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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: Typical APDs

256 codes in list

Code Coding system Description Entity type List name
00443021 Multilex Haloperidol 1mg/5ml oral suspension drug res41: Typical APDs
00511021 Multilex Haloperidol 1mg/5ml oral solution drug res41: Typical APDs
03365020 Multilex Nozinan 25mg/1ml solution for injection ampoules (Lexon (UK) Ltd) drug res41: Typical APDs
04123020 Multilex Stemetil 5mg tablets (Sigma Pharmaceuticals Plc) drug res41: Typical APDs
04128020 Multilex Stemetil 5mg tablets (Lexon (UK) Ltd) drug res41: Typical APDs
04129020 Multilex Stemetil 5mg tablets (Mawdsley-Brooks & Company Ltd) drug res41: Typical APDs
04131020 Multilex Stemetil 5mg tablets (DE Pharmaceuticals) drug res41: Typical APDs
20065020 Multilex Haloperidol 2mg/5ml oral solution drug res41: Typical APDs
20067020 Multilex Haloperidol 2mg/5ml oral suspension drug res41: Typical APDs
32615020 Multilex Levomepromazine 6.25mg/5ml oral solution drug res41: Typical APDs
38919020 Multilex Levinan 6mg tablets (Archimedes Pharma UK Ltd) drug res41: Typical APDs
48712020 Multilex Clopixol 2mg tablets (Lundbeck Ltd) drug res41: Typical APDs
48713020 Multilex Clopixol 10mg tablets (Lundbeck Ltd) drug res41: Typical APDs
48714020 Multilex Clopixol 25mg tablets (Lundbeck Ltd) drug res41: Typical APDs
48897020 Multilex Depixol 3mg tablets (Lundbeck Ltd) drug res41: Typical APDs
49428020 Multilex Fentazin 2mg tablets (AMCo) drug res41: Typical APDs
49429020 Multilex Fentazin 4mg tablets (AMCo) drug res41: Typical APDs
49952020 Multilex Integrin 10mg Capsule (Sanofi-Synthelabo Ltd) drug res41: Typical APDs
50459020 Multilex Moditen 1mg tablets (Sanofi) drug res41: Typical APDs
50472020 Multilex Moditen enanthate 25mg/ml Injection (Sanofi-Synthelabo Ltd) drug res41: Typical APDs
50677020 Multilex Neulactil 2.5mg Tablet (JHC Healthcare Ltd) drug res41: Typical APDs
50678020 Multilex Neulactil 10mg Tablet (JHC Healthcare Ltd) drug res41: Typical APDs
50679020 Multilex Neulactil 25mg Tablet (JHC Healthcare Ltd) drug res41: Typical APDs
51013020 Multilex Parstelin Tablet (GlaxoSmithKline Consumer Healthcare) drug res41: Typical APDs
51357020 Multilex Redeptin 2mg/ml Injection (Janssen-Cilag Ltd) drug res41: Typical APDs
51649020 Multilex Sparine 50mg/ml Injection (Wyeth Pharmaceuticals) drug res41: Typical APDs
51663020 Multilex Stelabid Tablet (GlaxoSmithKline Consumer Healthcare) drug res41: Typical APDs
51676020 Multilex Stelazine 1mg tablets (Mercury Pharma Group Ltd) drug res41: Typical APDs
51677020 Multilex Stelazine 5mg tablets (Mercury Pharma Group Ltd) drug res41: Typical APDs
51678020 Multilex Stelazine 1mg/5ml syrup (Mercury Pharma Group Ltd) drug res41: Typical APDs
51681020 Multilex Stelazine 10mg/ml Concentrate (Goldshield Pharmaceuticals Ltd) drug res41: Typical APDs
51687020 Multilex Stelazine 1mg/ml Injection (Goldshield Pharmaceuticals Ltd) drug res41: Typical APDs
51690020 Multilex Stemetil 5mg Tablet (Castlemead Healthcare Ltd) drug res41: Typical APDs
51692020 Multilex Stemetil 5mg/5ml Oral solution (Castlemead Healthcare Ltd) drug res41: Typical APDs
51749020 Multilex Promazine 25mg Tablet (Biorex Laboratories Ltd) drug res41: Typical APDs
51751020 Multilex Promazine 50mg tablets (Teva UK Ltd) drug res41: Typical APDs
51832020 Multilex Taractan 15mg Tablet (Roche Products Ltd) drug res41: Typical APDs
52047020 Multilex Triptafen m 2mg+10mg Tablet (Goldshield Pharmaceuticals Ltd) drug res41: Typical APDs
52087020 Multilex Chlorpromazine 25mg/5ml Oral solution (Rosemont Pharmaceuticals Ltd) drug res41: Typical APDs
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