[ { "phenotype_id": "PH588", "phenotype_version_id": 1176, "name": "Extra Referral Codes", "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": "2021-10-06T16:26:05.452207Z", "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": "2021-10-06T16:26:05.452235Z", "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": 1993, "concept_version_id": 5124, "concept_name": "Extra Referral Codes - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH588", "phenotype_version_id": 1176, "phenotype_name": "Extra Referral Codes", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "64R7.11", "description": "Child refer- clinical psychol.", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8H23.00", "description": "Admit psychiatric emergency", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8H23000", "description": "Emerg psychiatric admiss MHA", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8H49.00", "description": "Psychiatric referral", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8H4f.00", "description": "Referral to learning disabilities psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8H4P.00", "description": "Referral to child psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8H7T.00", "description": "Refer to psychologist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8Hc..00", "description": "Referral to mental health team", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8Hc0.00", "description": "Referral to community mental health team", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8Hc2.00", "description": "Referral to primary care mental health team", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HHR.00", "description": "Referral to child and adolescent psychiatry service", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HHs.00", "description": "Referral to psychosis early intervention service", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HHT.00", "description": "Referral to psychotherapist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HHu.00", "description": "Referral to primary care mental health gateway worker", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HHv.00", "description": "Referral to primary care mental health graduate worker", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HJ3.00", "description": "Psychiatric self-referral", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HlB.00", "description": "Urgent referral to psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HlD.00", "description": "Referral to forensic psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HVi.00", "description": "Private referral to psychologist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HVO.00", "description": "Private referral to psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL5B.00", "description": "Referral to psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL5B100", "description": "Referral to child and adolescent psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL5B111", "description": "Referral to child psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL5B200", "description": "Referral to forensic psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL5B300", "description": "Referral to liaison psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL5B400", "description": "Referral to rehabilitation psychiatrist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL5B500", "description": "Referral to psychiatrist for mental handicap", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL62A00", "description": "Referral to nurse behavioural therapist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL62B00", "description": "Referral to nurse psychotherapist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL62E00", "description": "Referral to psychiatric nurse", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL77.00", "description": "Referral to psychotherapist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL78.00", "description": "Referral to psychologist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZL78.11", "description": "Refer to psychologist", "attributes": { "Entity type": "res59: Extra_referral_codes", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/n8z5-1v88", "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": 1176, "version_name": "Extra Referral Codes", "version_date": "2021-10-06T16:26:05.480886Z", "is_published": true, "is_latest": true } ] } ]