[
  {
    "phenotype_id": "PH883",
    "phenotype_version_id": 1845,
    "name": "MHS Referrals",
    "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": "2022-04-04T07:08:13.774878Z",
    "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": "2022-04-04T07:08:13.774903Z",
    "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": 2646,
        "concept_version_id": 6705,
        "concept_name": "MHS Referrals - Primary Care",
        "coding_system": {
          "id": 5,
          "name": "Read codes v2",
          "description": "Read codes v2"
        },
        "phenotype_id": "PH883",
        "phenotype_version_id": 1845,
        "phenotype_name": "MHS Referrals",
        "code_attribute_header": [
          "Entity type",
          "Category",
          "Coding System (Read)"
        ],
        "codes": [
          {
            "code": "64R7.11",
            "description": "Child refer- clinical psychol.",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H23.00",
            "description": "Admit psychiatric emergency",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H23000",
            "description": "Emerg psychiatric admiss MHA",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H2L.00",
            "description": "Admit psychogeriatric emergency",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H2T.00",
            "description": "Emergency voluntary psychiatric admission Mental Health Act",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H38.00",
            "description": "Non-urgent psychiatric admisn.",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H3Q.00",
            "description": "Non-urgent psychogeriatric admission",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H49.00",
            "description": "Psychiatric referral",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H4D.00",
            "description": "Referral to psychogeriatrician",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H4f.00",
            "description": "Referral to learning disabilities psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H4P.00",
            "description": "Referral to child psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8H7T.00",
            "description": "Refer to psychologist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8Hc..00",
            "description": "Referral to mental health team",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8Hc0.00",
            "description": "Referral to community mental health team",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8Hc2.00",
            "description": "Referral to primary care mental health team",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HHn.00",
            "description": "Referral to non NHS mental health community service",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HHo.00",
            "description": "Referral to older age communiy mental health team",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HHR.00",
            "description": "Referral to child and adolescent psychiatry service",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HHs.00",
            "description": "Referral to psychosis early intervention service",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HHT.00",
            "description": "Referral to psychotherapist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HHu.00",
            "description": "Referral to primary care mental health gateway worker",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HHv.00",
            "description": "Referral to primary care mental health graduate worker",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HJ3.00",
            "description": "Psychiatric self-referral",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HlB.00",
            "description": "Urgent referral to psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HlD.00",
            "description": "Referral to forensic psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HVi.00",
            "description": "Private referral to psychologist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HVO.00",
            "description": "Private referral to psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "8HVS.00",
            "description": "Private referral to psychogeriatrician",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL5B.00",
            "description": "Referral to psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL5B100",
            "description": "Referral to child and adolescent psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL5B111",
            "description": "Referral to child psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL5B200",
            "description": "Referral to forensic psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL5B300",
            "description": "Referral to liaison psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL5B400",
            "description": "Referral to rehabilitation psychiatrist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL5B500",
            "description": "Referral to psychiatrist for mental handicap",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL62A00",
            "description": "Referral to nurse behavioural therapist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL62B00",
            "description": "Referral to nurse psychotherapist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL62E00",
            "description": "Referral to psychiatric nurse",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL77.00",
            "description": "Referral to psychotherapist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL78.00",
            "description": "Referral to psychologist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          },
          {
            "code": "ZL78.11",
            "description": "Refer to psychologist",
            "attributes": {
              "Entity type": "res69: MHS referrals",
              "Category": "diagnostic",
              "Coding System (Read)": "Read"
            }
          }
        ]
      }
    ],
    "status": 2,
    "doi": "https://doi.org/10.48533/xz73-ph62",
    "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": 1845,
        "version_name": "MHS Referrals",
        "version_date": "2022-04-04T07:08:13.795522Z",
        "is_published": true,
        "is_latest": true
      }
    ]
  }
]