[ { "phenotype_id": "PH590", "phenotype_version_id": 1180, "name": "Personality 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": "2021-10-06T16:26:08.411447Z", "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": "2021-10-06T16:26:08.411475Z", "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": 1995, "concept_version_id": 5128, "concept_name": "Personality Disorder - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH590", "phenotype_version_id": 1180, "phenotype_name": "Personality Disorder", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "E21..00", "description": "Personality disorders", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E210.00", "description": "Paranoid personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E211.00", "description": "Affective personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E211000", "description": "Unspecified affective personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21..11", "description": "Neurotic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E211100", "description": "hypomanic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E211200", "description": "depressive personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E211300", "description": "cyclothymic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E211z00", "description": "Affective personality disorder NOS", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E212.00", "description": "schizoid personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E212000", "description": "unspecified schizoid personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E212z00", "description": "schizoid personality disorder nos", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E213.00", "description": "Explosive personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E214.00", "description": "Compulsive personality disorders", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E214000", "description": "Anankastic personality", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E214.11", "description": "Anancastic personality", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E214z00", "description": "Compulsive personality disorder NOS", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E215.00", "description": "Histrionic personality disorders", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E215000", "description": "Unspecified histrionic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E215.11", "description": "Hysterical personality disorders", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E215z00", "description": "Histrionic personality disorder NOS", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E216.00", "description": "Inadequate personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E217.00", "description": "Antisocial or sociopathic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21y.00", "description": "Other personality disorders", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21y000", "description": "Narcissistic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21y100", "description": "Avoidant personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21y200", "description": "Borderline personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21y300", "description": "Passive-aggressive personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21y400", "description": "Eccentric personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21y500", "description": "Immature personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21y600", "description": "Masochistic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21y700", "description": "Psychoneurotic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21yz00", "description": "Other personality disorder NOS", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21z.00", "description": "Personality disorder NOS", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E21z.11", "description": "Psychopathic personality", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu06000", "description": "[X]Organic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu06011", "description": "[X]Organic pseudopsychopathic personality", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu21.17", "description": "[x]pseudopsychopathic schizophrenia", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu21.18", "description": "[x]schizotypal personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu34011", "description": "[X]Affective personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu34112", "description": "[x]depressive personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60.00", "description": "[X]Specific personality disorders", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60000", "description": "[X]Paranoid personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60013", "description": "[X]Querulant personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60014", "description": "[X]Sensitive paranoid personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60100", "description": "[x]schizoid personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60200", "description": "[X]Dissocial personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60211", "description": "[X]Amoral personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60212", "description": "[X]Antisocial personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60213", "description": "[X]Asocial personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60214", "description": "[X]Psychopathic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60215", "description": "[X]Sociopathic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60300", "description": "[X]Emotionally unstable personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60311", "description": "[X]Aggressive personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60312", "description": "[X]Borderline personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60313", "description": "[X]Explosive personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60400", "description": "[X]Histrionic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60411", "description": "[X]Hysterical personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60412", "description": "[X]Psychoinfantile personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60500", "description": "[X]Anankastic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60511", "description": "[X]Compulsive personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60512", "description": "[X]Obsessional personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60513", "description": "[X]Obsessive-compulsive personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60600", "description": "[x]anxious [avoidant] personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60700", "description": "[X]Dependent personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60711", "description": "[X]Asthenic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60712", "description": "[X]Inadequate personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60713", "description": "[X]Passive personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60714", "description": "[X]Self defeating personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60800", "description": "[X]Addictive personality", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60y00", "description": "[X]Other specific personality disorders", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60y11", "description": "[X]Eccentric personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60y12", "description": "[X]Haltlose type personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60y13", "description": "[X]Immature personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60y14", "description": "[X]Narcissistic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60y16", "description": "[X]Psychoneurotic personality disorder", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60z00", "description": "[X]Personality disorder; unspecified", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60z11", "description": "[X]Character neurosis NOS", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu60z12", "description": "[X]Pathological personality NOS", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu61.00", "description": "[X]Mixed and other personality disorders", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu84511", "description": "[x]autistic psychopathy", "attributes": { "Entity type": "res59: Personality_disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/cry8-yr20", "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": 1180, "version_name": "Personality Disorder", "version_date": "2021-10-06T16:26:08.440092Z", "is_published": true, "is_latest": true } ] } ]