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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: Schizophrenia_spectrum

181 codes in list

Code Coding system Description Entity type List name
1BH..00 Read delusions diagnostic res59: Schizophrenia_spectrum
1BH0.00 Read delusion of persecution diagnostic res59: Schizophrenia_spectrum
1BH1.00 Read grandiose delusions diagnostic res59: Schizophrenia_spectrum
1BH..11 Read delusion diagnostic res59: Schizophrenia_spectrum
225E.00 Read o/e - paranoid delusions diagnostic res59: Schizophrenia_spectrum
225F.00 Read o/e - delusion of persecution diagnostic res59: Schizophrenia_spectrum
285..11 Read psychotic condition, insight present diagnostic res59: Schizophrenia_spectrum
E1...00 Read Non-organic psychoses diagnostic res59: Schizophrenia_spectrum
E10..00 Read Schizophrenic disorders diagnostic res59: Schizophrenia_spectrum
E100.00 Read Simple schizophrenia diagnostic res59: Schizophrenia_spectrum
E100000 Read Unspecified schizophrenia diagnostic res59: Schizophrenia_spectrum
E100100 Read Subchronic schizophrenia diagnostic res59: Schizophrenia_spectrum
E100.11 Read Schizophrenia simplex diagnostic res59: Schizophrenia_spectrum
E100200 Read Chronic schizophrenic diagnostic res59: Schizophrenia_spectrum
E100300 Read Acute exacerbation of subchronic schizophrenia diagnostic res59: Schizophrenia_spectrum
E100400 Read Acute exacerbation of chronic schizophrenia diagnostic res59: Schizophrenia_spectrum
E100500 Read Schizophrenia in remission diagnostic res59: Schizophrenia_spectrum
E100z00 Read Simple schizophrenia NOS diagnostic res59: Schizophrenia_spectrum
E101.00 Read Hebephrenic schizophrenia diagnostic res59: Schizophrenia_spectrum
E101000 Read Unspecified hebephrenic schizophrenia diagnostic res59: Schizophrenia_spectrum
E101400 Read Acute exacerbation of chronic hebephrenic schizophrenia diagnostic res59: Schizophrenia_spectrum
E101500 Read Hebephrenic schizophrenia in remission diagnostic res59: Schizophrenia_spectrum
E101z00 Read Hebephrenic schizophrenia NOS diagnostic res59: Schizophrenia_spectrum
E102.00 Read catatonic schizophrenia diagnostic res59: Schizophrenia_spectrum
E102000 Read unspecified catatonic schizophrenia diagnostic res59: Schizophrenia_spectrum
E102100 Read subchronic catatonic schizophrenia diagnostic res59: Schizophrenia_spectrum
E102400 Read acute exacerbation of chronic catatonic schizophrenia diagnostic res59: Schizophrenia_spectrum
E102500 Read Catatonic schizophrenia in remission diagnostic res59: Schizophrenia_spectrum
E102z00 Read catatonic schizophrenia nos diagnostic res59: Schizophrenia_spectrum
E103.00 Read paranoid schizophrenia diagnostic res59: Schizophrenia_spectrum
E103000 Read unspecified paranoid schizophrenia diagnostic res59: Schizophrenia_spectrum
E103100 Read subchronic paranoid schizophrenia diagnostic res59: Schizophrenia_spectrum
E103200 Read Chronic paranoid schizophrenia diagnostic res59: Schizophrenia_spectrum
E103300 Read Acute exacerbation of subchronic paranoid schizophrenia diagnostic res59: Schizophrenia_spectrum
E103400 Read Acute exacerbation of chronic paranoid schizophrenia diagnostic res59: Schizophrenia_spectrum
E103500 Read Paranoid schizophrenia in remission diagnostic res59: Schizophrenia_spectrum
E103z00 Read Paranoid schizophrenia NOS diagnostic res59: Schizophrenia_spectrum
E104.00 Read Acute schizophrenic episode diagnostic res59: Schizophrenia_spectrum
E105.00 Read Latent schizophrenia diagnostic res59: Schizophrenia_spectrum
E105000 Read Unspecified latent schizophrenia diagnostic res59: Schizophrenia_spectrum
E105200 Read Chronic latent schizophrenia diagnostic res59: Schizophrenia_spectrum
E105500 Read Latent schizophrenia in remission diagnostic res59: Schizophrenia_spectrum
E105z00 Read Latent schizophrenia NOS diagnostic res59: Schizophrenia_spectrum
E106.00 Read Residual schizophrenia diagnostic res59: Schizophrenia_spectrum
E107.00 Read Schizo-affective schizophrenia diagnostic res59: Schizophrenia_spectrum
E107000 Read Unspecified schizo-affective schizophrenia diagnostic res59: Schizophrenia_spectrum
E107100 Read Subchronic schizo-affective schizophrenia diagnostic res59: Schizophrenia_spectrum
E107.11 Read cyclic schizophrenia diagnostic res59: Schizophrenia_spectrum
E107200 Read Chronic schizo-affective schizophrenia diagnostic res59: Schizophrenia_spectrum
E107300 Read Acute exacerbation subchronic schizo-affective schizophrenia diagnostic res59: Schizophrenia_spectrum
E107400 Read Acute exacerbation of chronic schizo-affective schizophrenia diagnostic res59: Schizophrenia_spectrum
E107500 Read Schizo-affective schizophrenia in remission diagnostic res59: Schizophrenia_spectrum
E107z00 Read Schizo-affective schizophrenia NOS diagnostic res59: Schizophrenia_spectrum
E10y.00 Read Other schizophrenia diagnostic res59: Schizophrenia_spectrum
E10y000 Read atypical schizophrenia diagnostic res59: Schizophrenia_spectrum
E10y100 Read coenesthopathic schizophrenia diagnostic res59: Schizophrenia_spectrum
E10y.11 Read cenesthopathic schizophrenia diagnostic res59: Schizophrenia_spectrum
E10yz00 Read other schizophrenia nos diagnostic res59: Schizophrenia_spectrum
E10z.00 Read schizophrenia nos diagnostic res59: Schizophrenia_spectrum
E11z.00 Read Other and unspecified affective psychoses diagnostic res59: Schizophrenia_spectrum
E11z000 Read Unspecified affective psychoses NOS diagnostic res59: Schizophrenia_spectrum
E11zz00 Read Other affective psychosis NOS diagnostic res59: Schizophrenia_spectrum
E121.00 Read chronic paranoid psychosis diagnostic res59: Schizophrenia_spectrum
E122.00 Read paraphrenia diagnostic res59: Schizophrenia_spectrum
E123.00 Read shared paranoid disorder diagnostic res59: Schizophrenia_spectrum
E12y000 Read paranoia querulans diagnostic res59: Schizophrenia_spectrum
E12z.00 Read paranoid psychosis nos diagnostic res59: Schizophrenia_spectrum
E13..00 Read Other nonorganic psychoses diagnostic res59: Schizophrenia_spectrum
E130.00 Read reactive depressive psychosis diagnostic res59: Schizophrenia_spectrum
E130.11 Read psychotic reactive depression diagnostic res59: Schizophrenia_spectrum
E13..11 Read reactive psychoses diagnostic res59: Schizophrenia_spectrum
E133.00 Read acute paranoid reaction diagnostic res59: Schizophrenia_spectrum
E134.00 Read psychogenic paranoid psychosis diagnostic res59: Schizophrenia_spectrum
E13z.00 Read Nonorganic psychosis NOS diagnostic res59: Schizophrenia_spectrum
E13z.11 Read Psychotic episode NOS diagnostic res59: Schizophrenia_spectrum
E14..00 Read Psychoses with origin in childhood diagnostic res59: Schizophrenia_spectrum
E141.00 Read Disintegrative psychosis diagnostic res59: Schizophrenia_spectrum
E141100 Read Residual disintegrative psychoses diagnostic res59: Schizophrenia_spectrum
E14y.00 Read Other childhood psychoses diagnostic res59: Schizophrenia_spectrum
E14yz00 Read Other childhood psychoses NOS diagnostic res59: Schizophrenia_spectrum
E14z.00 Read Child psychosis NOS diagnostic res59: Schizophrenia_spectrum
E14z.11 Read Childhood schizophrenia NOS diagnostic res59: Schizophrenia_spectrum
E1y..00 Read Other specified non-organic psychoses diagnostic res59: Schizophrenia_spectrum
E1z..00 Read Non-organic psychosis NOS diagnostic res59: Schizophrenia_spectrum
Eu02z12 Read [X] Presenile psychosis NOS diagnostic res59: Schizophrenia_spectrum
Eu0z.12 Read [X]Symptomatic psychosis NOS diagnostic res59: Schizophrenia_spectrum
Eu2..00 Read [X]Schizophrenia, schizotypal and delusional disorders diagnostic res59: Schizophrenia_spectrum
Eu20.00 Read [X]Schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20000 Read [X]Paranoid schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20011 Read [X]Paraphrenic schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20100 Read [X]Hebephrenic schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20111 Read [X]Disorganised schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20200 Read [X]Catatonic schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20211 Read [X]Catatonic stupor diagnostic res59: Schizophrenia_spectrum
Eu20212 Read [X]Schizophrenic catalepsy diagnostic res59: Schizophrenia_spectrum
Eu20213 Read [X]Schizophrenic catatonia diagnostic res59: Schizophrenia_spectrum
Eu20214 Read [X]Schizophrenic flexibilatis cerea diagnostic res59: Schizophrenia_spectrum
Eu20300 Read [X]Undifferentiated schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20311 Read [X]Atypical schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20500 Read [X]Residual schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20511 Read [X]Chronic undifferentiated schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20600 Read [X]Simple schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20y00 Read [X]Other schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu20y12 Read [X]Schizophreniform disord NOS diagnostic res59: Schizophrenia_spectrum
Eu20y13 Read [X]Schizophrenifrm psychos NOS diagnostic res59: Schizophrenia_spectrum
Eu20z00 Read [X]Schizophrenia, unspecified diagnostic res59: Schizophrenia_spectrum
Eu21.11 Read [X]Latent schizophrenic reaction diagnostic res59: Schizophrenia_spectrum
Eu21.13 Read [X]Latent schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu21.14 Read [X]Prepsychotic schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu21.15 Read [X]Prodromal schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu21.16 Read [X]Pseudoneurotic schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu21.17 Read [X]Pseudopsychopathic schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu22.00 Read [X]Persistent delusional disorders diagnostic res59: Schizophrenia_spectrum
Eu22000 Read [X]Delusional disorder diagnostic res59: Schizophrenia_spectrum
Eu22011 Read [X]Paranoid psychosis diagnostic res59: Schizophrenia_spectrum
Eu22012 Read [X]Paranoid state diagnostic res59: Schizophrenia_spectrum
Eu22013 Read [X]Paraphrenia - late diagnostic res59: Schizophrenia_spectrum
Eu22014 Read [X]Sensitiver Beziehungswahn diagnostic res59: Schizophrenia_spectrum
Eu22015 Read [X]Paranoia diagnostic res59: Schizophrenia_spectrum
Eu22100 Read [X]Delusional misidentification syndrome diagnostic res59: Schizophrenia_spectrum
Eu22111 Read [X]Capgras syndrome diagnostic res59: Schizophrenia_spectrum
Eu22y00 Read [X]Other persistent delusional disorders diagnostic res59: Schizophrenia_spectrum
Eu22y11 Read [X]Delusional dysmorphophobia diagnostic res59: Schizophrenia_spectrum
Eu22y12 Read [X]Involutional paranoid state diagnostic res59: Schizophrenia_spectrum
Eu22z00 Read [X]Persistent delusional disorder, unspecified diagnostic res59: Schizophrenia_spectrum
Eu23.00 Read [X]Acute and transient psychotic disorders diagnostic res59: Schizophrenia_spectrum
Eu23000 Read [X]Acute polymorphic psychot disord without symp of schizoph diagnostic res59: Schizophrenia_spectrum
Eu23012 Read [X]Cycloid psychosis diagnostic res59: Schizophrenia_spectrum
Eu23100 Read [X]Acute polymorphic psychot disord with symp of schizophren diagnostic res59: Schizophrenia_spectrum
Eu23112 Read [X]Cycloid psychosis with symptoms of schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu23200 Read [X]Acute schizophrenia-like psychotic disorder diagnostic res59: Schizophrenia_spectrum
Eu23211 Read [X]Brief schizophreniform disorder diagnostic res59: Schizophrenia_spectrum
Eu23212 Read [X]Brief schizophrenifrm psych diagnostic res59: Schizophrenia_spectrum
Eu23214 Read [X]Schizophrenic reaction diagnostic res59: Schizophrenia_spectrum
Eu23300 Read [X]Other acute predominantly delusional psychotic disorders diagnostic res59: Schizophrenia_spectrum
Eu23312 Read [X]Psychogenic paranoid psychosis diagnostic res59: Schizophrenia_spectrum
Eu23y00 Read [X]Other acute and transient psychotic disorders diagnostic res59: Schizophrenia_spectrum
Eu23z00 Read [X]Acute and transient psychotic disorder, unspecified diagnostic res59: Schizophrenia_spectrum
Eu24.00 Read [x]induced delusional disorder diagnostic res59: Schizophrenia_spectrum
Eu24.12 Read [x]induced paranoid disorder diagnostic res59: Schizophrenia_spectrum
Eu24.13 Read [x]induced psychotic disorder diagnostic res59: Schizophrenia_spectrum
Eu25.00 Read [X]Schizoaffective disorders diagnostic res59: Schizophrenia_spectrum
Eu25000 Read [x]schizoaffective disorder, manic type diagnostic res59: Schizophrenia_spectrum
Eu25011 Read [x]schizoaffective psychosis, manic type diagnostic res59: Schizophrenia_spectrum
Eu25012 Read [x]schizophreniform psychosis, manic type diagnostic res59: Schizophrenia_spectrum
Eu25100 Read [X]Schizoaffective disorder, depressive type diagnostic res59: Schizophrenia_spectrum
Eu25111 Read [X]Schizoaffective psychosis, depressive type diagnostic res59: Schizophrenia_spectrum
Eu25112 Read [x]schizophreniform psychosis, depressive type diagnostic res59: Schizophrenia_spectrum
Eu25200 Read [X]Schizoaffective disorder, mixed type diagnostic res59: Schizophrenia_spectrum
Eu25211 Read [x]cyclic schizophrenia diagnostic res59: Schizophrenia_spectrum
Eu25212 Read [X]Mixed schizophrenic and affective psychosis diagnostic res59: Schizophrenia_spectrum
Eu25y00 Read [X]Other schizoaffective disorders diagnostic res59: Schizophrenia_spectrum
Eu25z00 Read [X]Schizoaffective disorder, unspecified diagnostic res59: Schizophrenia_spectrum
Eu25z11 Read [X]Schizoaffective psychosis NOS diagnostic res59: Schizophrenia_spectrum
Eu2y.00 Read [X]Other nonorganic psychotic disorders diagnostic res59: Schizophrenia_spectrum
Eu2y.11 Read [x]chronic hallucinatory psychosis diagnostic res59: Schizophrenia_spectrum
Eu2z.00 Read [X]Unspecified nonorganic psychosis diagnostic res59: Schizophrenia_spectrum
Eu2z.11 Read [x]psychosis nos diagnostic res59: Schizophrenia_spectrum
Eu32300 Read [x]severe depressive episode with psychotic symptoms diagnostic res59: Schizophrenia_spectrum
Eu32311 Read [x]single episode of major depression and psychotic symptoms diagnostic res59: Schizophrenia_spectrum
Eu32312 Read [x]single episode of psychogenic depressive psychosis diagnostic res59: Schizophrenia_spectrum
Eu32313 Read [x]single episode of psychotic depression diagnostic res59: Schizophrenia_spectrum
Eu32314 Read [x]single episode of reactive depressive psychosis diagnostic res59: Schizophrenia_spectrum
Eu32900 Read [X]Single major depr ep, severe with psych, psych in remiss diagnostic res59: Schizophrenia_spectrum
Eu32A00 Read [X]Recurr major depr ep, severe with psych, psych in remiss diagnostic res59: Schizophrenia_spectrum
Eu33300 Read [X]Recurrent depress disorder cur epi severe with psyc symp diagnostic res59: Schizophrenia_spectrum
Eu33311 Read [x]endogenous depression with psychotic symptoms diagnostic res59: Schizophrenia_spectrum
Eu33313 Read [x]recurr severe episodes/major depression+psychotic symptom diagnostic res59: Schizophrenia_spectrum
Eu33314 Read [x]recurr severe episodes/psychogenic depressive psychosis diagnostic res59: Schizophrenia_spectrum
Eu33315 Read [x]recurrent severe episodes of psychotic depression diagnostic res59: Schizophrenia_spectrum
Eu33316 Read [x]recurrent severe episodes/reactive depressive psychosis diagnostic res59: Schizophrenia_spectrum
Eu44.14 Read [x]hysterical psychosis diagnostic res59: Schizophrenia_spectrum
Eu84314 Read [x]symbiotic psychosis diagnostic res59: Schizophrenia_spectrum
Eu84512 Read [X]Schizoid disorder of childhood diagnostic res59: Schizophrenia_spectrum
R001000 Read [d]hallucinations, auditory diagnostic res59: Schizophrenia_spectrum
R001100 Read [d]hallucinations, gustatory diagnostic res59: Schizophrenia_spectrum
R001200 Read [d]hallucinations, olfactory diagnostic res59: Schizophrenia_spectrum
R001300 Read [d]hallucinations, tactile diagnostic res59: Schizophrenia_spectrum
R001z00 Read [d]hallucinations nos diagnostic res59: Schizophrenia_spectrum
Ryu5300 Read [x]other hallucinations diagnostic res59: Schizophrenia_spectrum
ZS7C611 Read schizophrenic language diagnostic res59: Schizophrenia_spectrum

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