[ { "phenotype_id": "PH874", "phenotype_version_id": 1827, "name": "Cerebrovascular Disease", "definition": "Background:\n\nSelf-harm is a major risk factor for suicide, with older adults (older than 65 years) having reportedly greater suicidal intent than any other age group. With the aging population rising and paucity of research focus in this age group, the extent of the problem of self-harm needs to be established. In a primary care cohort of older adults we aimed to investigate the incidence of self-harm, subsequent clinical management, prevalence of mental and physical diagnoses, and unnatural-cause mortality risk, including suicide.\n\n\nMethods:\n\nThe UK Clinical Practice Research Datalink contains anonymised patient records from general practice that routinely capture clinical information pertaining to both primary and secondary care services. We identified 4124 adults aged 65 years and older with a self-harm episode ascertained from Read codes recorded during 2001–14. We calculated standardised incidence and in 2854 adults with at least 12 months follow-up examined the frequency of psychiatric referrals and prescription of psychotropic medication after self-harm. We estimated prevalence of mental and physical illness diagnoses before and after self-harm and, using Cox regression in a matched cohort, we examined cause-specific mortality risks.\n\n\nFindings:\n\nOverall incidence of self-harm in older adults aged 65 years and older was 4·1 per 10 000 person-years with stable gender-specific rates observed over the 13-year period. After self-harm, 335 (11·7%) of 2854 adults were referred to mental health services, 1692 (59·3%) were prescribed an antidepressant, and 336 (11·8%) were prescribed a tricyclic antidepressant (TCA). Having a diagnosed previous mental illness was twice as prevalent in the self-harm cohort as in the comparison cohort (prevalence ratio 2·10 [95% CI 2·03–2·17]) and with a previous physical health condition prevalence was 20% higher in the self-harm cohort compared to the comparison cohort (1·20 [1·17–1·23]). Adults from the self-harm cohort (n=2454) died from unnatural causes an estimated 20 times more frequently than the comparison cohort (n=48 921) during the first year. A markedly elevated risk of suicide (hazard ratio 145·4 [95% CI 53·9–392·3]) was observed in the self-harm cohort.\n\n\nInterpretation: \n\nWithin primary care, we have identified a group of older adults at high risk from unnatural death, particularly within the first year of self-harm. We have highlighted a high frequency of prescription of TCAs, known to be potentially fatally toxic in overdose. We emphasise the need for early intervention, careful alternative prescribing, and increased support when older adults consult after an episode of self-harm and with other health conditions.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft, Self-harm in a primary care cohort of older people incidence, clinical management, and risk of suicide and other causes of death. Psychiatry, 5, 2018." } ], "validation": "", "citation_requirements": "", "created": "2022-04-04T07:07:50.077862Z", "author": "Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2022-04-04T07:07:50.077887Z", "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": "ICD10 codes", "value": 4 }, { "name": "Read codes v2", "value": 5 } ], "event_date_range": "01/01/2001 - 31/12/2014", "concept_information": [ { "concept_id": 2628, "concept_version_id": 6669, "concept_name": "Cerebrovascular Disease - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH874", "phenotype_version_id": 1827, "phenotype_name": "Cerebrovascular Disease", "code_attribute_header": [ "Entity type", "Coding System (ICD-10 Read)", "Category" ], "codes": [ { "code": "1477.00", "description": "H/O: cerebrovascular disease", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "14A7.00", "description": "H/O: CVA/stroke", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "14A7.12", "description": "H/O: stroke", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "662M.00", "description": "Stroke monitoring", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "7004300", "description": "Evacuation of intracerebral haematoma NEC", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "F11x200", "description": "Cerebral degeneration due to cerebrovascular disease", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G6...00", "description": "Cerebrovascular disease", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G60..00", "description": "Subarachnoid haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G600.00", "description": "Ruptured berry aneurysm", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G601.00", "description": "Subarachnoid haemorrhage from carotid siphon and bifurcation", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G602.00", "description": "Subarachnoid haemorrhage from middle cerebral artery", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G603.00", "description": "Subarachnoid haemorrhage from anterior communicating artery", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G604.00", "description": "Subarachnoid haemorrhage from posterior communicating artery", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G605.00", "description": "Subarachnoid haemorrhage from basilar artery", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G606.00", "description": "Subarachnoid haemorrhage from vertebral artery", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G60X.00", "description": "Subarachnoid haemorrh from intracranial artery, unspecif", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G60z.00", "description": "Subarachnoid haemorrhage NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G61..00", "description": "Intracerebral haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G61..11", "description": "CVA - cerebrovascular accid due to intracerebral haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G61..12", "description": "Stroke due to intracerebral haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G613.00", "description": "Cerebellar haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G617.00", "description": "Intracerebral haemorrhage, intraventricular", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G618.00", "description": "Intracerebral haemorrhage, multiple localized", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G61X.00", "description": "Intracerebral haemorrhage in hemisphere, unspecified", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G61X000", "description": "Left sided intracerebral haemorrhage, unspecified", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G61X100", "description": "Right sided intracerebral haemorrhage, unspecified", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G61z.00", "description": "Intracerebral haemorrhage NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G623.00", "description": "Subdural haemorrhage NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G62z.00", "description": "Intracranial haemorrhage NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G63..00", "description": "Precerebral arterial occlusion", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G63..12", "description": "Stenosis of precerebral arteries", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G633.00", "description": "Multiple and bilateral precerebral arterial occlusion", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G63y.00", "description": "Other precerebral artery occlusion", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G63z.00", "description": "Precerebral artery occlusion NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G641000", "description": "Cerebral infarction due to embolism of cerebral arteries", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G64..13", "description": "Stroke due to cerebral arterial occlusion", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G65..00", "description": "Transient cerebral ischaemia", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G65y.00", "description": "Other transient cerebral ischaemia", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G65z.00", "description": "Transient cerebral ischaemia NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G65zz00", "description": "Transient cerebral ischaemia NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G66..00", "description": "Stroke and cerebrovascular accident unspecified", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G660.00", "description": "Middle cerebral artery syndrome", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G661.00", "description": "Anterior cerebral artery syndrome", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G66..11", "description": "CVA unspecified", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G66..12", "description": "Stroke unspecified", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G66..13", "description": "CVA - Cerebrovascular accident unspecified", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G662.00", "description": "Posterior cerebral artery syndrome", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G663.00", "description": "Brain stem stroke syndrome", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G664.00", "description": "Cerebellar stroke syndrome", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G665.00", "description": "Pure motor lacunar syndrome", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G666.00", "description": "Pure sensory lacunar syndrome", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G667.00", "description": "Left sided CVA", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G668.00", "description": "Right sided CVA", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G669.00", "description": "Cerebral palsy, not congenital or infantile, acute", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G67..00", "description": "Other cerebrovascular disease", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G671.00", "description": "Generalised ischaemic cerebrovascular disease NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G671z00", "description": "Generalised ischaemic cerebrovascular disease NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G677400", "description": "Occlusion+stenosis of multiple and bilat cerebral arteries", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G67y.00", "description": "Other cerebrovascular disease OS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G67z.00", "description": "Other cerebrovascular disease NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G68..00", "description": "Late effects of cerebrovascular disease", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G680.00", "description": "Sequelae of subarachnoid haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G681.00", "description": "Sequelae of intracerebral haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G68W.00", "description": "Sequelae/other + unspecified cerebrovascular diseases", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G6y..00", "description": "Other specified cerebrovascular disease", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G6z..00", "description": "Cerebrovascular disease NOS", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Gyu6.00", "description": "[X]Cerebrovascular diseases", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Gyu6000", "description": "[X]Subarachnoid haemorrhage from other intracranial arteries", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Gyu6100", "description": "[X]Other subarachnoid haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Gyu6200", "description": "[X]Other intracerebral haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Gyu6500", "description": "[X]Occlusion and stenosis of other precerebral arteries", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Gyu6600", "description": "[X]Occlusion and stenosis of other cerebral arteries", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Gyu6F00", "description": "[X]Intracerebral haemorrhage in hemisphere, unspecified", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "S620.00", "description": "Closed traumatic subarachnoid haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "S621.00", "description": "Open traumatic subarachnoid haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "S62..12", "description": "Subarachnoid haemorrhage following injury", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "S627.00", "description": "Traumatic subarachnoid haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "S628.00", "description": "Traumatic subdural haemorrhage", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } } ] }, { "concept_id": 2629, "concept_version_id": 6671, "concept_name": "Cerebrovascular Disease - Primary Care", "coding_system": { "id": 4, "name": "ICD10 codes", "description": "ICD10 Codes" }, "phenotype_id": "PH874", "phenotype_version_id": 1827, "phenotype_name": "Cerebrovascular Disease", "code_attribute_header": [ "Entity type", "Coding System (ICD-10 Read)", "Category" ], "codes": [ { "code": "G45", "description": "Transient cerebral ischaemic attacks and related syndromes", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "G46", "description": "Vascular syndromes of brain in cerebrovascular diseases", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "I60-I69", "description": "Cerebrovascular diseases", "attributes": { "Entity type": "res69: cerebrovascular_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/kxpj-5v20", "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": 1827, "version_name": "Cerebrovascular Disease", "version_date": "2022-04-04T07:07:50.100363Z", "is_published": true, "is_latest": true } ] } ]