Code list: res59: Autism

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: res59: Autism_spectrum

19 codes in list

Code	Coding system	Description	Entity type	List name
E140.00	Read	infantile autism	diagnostic	res59: Autism_spectrum
E140000	Read	active infantile autism	diagnostic	res59: Autism_spectrum
E140100	Read	residual infantile autism	diagnostic	res59: Autism_spectrum
E140.11	Read	kanner's syndrome	diagnostic	res59: Autism_spectrum
E140.12	Read	autism	diagnostic	res59: Autism_spectrum
E140.13	Read	childhood autism	diagnostic	res59: Autism_spectrum
E140z00	Read	infantile autism nos	diagnostic	res59: Autism_spectrum
E141.11	Read	Heller's syndrome	diagnostic	res59: Autism_spectrum
Eu84000	Read	[x]childhood autism	diagnostic	res59: Autism_spectrum
Eu84011	Read	[x]autistic disorder	diagnostic	res59: Autism_spectrum
Eu84012	Read	[x]infantile autism	diagnostic	res59: Autism_spectrum
Eu84013	Read	[x]infantile psychosis	diagnostic	res59: Autism_spectrum
Eu84100	Read	[x]atypical autism	diagnostic	res59: Autism_spectrum
Eu84111	Read	[x]atypical childhood psychosis	diagnostic	res59: Autism_spectrum
Eu84112	Read	[x]mental retardation with autistic features	diagnostic	res59: Autism_spectrum
Eu84312	Read	[X]Disintegrative psychosis	diagnostic	res59: Autism_spectrum
Eu84500	Read	[x]asperger's syndrome	diagnostic	res59: Autism_spectrum
Eu84511	Read	[x]autistic psychopathy	diagnostic	res59: Autism_spectrum
Eu84z11	Read	[x]autistic spectrum disorder	diagnostic	res59: Autism_spectrum

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