ClinicalCodes.org
An online clinical codes repository to improve validity and reproducibility of medical database research
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: Extra_referral_codes
33 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 64R7.11 | Read | Child refer- clinical psychol. | diagnostic | res59: Extra_referral_codes | |||
| 8H23.00 | Read | Admit psychiatric emergency | diagnostic | res59: Extra_referral_codes | |||
| 8H23000 | Read | Emerg psychiatric admiss MHA | diagnostic | res59: Extra_referral_codes | |||
| 8H49.00 | Read | Psychiatric referral | diagnostic | res59: Extra_referral_codes | |||
| 8H4f.00 | Read | Referral to learning disabilities psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| 8H4P.00 | Read | Referral to child psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| 8H7T.00 | Read | Refer to psychologist | diagnostic | res59: Extra_referral_codes | |||
| 8Hc..00 | Read | Referral to mental health team | diagnostic | res59: Extra_referral_codes | |||
| 8Hc0.00 | Read | Referral to community mental health team | diagnostic | res59: Extra_referral_codes | |||
| 8Hc2.00 | Read | Referral to primary care mental health team | diagnostic | res59: Extra_referral_codes | |||
| 8HHR.00 | Read | Referral to child and adolescent psychiatry service | diagnostic | res59: Extra_referral_codes | |||
| 8HHs.00 | Read | Referral to psychosis early intervention service | diagnostic | res59: Extra_referral_codes | |||
| 8HHT.00 | Read | Referral to psychotherapist | diagnostic | res59: Extra_referral_codes | |||
| 8HHu.00 | Read | Referral to primary care mental health gateway worker | diagnostic | res59: Extra_referral_codes | |||
| 8HHv.00 | Read | Referral to primary care mental health graduate worker | diagnostic | res59: Extra_referral_codes | |||
| 8HJ3.00 | Read | Psychiatric self-referral | diagnostic | res59: Extra_referral_codes | |||
| 8HlB.00 | Read | Urgent referral to psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| 8HlD.00 | Read | Referral to forensic psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| 8HVi.00 | Read | Private referral to psychologist | diagnostic | res59: Extra_referral_codes | |||
| 8HVO.00 | Read | Private referral to psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| ZL5B.00 | Read | Referral to psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| ZL5B100 | Read | Referral to child and adolescent psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| ZL5B111 | Read | Referral to child psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| ZL5B200 | Read | Referral to forensic psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| ZL5B300 | Read | Referral to liaison psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| ZL5B400 | Read | Referral to rehabilitation psychiatrist | diagnostic | res59: Extra_referral_codes | |||
| ZL5B500 | Read | Referral to psychiatrist for mental handicap | diagnostic | res59: Extra_referral_codes | |||
| ZL62A00 | Read | Referral to nurse behavioural therapist | diagnostic | res59: Extra_referral_codes | |||
| ZL62B00 | Read | Referral to nurse psychotherapist | diagnostic | res59: Extra_referral_codes | |||
| ZL62E00 | Read | Referral to psychiatric nurse | diagnostic | res59: Extra_referral_codes | |||
| ZL77.00 | Read | Referral to psychotherapist | diagnostic | res59: Extra_referral_codes | |||
| ZL78.00 | Read | Referral to psychologist | diagnostic | res59: Extra_referral_codes | |||
| ZL78.11 | Read | Refer to psychologist | diagnostic | res59: Extra_referral_codes |
Please log in to leave a comment.
Code list links:
ClinicalCodes is a project at the University of Manchester Institute of Population Health
The ClinicalCodes project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR)