Background:
Little is known about the precursors of suicide risk among primary-care patients. This study aimed to examine suicide risk in relation to patterns of clinical consultation, psychotropic drug prescribing, and psychiatric diagnoses.
Method:
Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged516 years who died by suicide during 2002–2011 (N = 2384) were matched on gender, age and practice with up to 20 living control patients (N = 46 899).
Results:
Risk was raised among non-consulting patients, and increased sharply with rising number of consultations in the preceding year [512 consultations v. 1: unadjusted odds ratio (OR) 6.0, 95% confidence interval (CI) 4.9–7.3]. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types (55 types v. 0: OR 62.6, CI 44.3–88.4) and with having several psychiatric diagnoses (54 diagnoses v. 0: OR 31.1, CI 19.3–50.1). Risk was also raised among patients living in more socially deprived localities. The confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing consultation frequency.
Conclusions:
A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-consulters are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties.
K Windfuhr, D While, N Kapur, D M Ashcroft, E Kontopantelis, M J Carr, J Shaw, L Appleby, R T Webb, Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary-care patients. Psychological Medicine, 46, 3407-3417, 2016.
Code | Description | Entity type | Category | Coding System (Read) |
---|---|---|---|---|
1464.00 | H/O: schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
146H.00 | H/O: psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
1BH..00 | Delusions | res38: Schizophrenia spectrum | diagnostic | Read |
1BH..11 | Delusion | res38: Schizophrenia spectrum | diagnostic | Read |
1BH0.00 | Delusion of persecution | res38: Schizophrenia spectrum | diagnostic | Read |
1BH1.00 | Grandiose delusions | res38: Schizophrenia spectrum | diagnostic | Read |
1BH2.00 | Ideas of reference | res38: Schizophrenia spectrum | diagnostic | Read |
1BH3.00 | Paranoid ideation | res38: Schizophrenia spectrum | diagnostic | Read |
225E.00 | O/E - paranoid delusions | res38: Schizophrenia spectrum | diagnostic | Read |
225F.00 | O/E - delusion of persecution | res38: Schizophrenia spectrum | diagnostic | Read |
285..11 | Psychotic condition, insight present | res38: Schizophrenia spectrum | diagnostic | Read |
286..11 | Poor insight into psychotic condition | res38: Schizophrenia spectrum | diagnostic | Read |
665E.00 | Injectable neuroleptic given | res38: Schizophrenia spectrum | diagnostic | Read |
665F.00 | On injectable neuroleptic | res38: Schizophrenia spectrum | diagnostic | Read |
E1...00 | Non-organic psychoses | res38: Schizophrenia spectrum | diagnostic | Read |
E10..00 | Schizophrenic disorders | res38: Schizophrenia spectrum | diagnostic | Read |
E100.00 | Simple schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E100.11 | Schizophrenia simplex | res38: Schizophrenia spectrum | diagnostic | Read |
E100000 | Unspecified schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E100100 | Subchronic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E100200 | Chronic schizophrenic | res38: Schizophrenia spectrum | diagnostic | Read |
E100300 | Acute exacerbation of subchronic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E100400 | Acute exacerbation of chronic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E100500 | Schizophrenia in remission | res38: Schizophrenia spectrum | diagnostic | Read |
E100z00 | Simple schizophrenia NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E101.00 | Hebephrenic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E101000 | Unspecified hebephrenic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E101400 | Acute exacerbation of chronic hebephrenic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E101500 | Hebephrenic schizophrenia in remission | res38: Schizophrenia spectrum | diagnostic | Read |
E101z00 | Hebephrenic schizophrenia NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E102.00 | Catatonic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E102000 | Unspecified catatonic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E102100 | Subchronic catatonic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E102500 | Catatonic schizophrenia in remission | res38: Schizophrenia spectrum | diagnostic | Read |
E102z00 | Catatonic schizophrenia NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E103.00 | Paranoid schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E103000 | Unspecified paranoid schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E103200 | Chronic paranoid schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E103300 | Acute exacerbation of subchronic paranoid schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E103400 | Acute exacerbation of chronic paranoid schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E103500 | Paranoid schizophrenia in remission | res38: Schizophrenia spectrum | diagnostic | Read |
E103z00 | Paranoid schizophrenia NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E104.00 | Acute schizophrenic episode | res38: Schizophrenia spectrum | diagnostic | Read |
E105.00 | Latent schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E105000 | Unspecified latent schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E105200 | Chronic latent schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E105500 | Latent schizophrenia in remission | res38: Schizophrenia spectrum | diagnostic | Read |
E105z00 | Latent schizophrenia NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E106.00 | Residual schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E107.00 | Schizo-affective schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E107.11 | Cyclic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E107000 | Unspecified schizo-affective schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E107100 | Subchronic schizo-affective schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E107200 | Chronic schizo-affective schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E107300 | Acute exacerbation subchronic schizo-affective schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E107400 | Acute exacerbation of chronic schizo-affective schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E107500 | Schizo-affective schizophrenia in remission | res38: Schizophrenia spectrum | diagnostic | Read |
E107z00 | Schizo-affective schizophrenia NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E10y.00 | Other schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E10y.11 | Cenesthopathic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E10y000 | Atypical schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E10y100 | Coenesthopathic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E10yz00 | Other schizophrenia NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E10z.00 | Schizophrenia NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E11z.00 | Other and unspecified affective psychoses | res38: Schizophrenia spectrum | diagnostic | Read |
E11z000 | Unspecified affective psychoses NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E11zz00 | Other affective psychosis NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E12..00 | Paranoid states | res38: Schizophrenia spectrum | diagnostic | Read |
E120.00 | Simple paranoid state | res38: Schizophrenia spectrum | diagnostic | Read |
E121.00 | Chronic paranoid psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
E122.00 | Paraphrenia | res38: Schizophrenia spectrum | diagnostic | Read |
E123.00 | Shared paranoid disorder | res38: Schizophrenia spectrum | diagnostic | Read |
E12y.00 | Other paranoid states | res38: Schizophrenia spectrum | diagnostic | Read |
E12y000 | Paranoia querulans | res38: Schizophrenia spectrum | diagnostic | Read |
E12yz00 | Other paranoid states NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E12z.00 | Paranoid psychosis NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E13..00 | Other nonorganic psychoses | res38: Schizophrenia spectrum | diagnostic | Read |
E13..11 | Reactive psychoses | res38: Schizophrenia spectrum | diagnostic | Read |
E130.00 | Reactive depressive psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
E130.11 | Psychotic reactive depression | res38: Schizophrenia spectrum | diagnostic | Read |
E131.00 | Acute hysterical psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
E133.00 | Acute paranoid reaction | res38: Schizophrenia spectrum | diagnostic | Read |
E134.00 | Psychogenic paranoid psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
E13y.00 | Other reactive psychoses | res38: Schizophrenia spectrum | diagnostic | Read |
E13y100 | Brief reactive psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
E13yz00 | Other reactive psychoses NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E13z.00 | Nonorganic psychosis NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E13z.11 | Psychotic episode NOS | res38: Schizophrenia spectrum | diagnostic | Read |
E14..00 | Psychoses with origin in childhood | res38: Schizophrenia spectrum | diagnostic | Read |
E141.00 | Disintegrative psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
E141.11 | Heller's syndrome | res38: Schizophrenia spectrum | diagnostic | Read |
E141100 | Residual disintegrative psychoses | res38: Schizophrenia spectrum | diagnostic | Read |
E1y..00 | Other specified non-organic psychoses | res38: Schizophrenia spectrum | diagnostic | Read |
E1z..00 | Non-organic psychosis NOS | res38: Schizophrenia spectrum | diagnostic | Read |
Eu02z12 | [X] Presenile psychosis NOS | res38: Schizophrenia spectrum | diagnostic | Read |
Eu0z.12 | [X]Symptomatic psychosis NOS | res38: Schizophrenia spectrum | diagnostic | Read |
Eu2..00 | [X]Schizophrenia, schizotypal and delusional disorders | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20.00 | [X]Schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20000 | [X]Paranoid schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20011 | [X]Paraphrenic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20100 | [X]Hebephrenic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20111 | [X]Disorganised schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20200 | [X]Catatonic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20211 | [X]Catatonic stupor | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20212 | [X]Schizophrenic catalepsy | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20213 | [X]Schizophrenic catatonia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20214 | [X]Schizophrenic flexibilatis cerea | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20300 | [X]Undifferentiated schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20311 | [X]Atypical schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20500 | [X]Residual schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20511 | [X]Chronic undifferentiated schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20600 | [X]Simple schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20y00 | [X]Other schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20y12 | [X]Schizophreniform disord NOS | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20y13 | [X]Schizophrenifrm psychos NOS | res38: Schizophrenia spectrum | diagnostic | Read |
Eu20z00 | [X]Schizophrenia, unspecified | res38: Schizophrenia spectrum | diagnostic | Read |
Eu21.00 | [X]Schizotypal disorder | res38: Schizophrenia spectrum | diagnostic | Read |
Eu21.11 | [X]Latent schizophrenic reaction | res38: Schizophrenia spectrum | diagnostic | Read |
Eu21.12 | [X]Borderline schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu21.13 | [X]Latent schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu21.14 | [X]Prepsychotic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu21.15 | [X]Prodromal schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu21.16 | [X]Pseudoneurotic schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22.00 | [X]Persistent delusional disorders | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22000 | [X]Delusional disorder | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22011 | [X]Paranoid psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22012 | [X]Paranoid state | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22013 | [X]Paraphrenia - late | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22014 | [X]Sensitiver Beziehungswahn | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22015 | [X]Paranoia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22100 | [X]Delusional misidentification syndrome | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22111 | [X]Capgras syndrome | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22y00 | [X]Other persistent delusional disorders | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22y11 | [X]Delusional dysmorphophobia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22y12 | [X]Involutional paranoid state | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22y13 | [X]Paranoia querulans | res38: Schizophrenia spectrum | diagnostic | Read |
Eu22z00 | [X]Persistent delusional disorder, unspecified | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23.00 | [X]Acute and transient psychotic disorders | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23000 | [X]Acute polymorphic psychot disord without symp of schizoph | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23012 | [X]Cycloid psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23100 | [X]Acute polymorphic psychot disord with symp of schizophren | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23112 | [X]Cycloid psychosis with symptoms of schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23200 | [X]Acute schizophrenia-like psychotic disorder | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23211 | [X]Brief schizophreniform disorder | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23212 | [X]Brief schizophrenifrm psych | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23214 | [X]Schizophrenic reaction | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23300 | [X]Other acute predominantly delusional psychotic disorders | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23312 | [X]Psychogenic paranoid psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23y00 | [X]Other acute and transient psychotic disorders | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23z00 | [X]Acute and transient psychotic disorder, unspecified | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23z11 | [X]Brief reactive psychosis NOS | res38: Schizophrenia spectrum | diagnostic | Read |
Eu23z12 | [X]Reactive psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25.00 | [X]Schizoaffective disorders | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25000 | [X]Schizoaffective disorder, manic type | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25011 | [X]Schizoaffective psychosis, manic type | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25012 | [X]Schizophreniform psychosis, manic type | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25100 | [X]Schizoaffective disorder, depressive type | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25111 | [X]Schizoaffective psychosis, depressive type | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25112 | [X]Schizophreniform psychosis, depressive type | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25200 | [X]Schizoaffective disorder, mixed type | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25212 | [X]Mixed schizophrenic and affective psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25y00 | [X]Other schizoaffective disorders | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25z00 | [X]Schizoaffective disorder, unspecified | res38: Schizophrenia spectrum | diagnostic | Read |
Eu25z11 | [X]Schizoaffective psychosis NOS | res38: Schizophrenia spectrum | diagnostic | Read |
Eu2y.00 | [X]Other nonorganic psychotic disorders | res38: Schizophrenia spectrum | diagnostic | Read |
Eu2y.11 | [X]Chronic hallucinatory psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu2z.00 | [X]Unspecified nonorganic psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu2z.11 | [X]Psychosis NOS | res38: Schizophrenia spectrum | diagnostic | Read |
Eu32300 | [X]Severe depressive episode with psychotic symptoms | res38: Schizophrenia spectrum | diagnostic | Read |
Eu32311 | [X]Single episode of major depression and psychotic symptoms | res38: Schizophrenia spectrum | diagnostic | Read |
Eu32312 | [X]Single episode of psychogenic depressive psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu32313 | [X]Single episode of psychotic depression | res38: Schizophrenia spectrum | diagnostic | Read |
Eu32314 | [X]Single episode of reactive depressive psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu32900 | [X]Single major depr ep, severe with psych, psych in remiss | res38: Schizophrenia spectrum | diagnostic | Read |
Eu32A00 | [X]Recurr major depr ep, severe with psych, psych in remiss | res38: Schizophrenia spectrum | diagnostic | Read |
Eu33300 | [X]Recurrent depress disorder cur epi severe with psyc symp | res38: Schizophrenia spectrum | diagnostic | Read |
Eu33311 | [X]Endogenous depression with psychotic symptoms | res38: Schizophrenia spectrum | diagnostic | Read |
Eu33313 | [X]Recurr severe episodes/major depression+psychotic symptom | res38: Schizophrenia spectrum | diagnostic | Read |
Eu33314 | [X]Recurr severe episodes/psychogenic depressive psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu33315 | [X]Recurrent severe episodes of psychotic depression | res38: Schizophrenia spectrum | diagnostic | Read |
Eu33316 | [X]Recurrent severe episodes/reactive depressive psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu44.14 | [X]Hysterical psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu84312 | [X]Disintegrative psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
Eu84314 | [X]Symbiotic psychosis | res38: Schizophrenia spectrum | diagnostic | Read |
R001.00 | [D]Hallucinations | res38: Schizophrenia spectrum | diagnostic | Read |
R001000 | [D]Hallucinations, auditory | res38: Schizophrenia spectrum | diagnostic | Read |
R001100 | [D]Hallucinations, gustatory | res38: Schizophrenia spectrum | diagnostic | Read |
R001200 | [D]Hallucinations, olfactory | res38: Schizophrenia spectrum | diagnostic | Read |
R001300 | [D]Hallucinations, tactile | res38: Schizophrenia spectrum | diagnostic | Read |
R001400 | [D]Visual hallucinations | res38: Schizophrenia spectrum | diagnostic | Read |
R001z00 | [D]Hallucinations NOS | res38: Schizophrenia spectrum | diagnostic | Read |
Ryu5300 | [X]Other hallucinations | res38: Schizophrenia spectrum | diagnostic | Read |
ZS7C611 | Schizophrenic language | res38: Schizophrenia spectrum | diagnostic | Read |
ZV11000 | [V]Personal history of schizophrenia | res38: Schizophrenia spectrum | diagnostic | Read |
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R Package |
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R Package |
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Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
1412 | Schizophrenia Spectrum | ieuan.scanlon | 2021-10-06 | currently shown |
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