To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age.
Population based cohort study.
UK Clinical Practice Research Datalink—electronic health records from 674 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records.
For the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274).
Main outcome measures:
In the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death), and fatal acute alcohol or drug poisoning were estimated as hazard ratios derived from stratified Cox proportional hazards models for the self harm cohort versus the matched unaffected comparison cohort.
The annual incidence of self harm was observed to increase in girls (37.4 per 10 000) compared with boys (12.3 per 10 000), and a sharp 68% increase occurred among girls aged 13-16, from 45.9 per 10 000 in 2011 to 77.0 per 10 000 in 2014. Referrals within 12 months of the index self harm episode were 23% less likely for young patients registered at the most socially deprived practices, even though incidences were considerably higher in these localities. Children and adolescents who harmed themselves were approximately nine times more likely to die unnaturally during follow-up, with especially noticeable increases in risks of suicide (deprivation adjusted hazard ratio 17.5, 95% confidence interval 7.6 to 40.5) and fatal acute alcohol or drug poisoning (34.3, 10.2 to 115.7).
Gaining a better understanding of the mechanisms responsible for the recent apparent increase in the incidence of self harm among early-mid teenage girls, and coordinated initiatives to tackle health inequalities in the provision of services to distressed children and adolescents, represent urgent priorities for multiple public agencies.
Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Jonathan Green, Carolyn A Chew-Graham, Nav Kapur, Darren M Aschcroft, Incidence, clinical management, and mortality risk following self harm among children and adolescents cohort study in primary care. BMJ, 359(j4351), 2017.
|Code||Description||Entity type||Category||Coding System (Read)|
|E284.00||stress reaction causing mixed disturbance of emotion/conduct||res59: Conduct_disorder||diagnostic||Read|
|E2C..00||disturbance of conduct nec||res59: Conduct_disorder||diagnostic||Read|
|E2C0.00||aggressive unsocial conduct disorder||res59: Conduct_disorder||diagnostic||Read|
|E2C0z00||aggressive unsocial conduct disorder nos||res59: Conduct_disorder||diagnostic||Read|
|E2C1.00||nonaggressive unsocial conduct disorder||res59: Conduct_disorder||diagnostic||Read|
|E2C1z00||nonaggressive unsocial conduct disorder nos||res59: Conduct_disorder||diagnostic||Read|
|E2C2.00||socialised conduct disorder||res59: Conduct_disorder||diagnostic||Read|
|E2C2z00||socialised conduct disorder nos||res59: Conduct_disorder||diagnostic||Read|
|E2C4.00||mixed disturbance of conduct and emotion||res59: Conduct_disorder||diagnostic||Read|
|E2C4z00||mixed disturbance of conduct and emotion nos||res59: Conduct_disorder||diagnostic||Read|
|E2Cy.00||other conduct disturbances||res59: Conduct_disorder||diagnostic||Read|
|E2Cyz00||other conduct disturbances nos||res59: Conduct_disorder||diagnostic||Read|
|E2Cz.00||unspecified disturbance of conduct||res59: Conduct_disorder||diagnostic||Read|
|E2Czz00||disturbance of conduct nos||res59: Conduct_disorder||diagnostic||Read|
|E2Dy000||childhood and adolescent oppositional disorder||res59: Conduct_disorder||diagnostic||Read|
|E2E2.00||Hyperkinetic conduct disorder||res59: Conduct_disorder||diagnostic||Read|
|Eu90100||[X]Hyperkinetic conduct disorder||res59: Conduct_disorder||diagnostic||Read|
|Eu90111||[X]Hyperkinetic disorder associated with conduct disorder||res59: Conduct_disorder||diagnostic||Read|
|Eu91.00||[x]conduct disorders||res59: Conduct_disorder||diagnostic||Read|
|Eu91000||[x]conduct disorder confined to the family context||res59: Conduct_disorder||diagnostic||Read|
|Eu91100||[x]unsocialized conduct disorder||res59: Conduct_disorder||diagnostic||Read|
|Eu91111||[x]conduct disorder, solitary aggressive type||res59: Conduct_disorder||diagnostic||Read|
|Eu91200||[x]socialized conduct disorder||res59: Conduct_disorder||diagnostic||Read|
|Eu91300||[X]Oppositional defiant disorder||res59: Conduct_disorder||diagnostic||Read|
|Eu91y00||[x]other conduct disorders||res59: Conduct_disorder||diagnostic||Read|
|Eu91z00||[x]conduct disorder, unspecified||res59: Conduct_disorder||diagnostic||Read|
|Eu91z11||[X]Childhood behavioural disorder NOS||res59: Conduct_disorder||diagnostic||Read|
|Eu91z12||[x]childhood conduct disorder nos||res59: Conduct_disorder||diagnostic||Read|
|Eu92.00||[x]mixed disorders of conduct and emotions||res59: Conduct_disorder||diagnostic||Read|
|Eu92000||[x]depressive conduct disorder||res59: Conduct_disorder||diagnostic||Read|
|Eu92y00||[x]other mixed disorders of conduct and emotions||res59: Conduct_disorder||diagnostic||Read|
|Eu92y11||[x]conduct disorder associated with emotional disorder||res59: Conduct_disorder||diagnostic||Read|
|Eu92y12||[x]conduct disorder associated with neurotic disorder||res59: Conduct_disorder||diagnostic||Read|
|Eu92z00||[x]mixed disorder of conduct and emotions, unspecified||res59: Conduct_disorder||diagnostic||Read|
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|1170||Conduct Disorder||ieuan.scanlon||2021-10-06||currently shown|
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