[ { "phenotype_id": "PH888", "phenotype_version_id": 1855, "name": "Peripheral Vascular", "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": "2022-04-04T07:08:24.985300Z", "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": "2022-04-04T07:08:24.985325Z", "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": 2655, "concept_version_id": 6723, "concept_name": "Peripheral Vascular - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH888", "phenotype_version_id": 1855, "phenotype_name": "Peripheral Vascular", "code_attribute_header": [ "Entity type", "Coding System (ICD-10 Read)", "Category" ], "codes": [ { "code": "14AE.00", "description": "H/O: aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "14NB.00", "description": "H/O: Peripheral vascular disease procedure", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "2I16.00", "description": "O/E - gangrene", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "7A11211", "description": "Y graft of abdominal Aortic aneurysm (emergency)", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "7A11311", "description": "Y graft abdominal Aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "7A13.11", "description": "Emergency repair of aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "7A13411", "description": "Tube graft abdominal Aortic aneurysm (emergency)", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "7A14.11", "description": "Aortic aneurysm repair", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "7A14411", "description": "Tube graft of Abdominal aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "C107.12", "description": "Diabetes with gangrene", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G71..00", "description": "Aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G710.00", "description": "Dissecting aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G711.00", "description": "Thoracic aortic aneurysm which has ruptured", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G711.11", "description": "Ruptured thoracic aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G712.00", "description": "Thoracic aortic aneurysm without mention of rupture", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G713.00", "description": "Abdominal aortic aneurysm which has ruptured", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G713000", "description": "Ruptured suprarenal aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G713.11", "description": "Ruptured abdominal aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G714.00", "description": "Abdominal aortic aneurysm without mention of rupture", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G714000", "description": "Juxtarenal aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G714100", "description": "Inflammatory abdominal aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G714.11", "description": "AAA - Abdominal aortic aneurysm without mention of rupture", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G715.00", "description": "Ruptured aortic aneurysm NOS", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G715000", "description": "Thoracoabdominal aortic aneurysm, ruptured", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G716.00", "description": "Aortic aneurysm without mention of rupture NOS", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G716000", "description": "Thoracoabdominal aortic aneurysm, without mention of rupture", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G718.00", "description": "Leaking abdominal aortic aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G71z.00", "description": "Aortic aneurysm NOS", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G73..00", "description": "Other peripheral vascular disease", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G73..11", "description": "Peripheral ischaemic vascular disease", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G731100", "description": "Presenile gangrene", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G732.00", "description": "Peripheral gangrene", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G732000", "description": "Gangrene of toe", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G732100", "description": "Gangrene of foot", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G732200", "description": "Gangrene of finger", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G732300", "description": "Gangrene of thumb", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G732400", "description": "Gangrene of hand", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G73y.00", "description": "Other specified peripheral vascular disease", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G73yz00", "description": "Other specified peripheral vascular disease NOS", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G73z.00", "description": "Peripheral vascular disease NOS", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G73z000", "description": "Intermittent claudication", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G73z011", "description": "Claudication", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G73zz00", "description": "Peripheral vascular disease NOS", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Gyu7100", "description": "[X]Aortic aneurysm of unspecified site, ruptured", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Gyu7200", "description": "[X]Aortic aneurysm of unspecified site, nonruptured", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Gyu7400", "description": "[X]Other specified peripheral vascular diseases", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "R054.00", "description": "[D]Gangrene", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "R054000", "description": "[D]Gangrene, spreading cutaneous", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "R054200", "description": "[D]Gangrene of toe in diabetic", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "R054300", "description": "[D]Widespread diabetic foot gangrene", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "R054z00", "description": "[D]Gangrene NOS", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } } ] }, { "concept_id": 2656, "concept_version_id": 6725, "concept_name": "Peripheral Vascular - Primary Care", "coding_system": { "id": 4, "name": "ICD10 codes", "description": "ICD10 Codes" }, "phenotype_id": "PH888", "phenotype_version_id": 1855, "phenotype_name": "Peripheral Vascular", "code_attribute_header": [ "Entity type", "Coding System (ICD-10 Read)", "Category" ], "codes": [ { "code": "I70", "description": "Atherosclerosis", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "I71", "description": "Aortic aneurysm and dissection", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "I72", "description": "Other aneurysm", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "I73", "description": "Other peripheral vascular diseases", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "I74", "description": "Arterial embolism and thrombosis", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "I77", "description": "Other disorders of arteries and arterioles", "attributes": { "Entity type": "res69: peripheral_vascular", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/x2ac-r117", "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": 1855, "version_name": "Peripheral Vascular", "version_date": "2022-04-04T07:08:25.011841Z", "is_published": true, "is_latest": true } ] } ]