PURPOSE:
Self-harm is a public health problem that requires a better understanding of mortality risk. We undertook a study to examine premature mortality in a nationally representative cohort of primary care patients who had harmed themselves.
METHODS:
During 2001-2013, a total of 385 general practices in England contributed data to the Clinical Practice Research Datalink with linkage to Office for National Statistics mortality records. We identified 30,017 persons aged 15 to 64 years with a recorded episode of self-harm. We estimated the relative risks of all-cause and cause-specific natural and unnatural mortality using a comparison cohort of 600,258 individuals matched on age, sex, and general practice.
RESULTS:
We found an elevated risk of dying prematurely from any cause among the self-harm cohort, especially in the first year of follow-up (adjusted hazard ratio for that year, 3.6; 95% CI, 3.1-4.2). In particular, suicide risk was especially high during the first year (adjusted hazard ratio, 54.4; 95% CI, 34.3-86.3); although it declined sharply, it remained much higher than that in the comparison cohort. Large elevations of risk throughout the follow-up period were also observed for accidental, alcohol-related, and drug poisoning deaths. At 10 years of follow-up, cumulative incidence values were 6.5% (95% CI, 6.0%-7.1%) for allcause mortality and 1.3% (95% CI, 1.2%-1.5%) for suicide.
CONCLUSIONS:
Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by natural and unnatural causes, and especially within a year of a first episode. These individuals visit clinicians at a relatively high frequency, which presents a clear opportunity for preventive action. Primary care patients with myriad comorbidities, including self-harming behavior, mental disorder, addictions, and physical illnesses, will require concerted, multipronged, multidisciplinary collaborative care approaches.
Matthew J Carr, Darren M Ashcroft, Evangelos Kontopantelis, David While, Yvonne Awenat, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T Webb, Premature Death Among Primary Care Patients With a History of Self-Harm. Annals of Family Medicine, 15(3), 2017.
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59237020 | Zopiclone 7.5mg tablets (IVAX Pharmaceuticals UK Ltd) | res41: Anxiolitics | Multilex | drug |
59593020 | Zopiclone 3.75mg tablets (Teva UK Ltd) | res41: Anxiolitics | Multilex | drug |
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59784020 | Zopiclone 7.5mg tablets (Generics (UK) Ltd) | res41: Anxiolitics | Multilex | drug |
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60509020 | Zopiclone 3.75mg tablets (A A H Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
60510020 | Zopiclone 7.5mg tablets (A A H Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
62715020 | Zopiclone 7.5mg tablets (Sandoz Ltd) | res41: Anxiolitics | Multilex | drug |
63436020 | Zopiclone 7.5mg tablets (Kent Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
63765020 | Zopiclone 7.5mg tablets (PLIVA Pharma Ltd) | res41: Anxiolitics | Multilex | drug |
63881020 | Zolpidem 5mg Tablet (Winthrop Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
63882020 | Zolpidem 10mg Tablet (Winthrop Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
64484020 | Zolpidem 5mg tablets (Teva UK Ltd) | res41: Anxiolitics | Multilex | drug |
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64733020 | Zolpidem 5mg tablets (A A H Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
64738020 | Zolpidem 10mg tablets (A A H Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
65546020 | Zopiclone 3.75mg tablets (Kent Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
65832020 | Zolpidem 5mg tablets (IVAX Pharmaceuticals UK Ltd) | res41: Anxiolitics | Multilex | drug |
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66946020 | Zolpidem 10mg tablets (Generics (UK) Ltd) | res41: Anxiolitics | Multilex | drug |
72408020 | Zimovane 7.5mg tablets (Sanofi) | res41: Anxiolitics | Multilex | drug |
72416020 | Zopiclone 7.5mg tablets | res41: Anxiolitics | Multilex | drug |
72417020 | Zopiclone 3.75mg tablets | res41: Anxiolitics | Multilex | drug |
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85821020 | Zileze 3.75 tablets (Opus Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
85822020 | Zileze 7.5 tablets (Opus Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
86240020 | Zaleplon 5mg capsules | res41: Anxiolitics | Multilex | drug |
86241020 | Zaleplon 10mg capsules | res41: Anxiolitics | Multilex | drug |
86243020 | Sonata 5mg capsules (Meda Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
86244020 | Sonata 10mg capsules (Meda Pharmaceuticals Ltd) | res41: Anxiolitics | Multilex | drug |
91009020 | Zopiclone 3.75mg/5ml oral suspension | res41: Anxiolitics | Multilex | drug |
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