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) |
---|---|---|---|---|
1612.00 | Appetite loss - anorexia | res41: Eating disorder | diagnostic | Read |
1612.11 | Anorexia symptom | res41: Eating disorder | diagnostic | Read |
1614.00 | Excessive eating - polyphagia | res41: Eating disorder | diagnostic | Read |
1614.11 | Hyperalimentation - symptom | res41: Eating disorder | diagnostic | Read |
1614.12 | Polyphagia symptom | res41: Eating disorder | diagnostic | Read |
8HTN.00 | Referral to eating disorders clinic | res41: Eating disorder | diagnostic | Read |
9Nk9.00 | Seen in eating disorder clinic | res41: Eating disorder | diagnostic | Read |
E271.00 | Anorexia nervosa | res41: Eating disorder | diagnostic | Read |
E275.00 | Other and unspecified non-organic eating disorders | res41: Eating disorder | diagnostic | Read |
E275000 | Unspecified non-organic eating disorder | res41: Eating disorder | diagnostic | Read |
E275100 | Bulimia (non-organic overeating) | res41: Eating disorder | diagnostic | Read |
E275111 | Compulsive eating disorder | res41: Eating disorder | diagnostic | Read |
E275y00 | Other specified non-organic eating disorder | res41: Eating disorder | diagnostic | Read |
E275z00 | Non-organic eating disorder NOS | res41: Eating disorder | diagnostic | Read |
Eu50.00 | [X]Eating disorders | res41: Eating disorder | diagnostic | Read |
Eu50000 | [X]Anorexia nervosa | res41: Eating disorder | diagnostic | Read |
Eu50100 | [X]Atypical anorexia nervosa | res41: Eating disorder | diagnostic | Read |
Eu50200 | [X]Bulimia nervosa | res41: Eating disorder | diagnostic | Read |
Eu50211 | [X]Bulimia NOS | res41: Eating disorder | diagnostic | Read |
Eu50212 | [X]Hyperorexia nervosa | res41: Eating disorder | diagnostic | Read |
Eu50300 | [X]Atypical bulimia nervosa | res41: Eating disorder | diagnostic | Read |
Eu50400 | [X]Overeating associated with other psychological disturbncs | res41: Eating disorder | diagnostic | Read |
Eu50411 | [X]Psychogenic overeating | res41: Eating disorder | diagnostic | Read |
Eu50y00 | [X]Other eating disorders | res41: Eating disorder | diagnostic | Read |
Eu50y11 | [X]Pica in adults | res41: Eating disorder | diagnostic | Read |
Eu50z00 | [X]Eating disorder, unspecified | res41: Eating disorder | diagnostic | Read |
Fy05.00 | Nocturnal sleep-related eating disorder | res41: Eating disorder | diagnostic | Read |
R030.00 | [D]Anorexia | res41: Eating disorder | diagnostic | Read |
R030z00 | [D]Anorexia NOS | res41: Eating disorder | diagnostic | Read |
R036.00 | [D]Polyphagia | res41: Eating disorder | diagnostic | Read |
R036000 | [D]Excessive eating | res41: Eating disorder | diagnostic | Read |
R036011 | [D]Bulimia NOS | res41: Eating disorder | diagnostic | Read |
R036100 | [D]Hyperalimentation | res41: Eating disorder | diagnostic | Read |
R036z00 | [D]Polyphagia NOS | res41: Eating disorder | diagnostic | Read |
SN42100 | Starvation | res41: Eating disorder | diagnostic | Read |
U1B3.11 | [X]Starvation | res41: Eating disorder | diagnostic | Read |
Z4B5.00 | Eating disorder counselling | res41: Eating disorder | diagnostic | Read |
ZC2CD00 | Dietary advice for eating disorder | res41: Eating disorder | diagnostic | Read |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH377/version/754/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH377/version/754/detail/?format=json |
R Package |
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To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH377/version/754/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH377/version/754/export/codes/?format=json |
CSV | site_root/phenotypes/PH377/version/754/export/codes/ |
R Package |
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Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
754 | Eating Disorder | ieuan.scanlon | 2021-10-06 | currently shown |
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