Background:
Self-harm is a major risk factor for suicide, with older adults (older than 65 years) having reportedly greater suicidal intent than any other age group. With the aging population rising and paucity of research focus in this age group, the extent of the problem of self-harm needs to be established. In a primary care cohort of older adults we aimed to investigate the incidence of self-harm, subsequent clinical management, prevalence of mental and physical diagnoses, and unnatural-cause mortality risk, including suicide.
Methods:
The UK Clinical Practice Research Datalink contains anonymised patient records from general practice that routinely capture clinical information pertaining to both primary and secondary care services. We identified 4124 adults aged 65 years and older with a self-harm episode ascertained from Read codes recorded during 2001–14. We calculated standardised incidence and in 2854 adults with at least 12 months follow-up examined the frequency of psychiatric referrals and prescription of psychotropic medication after self-harm. We estimated prevalence of mental and physical illness diagnoses before and after self-harm and, using Cox regression in a matched cohort, we examined cause-specific mortality risks.
Findings:
Overall incidence of self-harm in older adults aged 65 years and older was 4·1 per 10 000 person-years with stable gender-specific rates observed over the 13-year period. After self-harm, 335 (11·7%) of 2854 adults were referred to mental health services, 1692 (59·3%) were prescribed an antidepressant, and 336 (11·8%) were prescribed a tricyclic antidepressant (TCA). Having a diagnosed previous mental illness was twice as prevalent in the self-harm cohort as in the comparison cohort (prevalence ratio 2·10 [95% CI 2·03–2·17]) and with a previous physical health condition prevalence was 20% higher in the self-harm cohort compared to the comparison cohort (1·20 [1·17–1·23]). Adults from the self-harm cohort (n=2454) died from unnatural causes an estimated 20 times more frequently than the comparison cohort (n=48 921) during the first year. A markedly elevated risk of suicide (hazard ratio 145·4 [95% CI 53·9–392·3]) was observed in the self-harm cohort.
Interpretation:
Within primary care, we have identified a group of older adults at high risk from unnatural death, particularly within the first year of self-harm. We have highlighted a high frequency of prescription of TCAs, known to be potentially fatally toxic in overdose. We emphasise the need for early intervention, careful alternative prescribing, and increased support when older adults consult after an episode of self-harm and with other health conditions.
Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft, Self-harm in a primary care cohort of older people incidence, clinical management, and risk of suicide and other causes of death. Psychiatry, 5, 2018.
Code | Description | Entity type | Coding System (ICD-10 Read) | Category |
---|---|---|---|---|
A411.00 | Jakob-Creutzfeldt disease | res69: dementia | Read | diagnostic |
E00..00 | Senile and presenile organic psychotic conditions | res69: dementia | Read | diagnostic |
E00..11 | Senile dementia | res69: dementia | Read | diagnostic |
E00..12 | Senile/presenile dementia | res69: dementia | Read | diagnostic |
E000.00 | Uncomplicated senile dementia | res69: dementia | Read | diagnostic |
E001.00 | Presenile dementia | res69: dementia | Read | diagnostic |
E001000 | Uncomplicated presenile dementia | res69: dementia | Read | diagnostic |
E001100 | Presenile dementia with delirium | res69: dementia | Read | diagnostic |
E001200 | Presenile dementia with paranoia | res69: dementia | Read | diagnostic |
E001300 | Presenile dementia with depression | res69: dementia | Read | diagnostic |
E001z00 | Presenile dementia NOS | res69: dementia | Read | diagnostic |
E002.00 | Senile dementia with depressive or paranoid features | res69: dementia | Read | diagnostic |
E002000 | Senile dementia with paranoia | res69: dementia | Read | diagnostic |
E002100 | Senile dementia with depression | res69: dementia | Read | diagnostic |
E002z00 | Senile dementia with depressive or paranoid features NOS | res69: dementia | Read | diagnostic |
E003.00 | Senile dementia with delirium | res69: dementia | Read | diagnostic |
E004.00 | Arteriosclerotic dementia | res69: dementia | Read | diagnostic |
E004.11 | Multi infarct dementia | res69: dementia | Read | diagnostic |
E004000 | Uncomplicated arteriosclerotic dementia | res69: dementia | Read | diagnostic |
E004100 | Arteriosclerotic dementia with delirium | res69: dementia | Read | diagnostic |
E004200 | Arteriosclerotic dementia with paranoia | res69: dementia | Read | diagnostic |
E004300 | Arteriosclerotic dementia with depression | res69: dementia | Read | diagnostic |
E004z00 | Arteriosclerotic dementia NOS | res69: dementia | Read | diagnostic |
E00y.00 | Other senile and presenile organic psychoses | res69: dementia | Read | diagnostic |
E00y.11 | Presbyophrenic psychosis | res69: dementia | Read | diagnostic |
E00z.00 | Senile or presenile psychoses NOS | res69: dementia | Read | diagnostic |
E012.00 | Other alcoholic dementia | res69: dementia | Read | diagnostic |
E012.11 | Alcoholic dementia NOS | res69: dementia | Read | diagnostic |
E012000 | Chronic alcoholic brain syndrome | res69: dementia | Read | diagnostic |
E02y100 | Drug-induced dementia | res69: dementia | Read | diagnostic |
E041.00 | Dementia in conditions EC | res69: dementia | Read | diagnostic |
Eu00.00 | [X]Dementia in Alzheimer's disease | res69: dementia | Read | diagnostic |
Eu00000 | [X]Dementia in Alzheimer's disease with early onset | res69: dementia | Read | diagnostic |
Eu00011 | [X]Presenile dementia;Alzheimer's type | res69: dementia | Read | diagnostic |
Eu00012 | [X]Primary degen dementia; Alzheimer's type; presenile onset | res69: dementia | Read | diagnostic |
Eu00013 | [X]Alzheimer's disease type 2 | res69: dementia | Read | diagnostic |
Eu00100 | [X]Dementia in Alzheimer's disease with late onset | res69: dementia | Read | diagnostic |
Eu00111 | [X]Alzheimer's disease type 1 | res69: dementia | Read | diagnostic |
Eu00112 | [X]Senile dementia;Alzheimer's type | res69: dementia | Read | diagnostic |
Eu00113 | [X]Primary degen dementia of Alzheimer's type; senile onset | res69: dementia | Read | diagnostic |
Eu00200 | [X]Dementia in Alzheimer's dis; atypical or mixed type | res69: dementia | Read | diagnostic |
Eu00z00 | [X]Dementia in Alzheimer's disease; unspecified | res69: dementia | Read | diagnostic |
Eu00z11 | [X]Alzheimer's dementia unspec | res69: dementia | Read | diagnostic |
Eu01.00 | [X]Vascular dementia | res69: dementia | Read | diagnostic |
Eu01.11 | [X]Arteriosclerotic dementia | res69: dementia | Read | diagnostic |
Eu01000 | [X]Vascular dementia of acute onset | res69: dementia | Read | diagnostic |
Eu01100 | [X]Multi-infarct dementia | res69: dementia | Read | diagnostic |
Eu01111 | [X]Predominantly cortical dementia | res69: dementia | Read | diagnostic |
Eu01200 | [X]Subcortical vascular dementia | res69: dementia | Read | diagnostic |
Eu01300 | [X]Mixed cortical and subcortical vascular dementia | res69: dementia | Read | diagnostic |
Eu01y00 | [X]Other vascular dementia | res69: dementia | Read | diagnostic |
Eu01z00 | [X]Vascular dementia; unspecified | res69: dementia | Read | diagnostic |
Eu02.00 | [X]Dementia in other diseases classified elsewhere | res69: dementia | Read | diagnostic |
Eu02000 | [X]Dementia in Pick's disease | res69: dementia | Read | diagnostic |
Eu02100 | [X]Dementia in Creutzfeldt-Jakob disease | res69: dementia | Read | diagnostic |
Eu02200 | [X]Dementia in Huntington's disease | res69: dementia | Read | diagnostic |
Eu02300 | [X]Dementia in Parkinson's disease | res69: dementia | Read | diagnostic |
Eu02400 | [X]Dementia in human immunodef virus [HIV] disease | res69: dementia | Read | diagnostic |
Eu02500 | [X]Lewy body dementia | res69: dementia | Read | diagnostic |
Eu02y00 | [X]Dementia in other specified diseases classif elsewhere | res69: dementia | Read | diagnostic |
Eu02z00 | [X] Unspecified dementia | res69: dementia | Read | diagnostic |
Eu02z11 | [X] Presenile dementia NOS | res69: dementia | Read | diagnostic |
Eu02z12 | [X] Presenile psychosis NOS | res69: dementia | Read | diagnostic |
Eu02z13 | [X] Primary degenerative dementia NOS | res69: dementia | Read | diagnostic |
Eu02z14 | [X] Senile dementia NOS | res69: dementia | Read | diagnostic |
Eu02z15 | [X] Senile psychosis NOS | res69: dementia | Read | diagnostic |
Eu02z16 | [X] Senile dementia; depressed or paranoid type | res69: dementia | Read | diagnostic |
Eu04100 | [X]Delirium superimposed on dementia | res69: dementia | Read | diagnostic |
Eu05700 | [X]Mild cognitive disorder | res69: dementia | Read | diagnostic |
F110.00 | Alzheimer's disease | res69: dementia | Read | diagnostic |
F110000 | Alzheimer's disease with early onset | res69: dementia | Read | diagnostic |
F110100 | Alzheimer's disease with late onset | res69: dementia | Read | diagnostic |
F111.00 | Pick's disease | res69: dementia | Read | diagnostic |
F1110A | res69: dementia | Read | diagnostic | |
F112.00 | Senile degeneration of brain | res69: dementia | Read | diagnostic |
F116.00 | Lewy body disease | res69: dementia | Read | diagnostic |
F118.00 | res69: dementia | Read | diagnostic | |
F11x.00 | Cerebral degeneration in other disease EC | res69: dementia | Read | diagnostic |
F11x000 | Cerebral degeneration due to alcoholism | res69: dementia | Read | diagnostic |
F11x011 | Alcoholic encephalopathy | res69: dementia | Read | diagnostic |
F11x200 | Cerebral degeneration due to cerebrovascular disease | res69: dementia | Read | diagnostic |
F11x400 | Cerebral degeneration due to neoplastic disease | res69: dementia | Read | diagnostic |
F11x500 | Cerebral degeneration due to myxoedema | res69: dementia | Read | diagnostic |
F11x600 | Cerebral degeneration due to vitamin B12 deficiency | res69: dementia | Read | diagnostic |
F11x700 | Cerebral degeneration due to Jakob - Creutzfeldt disease | res69: dementia | Read | diagnostic |
F11x800 | Cerebral degeneration due to multifocal leucoencephalopathy | res69: dementia | Read | diagnostic |
F11x900 | Cerebral degeneration in Parkinson's disease | res69: dementia | Read | diagnostic |
F11xz00 | Cerebral degeneration other disease NOS | res69: dementia | Read | diagnostic |
F11y.00 | Other cerebral degeneration | res69: dementia | Read | diagnostic |
F11y000 | Reye's syndrome | res69: dementia | Read | diagnostic |
F11y100 | Cerebral ataxia | res69: dementia | Read | diagnostic |
F11yz00 | Other cerebral degeneration NOS | res69: dementia | Read | diagnostic |
F11z.00 | Cerebral degeneration NOS | res69: dementia | Read | diagnostic |
F11z.11 | Cerebral atrophy | res69: dementia | Read | diagnostic |
F134.00 | Huntington's chorea | res69: dementia | Read | diagnostic |
Fyu3000 | [X]Other Alzheimer's disease | res69: dementia | Read | diagnostic |
Code | Description | Entity type | Coding System (ICD-10 Read) | Category |
---|---|---|---|---|
F00-F03 | Dementia in Alzheimer's disease | res69: dementia | ICD-10 | diagnostic |
F05.1 | Delirium superimposed on dementia | res69: dementia | ICD-10 | diagnostic |
G30 | Alzheimer's disease | res69: dementia | ICD-10 | diagnostic |
G31.1 | Senile degeneration of brain, not elsewhere classified | res69: dementia | ICD-10 | diagnostic |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH877/version/1833/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH877/version/1833/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH877/version/1833/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH877/version/1833/export/codes/?format=json |
CSV | site_root/phenotypes/PH877/version/1833/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
1833 | Dementia | ieuan.scanlon | 2022-04-04 | currently shown |
Export - export all codes into a csv file/JSON/XML for the current phenotype version.
Print - Print page.