Code list: res55: anxiolytic

Research article:

Incidence, clinical management, and mortality risk following self-harm among children and adolescents: cohort study in primary care

Reference:

C Morgan, RT Webb, MJ Carr, E Kontopantelis, J Green, CA Chew-Graham, N Kapur, DM Ashcroft (2017) Incidence, clinical management, and mortality risk following self-harm among children and adolescents: cohort study in primary care. The BMJ, doi: doi.org/10.1136/bmj.j4351

Link to fulltext article
Abstract: Abstract Objectives To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age. Design Population based cohort study. Setting UK Clinical Practice Research Datalink—electronic health records from 674 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records. Participants For the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274). Main outcome measures In the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death), and fatal acute alcohol or drug poisoning were estimated as hazard ratios derived from stratified Cox proportional hazards models for the self harm cohort versus the matched unaffected comparison cohort. Results The annual incidence of self harm was observed to increase in girls (37.4 per 10 000) compared with boys (12.3 per 10 000), and a sharp 68% increase occurred among girls aged 13-16, from 45.9 per 10 000 in 2011 to 77.0 per 10 000 in 2014. Referrals within 12 months of the index self harm episode were 23% less likely for young patients registered at the most socially deprived practices, even though incidences were considerably higher in these localities. Children and adolescents who harmed themselves were approximately nine times more likely to die unnaturally during follow-up, with especially noticeable increases in risks of suicide (deprivation adjusted hazard ratio 17.5, 95% confidence interval 7.6 to 40.5) and fatal acute alcohol or drug poisoning (34.3, 10.2 to 115.7). Conclusions Gaining a better understanding of the mechanisms responsible for the recent apparent increase in the incidence of self harm among early-mid teenage girls, and coordinated initiatives to tackle health inequalities in the provision of services to distressed children and adolescents, represent urgent priorities for multiple public agencies.
Author for correspondence: Catharine Morgan
Email for correspondence: cathy.morgan@manchester.ac.uk

Code list: res55: anxiolytic_hypnotic

37 codes in list

Code	Coding system	Description	Entity type	List name
d1...	Read	hypnotics	drug	res55: anxiolytic_hypnotic
d11..	Read	chloral hydrate	drug	res55: anxiolytic_hypnotic
d12..	Read	clomethiazole ed. [hypnot]	drug	res55: anxiolytic_hypnotic
d13..	Read	*dichloralphenazone	drug	res55: anxiolytic_hypnotic
d14..	Read	*flunitrazepam	drug	res55: anxiolytic_hypnotic
d15..	Read	flurazepam	drug	res55: anxiolytic_hypnotic
d16..	Read	loprazolam	drug	res55: anxiolytic_hypnotic
d17..	Read	lormetazepam	drug	res55: anxiolytic_hypnotic
d18..	Read	nitrazepam	drug	res55: anxiolytic_hypnotic
d1a..	Read	temazepam [hypnotic]	drug	res55: anxiolytic_hypnotic
d1b..	Read	triazolam	drug	res55: anxiolytic_hypnotic
d1c..	Read	triclofos sodium	drug	res55: anxiolytic_hypnotic
d1d..	Read	zoplicone	drug	res55: anxiolytic_hypnotic
d1f..	Read	zolpidem	drug	res55: anxiolytic_hypnotic
d1g..	Read	zaleplon	drug	res55: anxiolytic_hypnotic
d2...	Read	anxiolytics	drug	res55: anxiolytic_hypnotic
d21..	Read	diazepam [anxiolytic]	drug	res55: anxiolytic_hypnotic
d22..	Read	alprazolam	drug	res55: anxiolytic_hypnotic
d23..	Read	bromazepam	drug	res55: anxiolytic_hypnotic
d24..	Read	chlordiazepoxide	drug	res55: anxiolytic_hypnotic
d25..	Read	chlormezanone	drug	res55: anxiolytic_hypnotic
d26..	Read	clobazam	drug	res55: anxiolytic_hypnotic
d29..	Read	*ketazolam	drug	res55: anxiolytic_hypnotic
d2a..	Read	lorazepam [anxiolytic]	drug	res55: anxiolytic_hypnotic
d2b..	Read	*medazepam	drug	res55: anxiolytic_hypnotic
d2c..	Read	meprobamate	drug	res55: anxiolytic_hypnotic
d2d..	Read	oxazepam	drug	res55: anxiolytic_hypnotic
d2e..	Read	*prazepam	drug	res55: anxiolytic_hypnotic
d2f..	Read	buspirone hydrochloride	drug	res55: anxiolytic_hypnotic
d3..	Read	barbiturates/methyprylone	drug	res55: anxiolytic_hypnotic
d31..	Read	barbiturates	drug	res55: anxiolytic_hypnotic
d32..	Read	methyprylone	drug	res55: anxiolytic_hypnotic
dC1..	Read	sodium oxybate	drug	res55: anxiolytic_hypnotic
dn4..	Read	clonazepam [epilepsy control]	drug	res55: anxiolytic_hypnotic
dn6..	Read	methylphenobarbital	drug	res55: anxiolytic_hypnotic
dn7..	Read	phenobarbital	drug	res55: anxiolytic_hypnotic
dnc..	Read	clobazam [epilepsy only]	drug	res55: anxiolytic_hypnotic

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