrum
E103300 Read Acute exacerbation of subchronic paranoid schizophrenia diagnostic res41: Schizophrenia spectrum
E103400 Read Acute exacerbation of chronic paranoid schizophrenia diagnostic res41: Schizophrenia spectrum
E103500 Read Paranoid schizophrenia in remission diagnostic res41: Schizophrenia spectrum
E103z00 Read Paranoid schizophrenia NOS diagnostic res41: Schizophrenia spectrum
E104.00 Read Acute schizophrenic episode diagnostic res41: Schizophrenia spectrum
E105.00 Read Latent schizophrenia diagnostic res41: Schizophrenia spectrum
E105000 Read Unspecified latent schizophrenia diagnostic res41: Schizophrenia spectrum
E105200 Read Chronic latent schizophrenia diagnostic res41: Schizophrenia spectrum
E105500 Read Latent schizophrenia in remission diagnostic res41: Schizophrenia spectrum
E105z00 Read Latent schizophrenia NOS diagnostic res41: Schizophrenia spectrum
E106.00 Read Residual schizophrenia diagnostic res41: Schizophrenia spectrum
E107.00 Read Schizo-affective schizophrenia diagnostic res41: Schizophrenia spectrum
E107000 Read Unspecified schizo-affective schizophrenia diagnostic res41: Schizophrenia spectrum
E107100 Read Subchronic schizo-affective schizophrenia diagnostic res41: Schizophrenia spectrum
E107.11 Read Cyclic schizophrenia diagnostic res41: Schizophrenia spectrum
E107200 Read Chronic schizo-affective schizophrenia diagnostic res41: Schizophrenia spectrum
E107300 Read Acute exacerbation subchronic schizo-affective schizophrenia diagnostic res41: Schizophrenia spectrum
E107400 Read Acute exacerbation of chronic schizo-affective schizophrenia diagnostic res41: Schizophrenia spectrum
E107500 Read Schizo-affective schizophrenia in remission diagnostic res41: Schizophrenia spectrum
E107z00 Read Schizo-affective schizophrenia NOS diagnostic res41: Schizophrenia spectrum
E10y.00 Read Other schizophrenia diagnostic res41: Schizophrenia spectrum
E10y000 Read Atypical schizophrenia diagnostic res41: Schizophrenia spectrum
E10y100 Read Coenesthopathic schizophrenia diagnostic res41: Schizophrenia spectrum
E10y.11 Read Cenesthopathic schizophrenia diagnostic res41: Schizophrenia spectrum
E10yz00 Read Other schizophrenia NOS diagnostic res41: Schizophrenia spectrum
E10z.00 Read Schizophrenia NOS diagnostic res41: Schizophrenia spectrum
E11z.00 Read Other and unspecified affective psychoses diagnostic res41: Schizophrenia spectrum
E11z000 Read Unspecified affective psychoses NOS diagnostic res41: Schizophrenia spectrum
E11zz00 Read Other affective psychosis NOS diagnostic res41: Schizophrenia spectrum
E12..00 Read Paranoid states diagnostic res41: Schizophrenia spectrum
E120.00 Read Simple paranoid state diagnostic res41: Schizophrenia spectrum
E121.00 Read Chronic paranoid psychosis diagnostic res41: Schizophrenia spectrum
E122.00 Read Paraphrenia diagnostic res41: Schizophrenia spectrum
E123.00 Read Shared paranoid disorder diagnostic res41: Schizophrenia spectrum
E12y.00 Read Other paranoid states diagnostic res41: Schizophrenia spectrum
E12y000 Read Paranoia querulans diagnostic res41: Schizophrenia spectrum
E12yz00 Read Other paranoid states NOS diagnostic res41: Schizophrenia spectrum
E12z.00 Read Paranoid psychosis NOS diagnostic res41: Schizophrenia spectrum
E13..00 Read Other nonorganic psychoses diagnostic res41: Schizophrenia spectrum
E130.00 Read Reactive depressive psychosis diagnostic res41: Schizophrenia spectrum
E130.11 Read Psychotic reactive depression diagnostic res41: Schizophrenia spectrum
E131.00 Read Acute hysterical psychosis diagnostic res41: Schizophrenia spectrum
E13..11 Read Reactive psychoses diagnostic res41: Schizophrenia spectrum
E133.00 Read Acute paranoid reaction diagnostic res41: Schizophrenia spectrum
E134.00 Read Psychogenic paranoid psychosis diagnostic res41: Schizophrenia spectrum
E13y.00 Read Other reactive psychoses diagnostic res41: Schizophrenia spectrum
E13y100 Read Brief reactive psychosis diagnostic res41: Schizophrenia spectrum
E13yz00 Read Other reactive psychoses NOS diagnostic res41: Schizophrenia spectrum
E13z.00 Read Nonorganic psychosis NOS diagnostic res41: Schizophrenia spectrum
E13z.11 Read Psychotic episode NOS diagnostic res41: Schizophrenia spectrum
E14..00 Read Psychoses with origin in childhood diagnostic res41: Schizophrenia spectrum
E141.00 Read Disintegrative psychosis diagnostic res41: Schizophrenia spectrum
E141100 Read Residual disintegrative psychoses diagnostic res41: Schizophrenia spectrum
E141.11 Read Heller's syndrome diagnostic res41: Schizophrenia spectrum
E1y..00 Read Other specified non-organic psychoses diagnostic res41: Schizophrenia spectrum
E1z..00 Read Non-organic psychosis NOS diagnostic res41: Schizophrenia spectrum
Eu02z12 Read [X] Presenile psychosis NOS diagnostic res41: Schizophrenia spectrum
Eu0z.12 Read [X]Symptomatic psychosis NOS diagnostic res41: Schizophrenia spectrum
Eu2..00 Read [X]Schizophrenia, schizotypal and delusional disorders diagnostic res41: Schizophrenia spectrum
Eu20.00 Read [X]Schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20000 Read [X]Paranoid schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20011 Read [X]Paraphrenic schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20100 Read [X]Hebephrenic schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20111 Read [X]Disorganised schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20200 Read [X]Catatonic schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20211 Read [X]Catatonic stupor diagnostic res41: Schizophrenia spectrum
Eu20212 Read [X]Schizophrenic catalepsy diagnostic res41: Schizophrenia spectrum
Eu20213 Read [X]Schizophrenic catatonia diagnostic res41: Schizophrenia spectrum
Eu20214 Read [X]Schizophrenic flexibilatis cerea diagnostic res41: Schizophrenia spectrum
Eu20300 Read [X]Undifferentiated schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20311 Read [X]Atypical schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20500 Read [X]Residual schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20511 Read [X]Chronic undifferentiated schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20600 Read [X]Simple schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20y00 Read [X]Other schizophrenia diagnostic res41: Schizophrenia spectrum
Eu20y12 Read [X]Schizophreniform disord NOS diagnostic res41: Schizophrenia spectrum
Eu20y13 Read [X]Schizophrenifrm psychos NOS diagnostic res41: Schizophrenia spectrum
Eu20z00 Read [X]Schizophrenia, unspecified diagnostic res41: Schizophrenia spectrum
Eu21.00 Read [X]Schizotypal disorder diagnostic res41: Schizophrenia spectrum
Eu21.11 Read [X]Latent schizophrenic reaction diagnostic res41: Schizophrenia spectrum
Eu21.12 Read [X]Borderline schizophrenia diagnostic res41: Schizophrenia spectrum
Eu21.13 Read [X]Latent schizophrenia diagnostic res41: Schizophrenia spectrum
Eu21.14 Read [X]Prepsychotic schizophrenia diagnostic res41: Schizophrenia spectrum
Eu21.15 Read [X]Prodromal schizophrenia diagnostic res41: Schizophrenia spectrum
Eu21.16 Read [X]Pseudoneurotic schizophrenia diagnostic res41: Schizophrenia spectrum
Eu22.00 Read [X]Persistent delusional disorders diagnostic res41: Schizophrenia spectrum
Eu22000 Read [X]Delusional disorder diagnostic res41: Schizophrenia spectrum
Eu22011 Read [X]Paranoid psychosis diagnostic res41: Schizophrenia spectrum
Eu22012 Read [X]Paranoid state diagnostic res41: Schizophrenia spectrum
Eu22013 Read [X]Paraphrenia - late diagnostic res41: Schizophrenia spectrum
Eu22014 Read [X]Sensitiver Beziehungswahn diagnostic res41: Schizophrenia spectrum
Eu22015 Read [X]Paranoia diagnostic res41: Schizophrenia spectrum
Eu22100 Read [X]Delusional misidentification syndrome diagnostic res41: Schizophrenia spectrum
Eu22111 Read [X]Capgras syndrome diagnostic res41: Schizophrenia spectrum
Eu22y00 Read [X]Other persistent delusional disorders diagnostic res41: Schizophrenia spectrum
Eu22y11 Read [X]Delusional dysmorphophobia diagnostic res41: Schizophrenia spectrum
Eu22y12 Read [X]Involutional paranoid state diagnostic res41: Schizophrenia spectrum
Eu22y13 Read [X]Paranoia querulans diagnostic res41: Schizophrenia spectrum
Eu22z00 Read [X]Persistent delusional disorder, unspecified diagnostic res41: Schizophrenia spectrum
Eu23.00 Read [X]Acute and transient psychotic disorders diagnostic res41: Schizophrenia spectrum
Eu23000 Read [X]Acute polymorphic psychot disord without symp of schizoph diagnostic res41: Schizophrenia spectrum
Eu23012 Read [X]Cycloid psychosis diagnostic res41: Schizophrenia spectrum
Eu23100 Read [X]Acute polymorphic psychot disord with symp of schizophren diagnostic res41: Schizophrenia spectrum
Eu23112 Read [X]Cycloid psychosis with symptoms of schizophrenia diagnostic res41: Schizophrenia spectrum
Eu23200 Read [X]Acute schizophrenia-like psychotic disorder diagnostic res41: Schizophrenia spectrum
Eu23211 Read [X]Brief schizophreniform disorder diagnostic res41: Schizophrenia spectrum
Eu23212 Read [X]Brief schizophrenifrm psych diagnostic res41: Schizophrenia spectrum
Eu23214 Read [X]Schizophrenic reaction diagnostic res41: Schizophrenia spectrum
Eu23300 Read [X]Other acute predominantly delusional psychotic disorders diagnostic res41: Schizophrenia spectrum
Eu23312 Read [X]Psychogenic paranoid psychosis diagnostic res41: Schizophrenia spectrum
Eu23y00 Read [X]Other acute and transient psychotic disorders diagnostic res41: Schizophrenia spectrum
Eu23z00 Read [X]Acute and transient psychotic disorder, unspecified diagnostic res41: Schizophrenia spectrum
Eu23z11 Read [X]Brief reactive psychosis NOS diagnostic res41: Schizophrenia spectrum
Eu23z12 Read [X]Reactive psychosis diagnostic res41: Schizophrenia spectrum
Eu25.00 Read [X]Schizoaffective disorders diagnostic res41: Schizophrenia spectrum
Eu25000 Read [X]Schizoaffective disorder, manic type diagnostic res41: Schizophrenia spectrum
Eu25011 Read [X]Schizoaffective psychosis, manic type diagnostic res41: Schizophrenia spectrum
Eu25012 Read [X]Schizophreniform psychosis, manic type diagnostic res41: Schizophrenia spectrum
Eu25100 Read [X]Schizoaffective disorder, depressive type diagnostic res41: Schizophrenia spectrum
Eu25111 Read [X]Schizoaffective psychosis, depressive type diagnostic res41: Schizophrenia spectrum
Eu25112 Read [X]Schizophreniform psychosis, depressive type diagnostic res41: Schizophrenia spectrum
Eu25200 Read [X]Schizoaffective disorder, mixed type diagnostic res41: Schizophrenia spectrum
Eu25212 Read [X]Mixed schizophrenic and affective psychosis diagnostic res41: Schizophrenia spectrum
Eu25y00 Read [X]Other schizoaffective disorders diagnostic res41: Schizophrenia spectrum
Eu25z00 Read [X]Schizoaffective disorder, unspecified diagnostic res41: Schizophrenia spectrum
Eu25z11 Read [X]Schizoaffective psychosis NOS diagnostic res41: Schizophrenia spectrum
Eu2y.00 Read [X]Other nonorganic psychotic disorders diagnostic res41: Schizophrenia spectrum
Eu2y.11 Read [X]Chronic hallucinatory psychosis diagnostic res41: Schizophrenia spectrum
Eu2z.00 Read [X]Unspecified nonorganic psychosis diagnostic res41: Schizophrenia spectrum
Eu2z.11 Read [X]Psychosis NOS diagnostic res41: Schizophrenia spectrum
Eu32300 Read [X]Severe depressive episode with psychotic symptoms diagnostic res41: Schizophrenia spectrum
Eu32311 Read [X]Single episode of major depression and psychotic symptoms diagnostic res41: Schizophrenia spectrum
Eu32312 Read [X]Single episode of psychogenic depressive psychosis diagnostic res41: Schizophrenia spectrum
Eu32313 Read [X]Single episode of psychotic depression diagnostic res41: Schizophrenia spectrum
Eu32314 Read [X]Single episode of reactive depressive psychosis diagnostic res41: Schizophrenia spectrum
Eu32900 Read [X]Single major depr ep, severe with psych, psych in remiss diagnostic res41: Schizophrenia spectrum
Eu32A00 Read [X]Recurr major depr ep, severe with psych, psych in remiss diagnostic res41: Schizophrenia spectrum
Eu33300 Read [X]Recurrent depress disorder cur epi severe with psyc symp diagnostic res41: Schizophrenia spectrum
Eu33311 Read [X]Endogenous depression with psychotic symptoms diagnostic res41: Schizophrenia spectrum
Eu33313 Read [X]Recurr severe episodes/major depression+psychotic symptom diagnostic res41: Schizophrenia spectrum
Eu33314 Read [X]Recurr severe episodes/psychogenic depressive psychosis diagnostic res41: Schizophrenia spectrum
Eu33315 Read [X]Recurrent severe episodes of psychotic depression diagnostic res41: Schizophrenia spectrum
Eu33316 Read [X]Recurrent severe episodes/reactive depressive psychosis diagnostic res41: Schizophrenia spectrum
Eu44.14 Read [X]Hysterical psychosis diagnostic res41: Schizophrenia spectrum
Eu84312 Read [X]Disintegrative psychosis diagnostic res41: Schizophrenia spectrum
Eu84314 Read [X]Symbiotic psychosis diagnostic res41: Schizophrenia spectrum
R001.00 Read [D]Hallucinations diagnostic res41: Schizophrenia spectrum
R001000 Read [D]Hallucinations, auditory diagnostic res41: Schizophrenia spectrum
R001100 Read [D]Hallucinations, gustatory diagnostic res41: Schizophrenia spectrum
R001200 Read [D]Hallucinations, olfactory diagnostic res41: Schizophrenia spectrum
R001300 Read [D]Hallucinations, tactile diagnostic res41: Schizophrenia spectrum
R001400 Read [D]Visual hallucinations diagnostic res41: Schizophrenia spectrum
R001z00 Read [D]Hallucinations NOS diagnostic res41: Schizophrenia spectrum
Ryu5300 Read [X]Other hallucinations diagnostic res41: Schizophrenia spectrum
ZS7C611 Read Schizophrenic language diagnostic res41: Schizophrenia spectrum
ZV11000 Read [V]Personal history of schizophrenia diagnostic res41: Schizophrenia spectrum

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