Objectives:
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.
Design:
Population based cohort study.
Setting:
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.
Participants:
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.
Results:
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).
Conclusions:
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) |
---|---|---|---|---|
1BH..00 | delusions | res59: Schizophrenia_spectrum | diagnostic | Read |
1BH..11 | delusion | res59: Schizophrenia_spectrum | diagnostic | Read |
1BH0.00 | delusion of persecution | res59: Schizophrenia_spectrum | diagnostic | Read |
1BH1.00 | grandiose delusions | res59: Schizophrenia_spectrum | diagnostic | Read |
225E.00 | o/e - paranoid delusions | res59: Schizophrenia_spectrum | diagnostic | Read |
225F.00 | o/e - delusion of persecution | res59: Schizophrenia_spectrum | diagnostic | Read |
285..11 | psychotic condition, insight present | res59: Schizophrenia_spectrum | diagnostic | Read |
E1...00 | Non-organic psychoses | res59: Schizophrenia_spectrum | diagnostic | Read |
E10..00 | Schizophrenic disorders | res59: Schizophrenia_spectrum | diagnostic | Read |
E100.00 | Simple schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E100.11 | Schizophrenia simplex | res59: Schizophrenia_spectrum | diagnostic | Read |
E100000 | Unspecified schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E100100 | Subchronic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E100200 | Chronic schizophrenic | res59: Schizophrenia_spectrum | diagnostic | Read |
E100300 | Acute exacerbation of subchronic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E100400 | Acute exacerbation of chronic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E100500 | Schizophrenia in remission | res59: Schizophrenia_spectrum | diagnostic | Read |
E100z00 | Simple schizophrenia NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E101.00 | Hebephrenic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E101000 | Unspecified hebephrenic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E101400 | Acute exacerbation of chronic hebephrenic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E101500 | Hebephrenic schizophrenia in remission | res59: Schizophrenia_spectrum | diagnostic | Read |
E101z00 | Hebephrenic schizophrenia NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E102.00 | catatonic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E102000 | unspecified catatonic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E102100 | subchronic catatonic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E102400 | acute exacerbation of chronic catatonic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E102500 | Catatonic schizophrenia in remission | res59: Schizophrenia_spectrum | diagnostic | Read |
E102z00 | catatonic schizophrenia nos | res59: Schizophrenia_spectrum | diagnostic | Read |
E103.00 | paranoid schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E103000 | unspecified paranoid schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E103100 | subchronic paranoid schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E103200 | Chronic paranoid schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E103300 | Acute exacerbation of subchronic paranoid schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E103400 | Acute exacerbation of chronic paranoid schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E103500 | Paranoid schizophrenia in remission | res59: Schizophrenia_spectrum | diagnostic | Read |
E103z00 | Paranoid schizophrenia NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E104.00 | Acute schizophrenic episode | res59: Schizophrenia_spectrum | diagnostic | Read |
E105.00 | Latent schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E105000 | Unspecified latent schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E105200 | Chronic latent schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E105500 | Latent schizophrenia in remission | res59: Schizophrenia_spectrum | diagnostic | Read |
E105z00 | Latent schizophrenia NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E106.00 | Residual schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E107.00 | Schizo-affective schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E107.11 | cyclic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E107000 | Unspecified schizo-affective schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E107100 | Subchronic schizo-affective schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E107200 | Chronic schizo-affective schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E107300 | Acute exacerbation subchronic schizo-affective schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E107400 | Acute exacerbation of chronic schizo-affective schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E107500 | Schizo-affective schizophrenia in remission | res59: Schizophrenia_spectrum | diagnostic | Read |
E107z00 | Schizo-affective schizophrenia NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E10y.00 | Other schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E10y.11 | cenesthopathic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E10y000 | atypical schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E10y100 | coenesthopathic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E10yz00 | other schizophrenia nos | res59: Schizophrenia_spectrum | diagnostic | Read |
E10z.00 | schizophrenia nos | res59: Schizophrenia_spectrum | diagnostic | Read |
E11z.00 | Other and unspecified affective psychoses | res59: Schizophrenia_spectrum | diagnostic | Read |
E11z000 | Unspecified affective psychoses NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E11zz00 | Other affective psychosis NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E121.00 | chronic paranoid psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
E122.00 | paraphrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
E123.00 | shared paranoid disorder | res59: Schizophrenia_spectrum | diagnostic | Read |
E12y000 | paranoia querulans | res59: Schizophrenia_spectrum | diagnostic | Read |
E12z.00 | paranoid psychosis nos | res59: Schizophrenia_spectrum | diagnostic | Read |
E13..00 | Other nonorganic psychoses | res59: Schizophrenia_spectrum | diagnostic | Read |
E13..11 | reactive psychoses | res59: Schizophrenia_spectrum | diagnostic | Read |
E130.00 | reactive depressive psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
E130.11 | psychotic reactive depression | res59: Schizophrenia_spectrum | diagnostic | Read |
E133.00 | acute paranoid reaction | res59: Schizophrenia_spectrum | diagnostic | Read |
E134.00 | psychogenic paranoid psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
E13z.00 | Nonorganic psychosis NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E13z.11 | Psychotic episode NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E14..00 | Psychoses with origin in childhood | res59: Schizophrenia_spectrum | diagnostic | Read |
E141.00 | Disintegrative psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
E141100 | Residual disintegrative psychoses | res59: Schizophrenia_spectrum | diagnostic | Read |
E14y.00 | Other childhood psychoses | res59: Schizophrenia_spectrum | diagnostic | Read |
E14yz00 | Other childhood psychoses NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E14z.00 | Child psychosis NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E14z.11 | Childhood schizophrenia NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
E1y..00 | Other specified non-organic psychoses | res59: Schizophrenia_spectrum | diagnostic | Read |
E1z..00 | Non-organic psychosis NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu02z12 | [X] Presenile psychosis NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu0z.12 | [X]Symptomatic psychosis NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu2..00 | [X]Schizophrenia, schizotypal and delusional disorders | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20.00 | [X]Schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20000 | [X]Paranoid schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20011 | [X]Paraphrenic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20100 | [X]Hebephrenic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20111 | [X]Disorganised schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20200 | [X]Catatonic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20211 | [X]Catatonic stupor | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20212 | [X]Schizophrenic catalepsy | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20213 | [X]Schizophrenic catatonia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20214 | [X]Schizophrenic flexibilatis cerea | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20300 | [X]Undifferentiated schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20311 | [X]Atypical schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20500 | [X]Residual schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20511 | [X]Chronic undifferentiated schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20600 | [X]Simple schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20y00 | [X]Other schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20y12 | [X]Schizophreniform disord NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20y13 | [X]Schizophrenifrm psychos NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu20z00 | [X]Schizophrenia, unspecified | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu21.11 | [X]Latent schizophrenic reaction | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu21.13 | [X]Latent schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu21.14 | [X]Prepsychotic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu21.15 | [X]Prodromal schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu21.16 | [X]Pseudoneurotic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu21.17 | [X]Pseudopsychopathic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22.00 | [X]Persistent delusional disorders | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22000 | [X]Delusional disorder | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22011 | [X]Paranoid psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22012 | [X]Paranoid state | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22013 | [X]Paraphrenia - late | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22014 | [X]Sensitiver Beziehungswahn | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22015 | [X]Paranoia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22100 | [X]Delusional misidentification syndrome | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22111 | [X]Capgras syndrome | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22y00 | [X]Other persistent delusional disorders | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22y11 | [X]Delusional dysmorphophobia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22y12 | [X]Involutional paranoid state | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu22z00 | [X]Persistent delusional disorder, unspecified | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23.00 | [X]Acute and transient psychotic disorders | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23000 | [X]Acute polymorphic psychot disord without symp of schizoph | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23012 | [X]Cycloid psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23100 | [X]Acute polymorphic psychot disord with symp of schizophren | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23112 | [X]Cycloid psychosis with symptoms of schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23200 | [X]Acute schizophrenia-like psychotic disorder | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23211 | [X]Brief schizophreniform disorder | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23212 | [X]Brief schizophrenifrm psych | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23214 | [X]Schizophrenic reaction | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23300 | [X]Other acute predominantly delusional psychotic disorders | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23312 | [X]Psychogenic paranoid psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23y00 | [X]Other acute and transient psychotic disorders | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu23z00 | [X]Acute and transient psychotic disorder, unspecified | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu24.00 | [x]induced delusional disorder | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu24.12 | [x]induced paranoid disorder | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu24.13 | [x]induced psychotic disorder | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25.00 | [X]Schizoaffective disorders | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25000 | [x]schizoaffective disorder, manic type | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25011 | [x]schizoaffective psychosis, manic type | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25012 | [x]schizophreniform psychosis, manic type | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25100 | [X]Schizoaffective disorder, depressive type | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25111 | [X]Schizoaffective psychosis, depressive type | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25112 | [x]schizophreniform psychosis, depressive type | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25200 | [X]Schizoaffective disorder, mixed type | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25211 | [x]cyclic schizophrenia | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25212 | [X]Mixed schizophrenic and affective psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25y00 | [X]Other schizoaffective disorders | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25z00 | [X]Schizoaffective disorder, unspecified | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu25z11 | [X]Schizoaffective psychosis NOS | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu2y.00 | [X]Other nonorganic psychotic disorders | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu2y.11 | [x]chronic hallucinatory psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu2z.00 | [X]Unspecified nonorganic psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu2z.11 | [x]psychosis nos | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu32300 | [x]severe depressive episode with psychotic symptoms | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu32311 | [x]single episode of major depression and psychotic symptoms | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu32312 | [x]single episode of psychogenic depressive psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu32313 | [x]single episode of psychotic depression | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu32314 | [x]single episode of reactive depressive psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu32900 | [X]Single major depr ep, severe with psych, psych in remiss | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu32A00 | [X]Recurr major depr ep, severe with psych, psych in remiss | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu33300 | [X]Recurrent depress disorder cur epi severe with psyc symp | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu33311 | [x]endogenous depression with psychotic symptoms | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu33313 | [x]recurr severe episodes/major depression+psychotic symptom | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu33314 | [x]recurr severe episodes/psychogenic depressive psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu33315 | [x]recurrent severe episodes of psychotic depression | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu33316 | [x]recurrent severe episodes/reactive depressive psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu44.14 | [x]hysterical psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu84314 | [x]symbiotic psychosis | res59: Schizophrenia_spectrum | diagnostic | Read |
Eu84512 | [X]Schizoid disorder of childhood | res59: Schizophrenia_spectrum | diagnostic | Read |
R001000 | [d]hallucinations, auditory | res59: Schizophrenia_spectrum | diagnostic | Read |
R001100 | [d]hallucinations, gustatory | res59: Schizophrenia_spectrum | diagnostic | Read |
R001200 | [d]hallucinations, olfactory | res59: Schizophrenia_spectrum | diagnostic | Read |
R001300 | [d]hallucinations, tactile | res59: Schizophrenia_spectrum | diagnostic | Read |
R001z00 | [d]hallucinations nos | res59: Schizophrenia_spectrum | diagnostic | Read |
Ryu5300 | [x]other hallucinations | res59: Schizophrenia_spectrum | diagnostic | Read |
ZS7C611 | schizophrenic language | res59: Schizophrenia_spectrum | diagnostic | Read |
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Name | Owner | Publish date | |
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1182 | Schizophrenia Spectrum | ieuan.scanlon | 2021-10-06 | currently shown |
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