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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: Personality_disorder
81 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| E21..00 | Read | Personality disorders | diagnostic | res59: Personality_disorder | |||
| E210.00 | Read | Paranoid personality disorder | diagnostic | res59: Personality_disorder | |||
| E211.00 | Read | Affective personality disorder | diagnostic | res59: Personality_disorder | |||
| E211000 | Read | Unspecified affective personality disorder | diagnostic | res59: Personality_disorder | |||
| E21..11 | Read | Neurotic personality disorder | diagnostic | res59: Personality_disorder | |||
| E211100 | Read | hypomanic personality disorder | diagnostic | res59: Personality_disorder | |||
| E211200 | Read | depressive personality disorder | diagnostic | res59: Personality_disorder | |||
| E211300 | Read | cyclothymic personality disorder | diagnostic | res59: Personality_disorder | |||
| E211z00 | Read | Affective personality disorder NOS | diagnostic | res59: Personality_disorder | |||
| E212.00 | Read | schizoid personality disorder | diagnostic | res59: Personality_disorder | |||
| E212000 | Read | unspecified schizoid personality disorder | diagnostic | res59: Personality_disorder | |||
| E212z00 | Read | schizoid personality disorder nos | diagnostic | res59: Personality_disorder | |||
| E213.00 | Read | Explosive personality disorder | diagnostic | res59: Personality_disorder | |||
| E214.00 | Read | Compulsive personality disorders | diagnostic | res59: Personality_disorder | |||
| E214000 | Read | Anankastic personality | diagnostic | res59: Personality_disorder | |||
| E214.11 | Read | Anancastic personality | diagnostic | res59: Personality_disorder | |||
| E214z00 | Read | Compulsive personality disorder NOS | diagnostic | res59: Personality_disorder | |||
| E215.00 | Read | Histrionic personality disorders | diagnostic | res59: Personality_disorder | |||
| E215000 | Read | Unspecified histrionic personality disorder | diagnostic | res59: Personality_disorder | |||
| E215.11 | Read | Hysterical personality disorders | diagnostic | res59: Personality_disorder | |||
| E215z00 | Read | Histrionic personality disorder NOS | diagnostic | res59: Personality_disorder | |||
| E216.00 | Read | Inadequate personality disorder | diagnostic | res59: Personality_disorder | |||
| E217.00 | Read | Antisocial or sociopathic personality disorder | diagnostic | res59: Personality_disorder | |||
| E21y.00 | Read | Other personality disorders | diagnostic | res59: Personality_disorder | |||
| E21y000 | Read | Narcissistic personality disorder | diagnostic | res59: Personality_disorder | |||
| E21y100 | Read | Avoidant personality disorder | diagnostic | res59: Personality_disorder | |||
| E21y200 | Read | Borderline personality disorder | diagnostic | res59: Personality_disorder | |||
| E21y300 | Read | Passive-aggressive personality disorder | diagnostic | res59: Personality_disorder | |||
| E21y400 | Read | Eccentric personality disorder | diagnostic | res59: Personality_disorder | |||
| E21y500 | Read | Immature personality disorder | diagnostic | res59: Personality_disorder | |||
| E21y600 | Read | Masochistic personality disorder | diagnostic | res59: Personality_disorder | |||
| E21y700 | Read | Psychoneurotic personality disorder | diagnostic | res59: Personality_disorder | |||
| E21yz00 | Read | Other personality disorder NOS | diagnostic | res59: Personality_disorder | |||
| E21z.00 | Read | Personality disorder NOS | diagnostic | res59: Personality_disorder | |||
| E21z.11 | Read | Psychopathic personality | diagnostic | res59: Personality_disorder | |||
| Eu06000 | Read | [X]Organic personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu06011 | Read | [X]Organic pseudopsychopathic personality | diagnostic | res59: Personality_disorder | |||
| Eu21.17 | Read | [x]pseudopsychopathic schizophrenia | diagnostic | res59: Personality_disorder | |||
| Eu21.18 | Read | [x]schizotypal personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu34011 | Read | [X]Affective personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu34112 | Read | [x]depressive personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60.00 | Read | [X]Specific personality disorders | diagnostic | res59: Personality_disorder | |||
| Eu60000 | Read | [X]Paranoid personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60013 | Read | [X]Querulant personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60014 | Read | [X]Sensitive paranoid personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60100 | Read | [x]schizoid personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60200 | Read | [X]Dissocial personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60211 | Read | [X]Amoral personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60212 | Read | [X]Antisocial personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60213 | Read | [X]Asocial personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60214 | Read | [X]Psychopathic personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60215 | Read | [X]Sociopathic personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60300 | Read | [X]Emotionally unstable personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60311 | Read | [X]Aggressive personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60312 | Read | [X]Borderline personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60313 | Read | [X]Explosive personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60400 | Read | [X]Histrionic personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60411 | Read | [X]Hysterical personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60412 | Read | [X]Psychoinfantile personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60500 | Read | [X]Anankastic personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60511 | Read | [X]Compulsive personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60512 | Read | [X]Obsessional personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60513 | Read | [X]Obsessive-compulsive personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60600 | Read | [x]anxious [avoidant] personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60700 | Read | [X]Dependent personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60711 | Read | [X]Asthenic personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60712 | Read | [X]Inadequate personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60713 | Read | [X]Passive personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60714 | Read | [X]Self defeating personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60800 | Read | [X]Addictive personality | diagnostic | res59: Personality_disorder | |||
| Eu60y00 | Read | [X]Other specific personality disorders | diagnostic | res59: Personality_disorder | |||
| Eu60y11 | Read | [X]Eccentric personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60y12 | Read | [X]Haltlose type personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60y13 | Read | [X]Immature personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60y14 | Read | [X]Narcissistic personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60y16 | Read | [X]Psychoneurotic personality disorder | diagnostic | res59: Personality_disorder | |||
| Eu60z00 | Read | [X]Personality disorder; unspecified | diagnostic | res59: Personality_disorder | |||
| Eu60z11 | Read | [X]Character neurosis NOS | diagnostic | res59: Personality_disorder | |||
| Eu60z12 | Read | [X]Pathological personality NOS | diagnostic | res59: Personality_disorder | |||
| Eu61.00 | Read | [X]Mixed and other personality disorders | diagnostic | res59: Personality_disorder | |||
| Eu84511 | Read | [x]autistic psychopathy | diagnostic | res59: Personality_disorder |
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