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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: Self-harm

261 codes in list

Code Coding system Description Entity type List name
14K1.00 Read Intentional overdose of prescription only medication diagnostic res41: Self-harm
SL...14 Read Overdose of biological substance diagnostic res41: Self-harm
SL...15 Read Overdose of drug diagnostic res41: Self-harm
SL90.00 Read Antidepressant poisoning diagnostic res41: Self-harm
SL90z00 Read Anti-depressant poisoning NOS diagnostic res41: Self-harm
SLHz.00 Read Drug and medicament poisoning NOS diagnostic res41: Self-harm
TK...00 Read Suicide and selfinflicted injury diagnostic res41: Self-harm
TK0..00 Read Suicide + selfinflicted poisoning by solid/liquid substances diagnostic res41: Self-harm
TK00.00 Read Suicide + selfinflicted poisoning by analgesic/antipyretic diagnostic res41: Self-harm
TK01.00 Read Suicide + selfinflicted poisoning by barbiturates diagnostic res41: Self-harm
TK01000 Read Suicide and self inflicted injury by Amylobarbitone diagnostic res41: Self-harm
TK01100 Read Suicide and self inflicted injury by Barbitone diagnostic res41: Self-harm
TK01400 Read Suicide and self inflicted injury by Phenobarbitone diagnostic res41: Self-harm
TK02.00 Read Suicide + selfinflicted poisoning by oth sedatives/hypnotics diagnostic res41: Self-harm
TK03.00 Read Suicide + selfinflicted poisoning tranquilliser/psychotropic diagnostic res41: Self-harm
TK04.00 Read Suicide + selfinflicted poisoning by other drugs/medicines diagnostic res41: Self-harm
TK05.00 Read Suicide + selfinflicted poisoning by drug or medicine NOS diagnostic res41: Self-harm
TK06.00 Read Suicide + selfinflicted poisoning by agricultural chemical diagnostic res41: Self-harm
TK07.00 Read Suicide + selfinflicted poisoning by corrosive/caustic subst diagnostic res41: Self-harm
TK0z.00 Read Suicide + selfinflicted poisoning by solid/liquid subst NOS diagnostic res41: Self-harm
TK1..00 Read Suicide + selfinflicted poisoning by gases in domestic use diagnostic res41: Self-harm
TK10.00 Read Suicide + selfinflicted poisoning by gas via pipeline diagnostic res41: Self-harm
TK...11 Read Cause of overdose - deliberate diagnostic res41: Self-harm
TK11.00 Read Suicide + selfinflicted poisoning by liquified petrol gas diagnostic res41: Self-harm
TK...12 Read Injury - self-inflicted diagnostic res41: Self-harm
TK...13 Read Poisoning - self-inflicted diagnostic res41: Self-harm
TK...14 Read Suicide and self harm diagnostic res41: Self-harm
TK...15 Read Attempted suicide diagnostic res41: Self-harm
TK...17 Read Para-suicide diagnostic res41: Self-harm
TK1y.00 Read Suicide and selfinflicted poisoning by other utility gas diagnostic res41: Self-harm
TK1z.00 Read Suicide + selfinflicted poisoning by domestic gases NOS diagnostic res41: Self-harm
TK2..00 Read Suicide + selfinflicted poisoning by other gases and vapours diagnostic res41: Self-harm
TK20.00 Read Suicide + selfinflicted poisoning by motor veh exhaust gas diagnostic res41: Self-harm
TK21.00 Read Suicide and selfinflicted poisoning by other carbon monoxide diagnostic res41: Self-harm
TK2z.00 Read Suicide + selfinflicted poisoning by gases and vapours NOS diagnostic res41: Self-harm
TK3..00 Read Suicide + selfinflicted injury by hang/strangulate/suffocate diagnostic res41: Self-harm
TK30.00 Read Suicide and selfinflicted injury by hanging diagnostic res41: Self-harm
TK31.00 Read Suicide + selfinflicted injury by suffocation by plastic bag diagnostic res41: Self-harm
TK3y.00 Read Suicide + selfinflicted inj oth mean hang/strangle/suffocate diagnostic res41: Self-harm
TK3z.00 Re