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Depression

Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft

Type
Disease or Syndrome
ID
PH878
Version ID
1835
Data Sources
Valid event data range
01/01/2001 - 31/12/2014
Sex
Female, Male
Agreement Date
2018-10-15
Coding system
Read codes v2 ICD10 codes
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

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.

Publications

  • 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.

Clinical Code List

Rows: 107
Code Description Entity type Coding System (ICD-10 Read) Category
1B17.00 depressed res69: depression Read diagnostic
2257.00 o/e - depressed res69: depression Read diagnostic
62T1.00 puerperal depression res69: depression Read diagnostic
9kQ..00 on full dose long term treatment depression - enh serv admin res69: depression Read diagnostic
E001300 presenile dementia with depression res69: depression Read diagnostic
E002100 Senile dementia with depression res69: depression Read diagnostic
E004300 Arteriosclerotic dementia with depression res69: depression Read diagnostic
E11..12 depressive psychoses res69: depression Read diagnostic
E112.00 single major depressive episode res69: depression Read diagnostic
E112.11 agitated depression res69: depression Read diagnostic
E112.12 endogenous depression first episode res69: depression Read diagnostic
E112.13 endogenous depression first episode res69: depression Read diagnostic
E112.14 endogenous depression res69: depression Read diagnostic
E112000 single major depressive episode, unspecified res69: depression Read diagnostic
E112100 single major depressive episode, mild res69: depression Read diagnostic
E112200 single major depressive episode, moderate res69: depression Read diagnostic
E112300 single major depressive episode, severe, without psychosis res69: depression Read diagnostic
E112400 single major depressive episode, severe, with psychosis res69: depression Read diagnostic
E112z00 single major depressive episode nos res69: depression Read diagnostic
E113.00 recurrent major depressive episode res69: depression Read diagnostic
E113.11 endogenous depression - recurrent res69: depression Read diagnostic
E113000 recurrent major depressive episodes, unspecified res69: depression Read diagnostic
E113100 recurrent major depressive episodes, mild res69: depression Read diagnostic
E113200 recurrent major depressive episodes, moderate res69: depression Read diagnostic
E113300 recurrent major depressive episodes, severe, no psychosis res69: depression Read diagnostic
E113400 recurrent major depressive episodes, severe, with psychosis res69: depression Read diagnostic
E113700 recurrent depression res69: depression Read diagnostic
E113z00 recurrent major depressive episode nos res69: depression Read diagnostic
E118.00 Seasonal affective disorder res69: depression Read diagnostic
E11y200 atypical depressive disorder res69: depression Read diagnostic
E11z200 masked depression res69: depression Read diagnostic
E130.00 reactive depressive psychosis res69: depression Read diagnostic
E130.11 psychotic reactive depression res69: depression Read diagnostic
E135.00 agitated depression res69: depression Read diagnostic
E200300 anxiety with depression res69: depression Read diagnostic
E204.00 neurotic depression reactive type res69: depression Read diagnostic
E204.11 Postnatal depression res69: depression Read diagnostic
E290.00 brief depressive reaction res69: depression Read diagnostic
E290z00 brief depressive reaction nos res69: depression Read diagnostic
E291.00 prolonged depressive reaction res69: depression Read diagnostic
E2B..00 depressive disorder nec res69: depression Read diagnostic
E2B0.00 postviral depression res69: depression Read diagnostic
E2B1.00 chronic depression res69: depression Read diagnostic
Eu20400 [x]post-schizophrenic depression res69: depression Read diagnostic
Eu32.00 [x]depressive episode res69: depression Read diagnostic
Eu32.11 [x]single episode of depressive reaction res69: depression Read diagnostic
Eu32.12 [x]single episode of psychogenic depression res69: depression Read diagnostic
Eu32.13 [x]single episode of reactive depression res69: depression Read diagnostic
Eu32000 [x]mild depressive episode res69: depression Read diagnostic
Eu32100 [x]moderate depressive episode res69: depression Read diagnostic
Eu32200 [x]severe depressive episode without psychotic symptoms res69: depression Read diagnostic
Eu32211 [X]Single episode agitated depressn w'out psychotic symptoms res69: depression Read diagnostic
Eu32212 [x]single episode major depression w'out psychotic symptoms res69: depression Read diagnostic
Eu32213 [x]single episode vital depression w'out psychotic symptoms res69: depression Read diagnostic
Eu32300 [x]severe depressive episode with psychotic symptoms res69: depression Read diagnostic
Eu32311 [x]single episode of major depression and psychotic symptoms res69: depression Read diagnostic
Eu32312 [x]single episode of psychogenic depressive psychosis res69: depression Read diagnostic
Eu32313 [x]single episode of psychotic depression res69: depression Read diagnostic
Eu32314 [x]single episode of reactive depressive psychosis res69: depression Read diagnostic
Eu32400 [x]mild depression res69: depression Read diagnostic
Eu32500 [x]major depression, mild res69: depression Read diagnostic
Eu32600 [x]major depression, moderately severe res69: depression Read diagnostic
Eu32700 [x]major depression, severe without psychotic symptoms res69: depression Read diagnostic
Eu32800 [x]major depression, severe with psychotic symptoms res69: depression Read diagnostic
Eu32900 [X]Single major depr ep, severe with psych, psych in remiss res69: depression Read diagnostic
Eu32A00 [X]Recurr major depr ep, severe with psych, psych in remiss res69: depression Read diagnostic
Eu32y00 [x]other depressive episodes res69: depression Read diagnostic
Eu32y11 [x]atypical depression res69: depression Read diagnostic
Eu32y12 [x]single episode of masked depression nos res69: depression Read diagnostic
Eu32z00 [x]depressive episode, unspecified res69: depression Read diagnostic
Eu32z11 [x]depression nos res69: depression Read diagnostic
Eu32z12 [x]depressive disorder nos res69: depression Read diagnostic
Eu32z13 [x]prolonged single episode of reactive depression res69: depression Read diagnostic
Eu32z14 [x] reactive depression nos res69: depression Read diagnostic
Eu33.00 [x]recurrent depressive disorder res69: depression Read diagnostic
Eu33.11 [x]recurrent episodes of depressive reaction res69: depression Read diagnostic
Eu33.12 [x]recurrent episodes of psychogenic depression res69: depression Read diagnostic
Eu33.13 [x]recurrent episodes of reactive depression res69: depression Read diagnostic
Eu33.14 [x]seasonal depressive disorder res69: depression Read diagnostic
Eu33.15 [X]SAD - Seasonal affective disorder res69: depression Read diagnostic
Eu33000 [x]recurrent depressive disorder, current episode mild res69: depression Read diagnostic
Eu33100 [x]recurrent depressive disorder, current episode moderate res69: depression Read diagnostic
Eu33200 [X]Recurr depress disorder cur epi severe without psyc sympt res69: depression Read diagnostic
Eu33211 [x]endogenous depression without psychotic symptoms res69: depression Read diagnostic
Eu33212 [x]major depression, recurrent without psychotic symptoms res69: depression Read diagnostic
Eu33214 [x]vital depression, recurrent without psychotic symptoms res69: depression Read diagnostic
Eu33300 [X]Recurrent depress disorder cur epi severe with psyc symp res69: depression Read diagnostic
Eu33311 [x]endogenous depression with psychotic symptoms res69: depression Read diagnostic
Eu33312 [x]manic-depress psychosis,depressed type+psychotic symptoms res69: depression Read diagnostic
Eu33313 [x]recurr severe episodes/major depression+psychotic symptom res69: depression Read diagnostic
Eu33314 [x]recurr severe episodes/psychogenic depressive psychosis res69: depression Read diagnostic
Eu33315 [x]recurrent severe episodes of psychotic depression res69: depression Read diagnostic
Eu33316 [x]recurrent severe episodes/reactive depressive psychosis res69: depression Read diagnostic
Eu33400 [x]recurrent depressive disorder, currently in remission res69: depression Read diagnostic
Eu33y00 [x]other recurrent depressive disorders res69: depression Read diagnostic
Eu33z00 [x]recurrent depressive disorder, unspecified res69: depression Read diagnostic
Eu33z11 [x]monopolar depression nos res69: depression Read diagnostic
Eu34100 [x]dysthymia res69: depression Read diagnostic
Eu34111 [x]depressive neurosis res69: depression Read diagnostic
Eu34113 [x]neurotic depression res69: depression Read diagnostic
Eu34114 [x]persistant anxiety depression res69: depression Read diagnostic
Eu3y111 [x]recurrent brief depressive episodes res69: depression Read diagnostic
Eu41200 [x]mixed anxiety and depressive disorder res69: depression Read diagnostic
Eu41211 [x]mild anxiety depression res69: depression Read diagnostic
Eu53011 [X]Postnatal depression NOS res69: depression Read diagnostic
Eu53012 [X]Postpartum depression NOS res69: depression Read diagnostic
Eu92000 [x]depressive conduct disorder res69: depression Read diagnostic
Rows: 2
Code Description Entity type Coding System (ICD-10 Read) Category
F32 Depressive episode res69: depression ICD-10 diagnostic
F33 Recurrent depressive disorder res69: depression ICD-10 diagnostic

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH878/version/1835/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH878/version/1835/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH878', '1835', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH878/version/1835/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH878/version/1835/export/codes/?format=json
CSV site_root/phenotypes/PH878/version/1835/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH878', '1835', api_client=client)

Version History

Version
ID
Name Owner Publish date
1835 Depression ieuan.scanlon 2022-04-04 currently shown

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