[ { "phenotype_id": "PH585", "phenotype_version_id": 1170, "name": "Conduct Disorder", "definition": "Objectives:\n\nTo 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.\n\n\nDesign:\n\nPopulation based cohort study.\n\n\nSetting:\n\nUK 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.\n\n\nParticipants:\n\nFor 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).\n\n\nMain outcome measures:\n\nIn 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.\n\n\nResults:\n\nThe 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).\n\n\nConclusions:\n\nGaining 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.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Jonathan Green, Carolyn A Chew-Graham, Nav Kapur, Darren M Aschcroft, Incidence, clinical management, and mortality risk following self harm among children and adolescents cohort study in primary care. BMJ, 359(j4351), 2017." } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:26:00.440448Z", "author": "Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Jonathan Green, Carolyn A Chew-Graham, Nav Kapur, Darren M Aschcroft", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:26:00.440476Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Disease or syndrome", "value": "2" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "CPRD GOLD", "value": 5, "uid": "a29feafa-7bdd-44e9-b977-c9d26425e67f", "url": "https://healthdatagateway.org/en/dataset/694", "datasource_id": 694 } ], "coding_system": [ { "name": "Read codes v2", "value": 5 } ], "event_date_range": "01/01/2001 - 31/12/2014", "concept_information": [ { "concept_id": 1990, "concept_version_id": 5118, "concept_name": "Conduct Disorder - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH585", "phenotype_version_id": 1170, "phenotype_name": "Conduct Disorder", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "E284.00", "description": "stress reaction causing mixed disturbance of emotion/conduct", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2C..00", "description": "disturbance of conduct nec", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2C0.00", "description": "aggressive unsocial conduct disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2C0z00", "description": "aggressive unsocial conduct disorder nos", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2C1.00", "description": "nonaggressive unsocial conduct disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2C1z00", "description": "nonaggressive unsocial conduct disorder nos", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2C2.00", "description": "socialised conduct disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2C2z00", "description": "socialised conduct disorder nos", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2C4.00", "description": "mixed disturbance of conduct and emotion", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2C4z00", "description": "mixed disturbance of conduct and emotion nos", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2Cy.00", "description": "other conduct disturbances", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2Cyz00", "description": "other conduct disturbances nos", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2Cz.00", "description": "unspecified disturbance of conduct", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2Czz00", "description": "disturbance of conduct nos", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2Dy000", "description": "childhood and adolescent oppositional disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E2E2.00", "description": "Hyperkinetic conduct disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu90100", "description": "[X]Hyperkinetic conduct disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu90111", "description": "[X]Hyperkinetic disorder associated with conduct disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu91.00", "description": "[x]conduct disorders", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu91000", "description": "[x]conduct disorder confined to the family context", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu91100", "description": "[x]unsocialized conduct disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu91111", "description": "[x]conduct disorder, solitary aggressive type", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu91200", "description": "[x]socialized conduct disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu91300", "description": "[X]Oppositional defiant disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu91y00", "description": "[x]other conduct disorders", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu91z00", "description": "[x]conduct disorder, unspecified", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu91z11", "description": "[X]Childhood behavioural disorder NOS", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu91z12", "description": "[x]childhood conduct disorder nos", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu92.00", "description": "[x]mixed disorders of conduct and emotions", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu92000", "description": "[x]depressive conduct disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu92y00", "description": "[x]other mixed disorders of conduct and emotions", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu92y11", "description": "[x]conduct disorder associated with emotional disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu92y12", "description": "[x]conduct disorder associated with neurotic disorder", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu92z00", "description": "[x]mixed disorder of conduct and emotions, unspecified", "attributes": { "Entity type": "res59: Conduct_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/a21j-2k18", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 1170, "version_name": "Conduct Disorder", "version_date": "2021-10-06T16:26:00.468885Z", "is_published": true, "is_latest": true } ] } ]