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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: Bipolar_disorder
102 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 1S42.00 | Read | manic mood | diagnostic | res59: Bipolar_disorder | |||
| 212V.00 | Read | bipolar affective disorder resolved | diagnostic | res59: Bipolar_disorder | |||
| E11..00 | Read | Affective psychoses | diagnostic | res59: Bipolar_disorder | |||
| E110.00 | Read | manic disorder, single episode | diagnostic | res59: Bipolar_disorder | |||
| E110000 | Read | single manic episode, unspecified | diagnostic | res59: Bipolar_disorder | |||
| E110100 | Read | single manic episode, mild | diagnostic | res59: Bipolar_disorder | |||
| E110.11 | Read | hypomanic psychoses | diagnostic | res59: Bipolar_disorder | |||
| E110200 | Read | single manic episode, moderate | diagnostic | res59: Bipolar_disorder | |||
| E110300 | Read | single manic episode, severe without mention of psychosis | diagnostic | res59: Bipolar_disorder | |||
| E110400 | Read | single manic episode, severe, with psychosis | diagnostic | res59: Bipolar_disorder | |||
| E110600 | Read | single manic episode in full remission | diagnostic | res59: Bipolar_disorder | |||
| E110z00 | Read | manic disorder, single episode nos | diagnostic | res59: Bipolar_disorder | |||
| E111.00 | Read | recurrent manic episodes | diagnostic | res59: Bipolar_disorder | |||
| E111000 | Read | recurrent manic episodes, unspecified | diagnostic | res59: Bipolar_disorder | |||
| E11..11 | Read | bipolar psychoses | diagnostic | res59: Bipolar_disorder | |||
| E111100 | Read | recurrent manic episodes, mild | diagnostic | res59: Bipolar_disorder | |||
| E111200 | Read | recurrent manic episodes, moderate | diagnostic | res59: Bipolar_disorder | |||
| E11..13 | Read | manic psychoses | diagnostic | res59: Bipolar_disorder | |||
| E111300 | Read | recurrent manic episodes, severe without mention psychosis | diagnostic | res59: Bipolar_disorder | |||
| E111400 | Read | recurrent manic episodes, severe, with psychosis | diagnostic | res59: Bipolar_disorder | |||
| E111500 | Read | recurrent manic episodes, partial or unspecified remission | diagnostic | res59: Bipolar_disorder | |||
| E111600 | Read | recurrent manic episodes, in full remission | diagnostic | res59: Bipolar_disorder | |||
| E111z00 | Read | recurrent manic episode nos | diagnostic | res59: Bipolar_disorder | |||
| E114.00 | Read | bipolar affective disorder, currently manic | diagnostic | res59: Bipolar_disorder | |||
| E114000 | Read | bipolar affective disorder, currently manic, unspecified | diagnostic | res59: Bipolar_disorder | |||
| E114100 | Read | bipolar affective disorder, currently manic, mild | diagnostic | res59: Bipolar_disorder | |||
| E114.11 | Read | manic-depressive - now manic | diagnostic | res59: Bipolar_disorder | |||
| E114200 | Read | bipolar affective disorder, currently manic, moderate | diagnostic | res59: Bipolar_disorder | |||
| E114300 | Read | bipolar affect disord, currently manic, severe, no psychosis | diagnostic | res59: Bipolar_disorder | |||
| E114400 | Read | bipolar affect disord, currently manic,severe with psychosis | diagnostic | res59: Bipolar_disorder | |||
| E114500 | Read | bipolar affect disord,currently manic, part/unspec remission | diagnostic | res59: Bipolar_disorder | |||
| E114600 | Read | bipolar affective disorder, currently manic, full remission | diagnostic | res59: Bipolar_disorder | |||
| E114z00 | Read | bipolar affective disorder, currently manic, nos | diagnostic | res59: Bipolar_disorder | |||
| E115.00 | Read | bipolar affective disorder, currently depressed | diagnostic | res59: Bipolar_disorder | |||
| E115000 | Read | bipolar affective disorder, currently depressed, unspecified | diagnostic | res59: Bipolar_disorder | |||
| E115100 | Read | bipolar affective disorder, currently depressed, mild | diagnostic | res59: Bipolar_disorder | |||
| E115.11 | Read | manic-depressive - now depressed | diagnostic | res59: Bipolar_disorder | |||
| E115200 | Read | bipolar affective disorder, currently depressed, moderate | diagnostic | res59: Bipolar_disorder | |||
| E115300 | Read | bipolar affect disord, now depressed, severe, no psychosis | diagnostic | res59: Bipolar_disorder | |||
| E115400 | Read | bipolar affect disord, now depressed, severe with psychosis | diagnostic | res59: Bipolar_disorder | |||
| E115500 | Read | bipolar affect disord, now depressed, part/unspec remission | diagnostic | res59: Bipolar_disorder | |||
| E115600 | Read | bipolar affective disorder, now depressed, in full remission | diagnostic | res59: Bipolar_disorder | |||
| E115z00 | Read | bipolar affective disorder, currently depressed, nos | diagnostic | res59: Bipolar_disorder | |||
| E116.00 | Read | mixed bipolar affective disorder | diagnostic | res59: Bipolar_disorder | |||
| E116000 | Read | mixed bipolar affective disorder, unspecified | diagnostic | res59: Bipolar_disorder | |||
| E116100 | Read | mixed bipolar affective disorder, mild | diagnostic | res59: Bipolar_disorder | |||
| E116200 | Read | mixed bipolar affective disorder, moderate | diagnostic | res59: Bipolar_disorder | |||
| E116300 | Read | mixed bipolar affective disorder, severe, without psychosis | diagnostic | res59: Bipolar_disorder | |||
| E116400 | Read | mixed bipolar affective disorder, severe, with psychosis | diagnostic | res59: Bipolar_disorder | |||
| E116500 | Read | mixed bipolar affective disorder, partial/unspec remission | diagnostic | res59: Bipolar_disorder | |||
| E116600 | Read | mixed bipolar affective disorder, in full remission | diagnostic | res59: Bipolar_disorder | |||
| E116z00 | Read | mixed bipolar affective disorder, nos | diagnostic | res59: Bipolar_disorder | |||
| E117.00 | Read | unspecified bipolar affective disorder | diagnostic | res59: Bipolar_disorder | |||
| E117000 | Read | unspecified bipolar affective disorder, unspecified | diagnostic | res59: Bipolar_disorder | |||
| E117100 | Read | unspecified bipolar affective disorder, mild | diagnostic | res59: Bipolar_disorder | |||
| E117200 | Read | unspecified bipolar affective disorder, moderate | diagnostic | res59: Bipolar_disorder | |||
| E117300 | Read | unspecified bipolar affective disorder, severe, no psychosis | diagnostic | res59: Bipolar_disorder | |||
| E117400 | Read | unspecified bipolar affective disorder,severe with psychosis | diagnostic | res59: Bipolar_disorder | |||
| E117500 | Read | unspecified bipolar affect disord, partial/unspec remission | diagnostic | res59: Bipolar_disorder | |||
| E117600 | Read | unspecified bipolar affective disorder, in full remission | diagnostic | res59: Bipolar_disorder | |||
| E117z00 | Read | unspecified bipolar affective disorder, nos | diagnostic | res59: Bipolar_disorder | |||
| E11y.00 | Read | other and unspecified manic-depressive psychoses | diagnostic | res59: Bipolar_disorder | |||
| E11y000 | Read | unspecified manic-depressive psychoses | diagnostic | res59: Bipolar_disorder | |||
| E11y100 | Read | atypical manic disorder | diagnostic | res59: Bipolar_disorder | |||
| E11y300 | Read | other mixed manic-depressive psychoses | diagnostic | res59: Bipolar_disorder | |||
| E11yz00 | Read | other and unspecified manic-depressive psychoses nos | diagnostic | res59: Bipolar_disorder | |||
| Eu3..00 | Read | [X]Mood - affective disorders | diagnostic | res59: Bipolar_disorder | |||
| Eu30.00 | Read | [x]manic episode | diagnostic | res59: Bipolar_disorder | |||
| Eu30000 | Read | [x]hypomania | diagnostic | res59: Bipolar_disorder | |||
| Eu30100 | Read | [x]mania without psychotic symptoms | diagnostic | res59: Bipolar_disorder | |||
| Eu30.11 | Read | [x]bipolar disorder, single manic episode | diagnostic | res59: Bipolar_disorder | |||
| Eu30200 | Read | [x]mania with psychotic symptoms | diagnostic | res59: Bipolar_disorder | |||
| Eu30211 | Read | [x]mania with mood-congruent psychotic symptoms | diagnostic | res59: Bipolar_disorder | |||
| Eu30212 | Read | [x]mania with mood-incongruent psychotic symptoms | diagnostic | res59: Bipolar_disorder | |||
| Eu30y00 | Read | [x]other manic episodes | diagnostic | res59: Bipolar_disorder | |||
| Eu30z00 | Read | [x]manic episode, unspecified | diagnostic | res59: Bipolar_disorder | |||
| Eu30z11 | Read | [x]mania nos | diagnostic | res59: Bipolar_disorder | |||
| Eu31.00 | Read | [x]bipolar affective disorder | diagnostic | res59: Bipolar_disorder | |||
| Eu31000 | Read | [x]bipolar affective disorder, current episode hypomanic | diagnostic | res59: Bipolar_disorder | |||
| Eu31100 | Read | [x]bipolar affect disorder cur epi manic wout psychotic symp | diagnostic | res59: Bipolar_disorder | |||
| Eu31.11 | Read | [x]manic-depressive illness | diagnostic | res59: Bipolar_disorder | |||
| Eu31.12 | Read | [x]manic-depressive psychosis | diagnostic | res59: Bipolar_disorder | |||
| Eu31.13 | Read | [x]manic-depressive reaction | diagnostic | res59: Bipolar_disorder | |||
| Eu31200 | Read | [x]bipolar affect disorder cur epi manic with psychotic symp | diagnostic | res59: Bipolar_disorder | |||
| Eu31300 | Read | [x]bipolar affect disorder cur epi mild or moderate depressn | diagnostic | res59: Bipolar_disorder | |||
| Eu31400 | Read | [x]bipol aff disord, curr epis sev depress, no psychot symp | diagnostic | res59: Bipolar_disorder | |||
| Eu31500 | Read | [x]bipolar affect dis cur epi severe depres with psyc symp | diagnostic | res59: Bipolar_disorder | |||
| Eu31600 | Read | [x]bipolar affective disorder, current episode mixed | diagnostic | res59: Bipolar_disorder | |||
| Eu31700 | Read | [x]bipolar affective disorder, currently in remission | diagnostic | res59: Bipolar_disorder | |||
| Eu31800 | Read | [x]bipolar affective disorder type i | diagnostic | res59: Bipolar_disorder | |||
| Eu31900 | Read | [x]bipolar affective disorder type ii | diagnostic | res59: Bipolar_disorder | |||
| Eu31911 | Read | [x]bipolar ii disorder | diagnostic | res59: Bipolar_disorder | |||
| Eu31y00 | Read | [x]other bipolar affective disorders | diagnostic | res59: Bipolar_disorder | |||
| Eu31y11 | Read | [x]bipolar ii disorder | diagnostic | res59: Bipolar_disorder | |||
| Eu31y12 | Read | [x]recurrent manic episodes | diagnostic | res59: Bipolar_disorder | |||
| Eu31z00 | Read | [x]bipolar affective disorder, unspecified | diagnostic | res59: Bipolar_disorder | |||
| Eu34.00 | Read | [X]Persistent mood affective disorders | diagnostic | res59: Bipolar_disorder | |||
| Eu34y00 | Read | [X]Other persistent mood affective disorders | diagnostic | res59: Bipolar_disorder | |||
| Eu34z00 | Read | [X]Persistent mood affective disorder, unspecified | diagnostic | res59: Bipolar_disorder | |||
| Eu3y011 | Read | [X]Mixed affective episode | diagnostic | res59: Bipolar_disorder | |||
| Eu3y100 | Read | [X]Other recurrent mood affective disorders | diagnostic | res59: Bipolar_disorder | |||
| Eu3z.11 | Read | [X]Affective psychosis NOS | diagnostic | res59: Bipolar_disorder |
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