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.
Code | Description | Entity type | Category | Coding System (Read) |
---|---|---|---|---|
146D.00 | H/O: manic depressive disorder | res41: Bipolar disorder | diagnostic | Read |
1S42.00 | Manic mood | res41: Bipolar disorder | diagnostic | Read |
6657.00 | On lithium | res41: Bipolar disorder | diagnostic | Read |
6657.11 | Lithium monitoring | res41: Bipolar disorder | diagnostic | Read |
6657.12 | Started lithium | res41: Bipolar disorder | diagnostic | Read |
E11..00 | Affective psychoses | res41: Bipolar disorder | diagnostic | Read |
E11..11 | Bipolar psychoses | res41: Bipolar disorder | diagnostic | Read |
E11..13 | Manic psychoses | res41: Bipolar disorder | diagnostic | Read |
E110.00 | Manic disorder, single episode | res41: Bipolar disorder | diagnostic | Read |
E110.11 | Hypomanic psychoses | res41: Bipolar disorder | diagnostic | Read |
E110000 | Single manic episode, unspecified | res41: Bipolar disorder | diagnostic | Read |
E110100 | Single manic episode, mild | res41: Bipolar disorder | diagnostic | Read |
E110200 | Single manic episode, moderate | res41: Bipolar disorder | diagnostic | Read |
E110300 | Single manic episode, severe without mention of psychosis | res41: Bipolar disorder | diagnostic | Read |
E110400 | Single manic episode, severe, with psychosis | res41: Bipolar disorder | diagnostic | Read |
E110600 | Single manic episode in full remission | res41: Bipolar disorder | diagnostic | Read |
E110z00 | Manic disorder, single episode NOS | res41: Bipolar disorder | diagnostic | Read |
E111.00 | Recurrent manic episodes | res41: Bipolar disorder | diagnostic | Read |
E111000 | Recurrent manic episodes, unspecified | res41: Bipolar disorder | diagnostic | Read |
E111100 | Recurrent manic episodes, mild | res41: Bipolar disorder | diagnostic | Read |
E111200 | Recurrent manic episodes, moderate | res41: Bipolar disorder | diagnostic | Read |
E111300 | Recurrent manic episodes, severe without mention psychosis | res41: Bipolar disorder | diagnostic | Read |
E111400 | Recurrent manic episodes, severe, with psychosis | res41: Bipolar disorder | diagnostic | Read |
E111500 | Recurrent manic episodes, partial or unspecified remission | res41: Bipolar disorder | diagnostic | Read |
E111600 | Recurrent manic episodes, in full remission | res41: Bipolar disorder | diagnostic | Read |
E111z00 | Recurrent manic episode NOS | res41: Bipolar disorder | diagnostic | Read |
E114.00 | Bipolar affective disorder, currently manic | res41: Bipolar disorder | diagnostic | Read |
E114.11 | Manic-depressive - now manic | res41: Bipolar disorder | diagnostic | Read |
E114000 | Bipolar affective disorder, currently manic, unspecified | res41: Bipolar disorder | diagnostic | Read |
E114100 | Bipolar affective disorder, currently manic, mild | res41: Bipolar disorder | diagnostic | Read |
E114200 | Bipolar affective disorder, currently manic, moderate | res41: Bipolar disorder | diagnostic | Read |
E114300 | Bipolar affect disord, currently manic, severe, no psychosis | res41: Bipolar disorder | diagnostic | Read |
E114400 | Bipolar affect disord, currently manic,severe with psychosis | res41: Bipolar disorder | diagnostic | Read |
E114500 | Bipolar affect disord,currently manic, part/unspec remission | res41: Bipolar disorder | diagnostic | Read |
E114600 | Bipolar affective disorder, currently manic, full remission | res41: Bipolar disorder | diagnostic | Read |
E114z00 | Bipolar affective disorder, currently manic, NOS | res41: Bipolar disorder | diagnostic | Read |
E115.00 | Bipolar affective disorder, currently depressed | res41: Bipolar disorder | diagnostic | Read |
E115.11 | Manic-depressive - now depressed | res41: Bipolar disorder | diagnostic | Read |
E115000 | Bipolar affective disorder, currently depressed, unspecified | res41: Bipolar disorder | diagnostic | Read |
E115100 | Bipolar affective disorder, currently depressed, mild | res41: Bipolar disorder | diagnostic | Read |
E115200 | Bipolar affective disorder, currently depressed, moderate | res41: Bipolar disorder | diagnostic | Read |
E115300 | Bipolar affect disord, now depressed, severe, no psychosis | res41: Bipolar disorder | diagnostic | Read |
E115400 | Bipolar affect disord, now depressed, severe with psychosis | res41: Bipolar disorder | diagnostic | Read |
E115500 | Bipolar affect disord, now depressed, part/unspec remission | res41: Bipolar disorder | diagnostic | Read |
E115600 | Bipolar affective disorder, now depressed, in full remission | res41: Bipolar disorder | diagnostic | Read |
E115z00 | Bipolar affective disorder, currently depressed, NOS | res41: Bipolar disorder | diagnostic | Read |
E116.00 | Mixed bipolar affective disorder | res41: Bipolar disorder | diagnostic | Read |
E116000 | Mixed bipolar affective disorder, unspecified | res41: Bipolar disorder | diagnostic | Read |
E116100 | Mixed bipolar affective disorder, mild | res41: Bipolar disorder | diagnostic | Read |
E116200 | Mixed bipolar affective disorder, moderate | res41: Bipolar disorder | diagnostic | Read |
E116300 | Mixed bipolar affective disorder, severe, without psychosis | res41: Bipolar disorder | diagnostic | Read |
E116400 | Mixed bipolar affective disorder, severe, with psychosis | res41: Bipolar disorder | diagnostic | Read |
E116500 | Mixed bipolar affective disorder, partial/unspec remission | res41: Bipolar disorder | diagnostic | Read |
E116600 | Mixed bipolar affective disorder, in full remission | res41: Bipolar disorder | diagnostic | Read |
E116z00 | Mixed bipolar affective disorder, NOS | res41: Bipolar disorder | diagnostic | Read |
E117.00 | Unspecified bipolar affective disorder | res41: Bipolar disorder | diagnostic | Read |
E117000 | Unspecified bipolar affective disorder, unspecified | res41: Bipolar disorder | diagnostic | Read |
E117100 | Unspecified bipolar affective disorder, mild | res41: Bipolar disorder | diagnostic | Read |
E117200 | Unspecified bipolar affective disorder, moderate | res41: Bipolar disorder | diagnostic | Read |
E117300 | Unspecified bipolar affective disorder, severe, no psychosis | res41: Bipolar disorder | diagnostic | Read |
E117400 | Unspecified bipolar affective disorder,severe with psychosis | res41: Bipolar disorder | diagnostic | Read |
E117500 | Unspecified bipolar affect disord, partial/unspec remission | res41: Bipolar disorder | diagnostic | Read |
E117600 | Unspecified bipolar affective disorder, in full remission | res41: Bipolar disorder | diagnostic | Read |
E117z00 | Unspecified bipolar affective disorder, NOS | res41: Bipolar disorder | diagnostic | Read |
E11y.00 | Other and unspecified manic-depressive psychoses | res41: Bipolar disorder | diagnostic | Read |
E11y000 | Unspecified manic-depressive psychoses | res41: Bipolar disorder | diagnostic | Read |
E11y100 | Atypical manic disorder | res41: Bipolar disorder | diagnostic | Read |
E11y300 | Other mixed manic-depressive psychoses | res41: Bipolar disorder | diagnostic | Read |
E11yz00 | Other and unspecified manic-depressive psychoses NOS | res41: Bipolar disorder | diagnostic | Read |
Eu3..00 | [X]Mood - affective disorders | res41: Bipolar disorder | diagnostic | Read |
Eu30.00 | [X]Manic episode | res41: Bipolar disorder | diagnostic | Read |
Eu30.11 | [X]Bipolar disorder, single manic episode | res41: Bipolar disorder | diagnostic | Read |
Eu30000 | [X]Hypomania | res41: Bipolar disorder | diagnostic | Read |
Eu30100 | [X]Mania without psychotic symptoms | res41: Bipolar disorder | diagnostic | Read |
Eu30200 | [X]Mania with psychotic symptoms | res41: Bipolar disorder | diagnostic | Read |
Eu30211 | [X]Mania with mood-congruent psychotic symptoms | res41: Bipolar disorder | diagnostic | Read |
Eu30212 | [X]Mania with mood-incongruent psychotic symptoms | res41: Bipolar disorder | diagnostic | Read |
Eu30y00 | [X]Other manic episodes | res41: Bipolar disorder | diagnostic | Read |
Eu30z00 | [X]Manic episode, unspecified | res41: Bipolar disorder | diagnostic | Read |
Eu30z11 | [X]Mania NOS | res41: Bipolar disorder | diagnostic | Read |
Eu31.00 | [X]Bipolar affective disorder | res41: Bipolar disorder | diagnostic | Read |
Eu31.11 | [X]Manic-depressive illness | res41: Bipolar disorder | diagnostic | Read |
Eu31.12 | [X]Manic-depressive psychosis | res41: Bipolar disorder | diagnostic | Read |
Eu31.13 | [X]Manic-depressive reaction | res41: Bipolar disorder | diagnostic | Read |
Eu31000 | [X]Bipolar affective disorder, current episode hypomanic | res41: Bipolar disorder | diagnostic | Read |
Eu31100 | [X]Bipolar affect disorder cur epi manic wout psychotic symp | res41: Bipolar disorder | diagnostic | Read |
Eu31200 | [X]Bipolar affect disorder cur epi manic with psychotic symp | res41: Bipolar disorder | diagnostic | Read |
Eu31300 | [X]Bipolar affect disorder cur epi mild or moderate depressn | res41: Bipolar disorder | diagnostic | Read |
Eu31400 | [X]Bipol aff disord, curr epis sev depress, no psychot symp | res41: Bipolar disorder | diagnostic | Read |
Eu31500 | [X]Bipolar affect dis cur epi severe depres with psyc symp | res41: Bipolar disorder | diagnostic | Read |
Eu31600 | [X]Bipolar affective disorder, current episode mixed | res41: Bipolar disorder | diagnostic | Read |
Eu31700 | [X]Bipolar affective disorder, currently in remission | res41: Bipolar disorder | diagnostic | Read |
Eu31y00 | [X]Other bipolar affective disorders | res41: Bipolar disorder | diagnostic | Read |
Eu31y11 | [X]Bipolar II disorder | res41: Bipolar disorder | diagnostic | Read |
Eu31y12 | [X]Recurrent manic episodes | res41: Bipolar disorder | diagnostic | Read |
Eu31z00 | [X]Bipolar affective disorder, unspecified | res41: Bipolar disorder | diagnostic | Read |
Eu33213 | [X]Manic-depress psychosis,depressd,no psychotic symptoms | res41: Bipolar disorder | diagnostic | Read |
Eu33312 | [X]Manic-depress psychosis,depressed type+psychotic symptoms | res41: Bipolar disorder | diagnostic | Read |
Eu34.00 | [X]Persistent mood affective disorders | res41: Bipolar disorder | diagnostic | Read |
Eu34000 | [X]Cyclothymia | res41: Bipolar disorder | diagnostic | Read |
Eu34y00 | [X]Other persistent mood affective disorders | res41: Bipolar disorder | diagnostic | Read |
Eu34z00 | [X]Persistent mood affective disorder, unspecified | res41: Bipolar disorder | diagnostic | Read |
Eu3y.00 | [X]Other mood affective disorders | res41: Bipolar disorder | diagnostic | Read |
Eu3y000 | [X]Other single mood affective disorders | res41: Bipolar disorder | diagnostic | Read |
Eu3y011 | [X]Mixed affective episode | res41: Bipolar disorder | diagnostic | Read |
Eu3y100 | [X]Other recurrent mood affective disorders | res41: Bipolar disorder | diagnostic | Read |
Eu3yy00 | [X]Other specified mood affective disorders | res41: Bipolar disorder | diagnostic | Read |
Eu3z.00 | [X]Unspecified mood affective disorder | res41: Bipolar disorder | diagnostic | Read |
Eu3z.11 | [X]Affective psychosis NOS | res41: Bipolar disorder | diagnostic | Read |
ZV11111 | [V]Personal history of manic-depressive psychosis | res41: Bipolar disorder | diagnostic | Read |
ZV11112 | [V]Personal history of manic-depressive psychosis | res41: Bipolar disorder | diagnostic | Read |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH368/version/736/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH368/version/736/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH368/version/736/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH368/version/736/export/codes/?format=json |
CSV | site_root/phenotypes/PH368/version/736/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
736 | Bipolar Disorder | ieuan.scanlon | 2021-10-06 | currently shown |
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